Luther Holden

“ This line is one of our guides in the diagnosis of inguinal and femoral herniæ. If the bulk of the tumour be above the line, the hernia is probably inguinal; if below it, femoral. The line is not a straight one drawn from the spine of the ilium to the spine of the pubes, but slightly curved, with the convexity downwards, owing to its close connection with the fascia lata of the thigh. In many persons it can be distinctly felt; in nearly all its precise course is indicated by a slight furrow in the skin. ”

“ Those who have not directed their attention to the subject are hardly aware what a little distance there is between the cricoid cartilage and the upper part of the sternum. In a person of the average height sitting with [Pg 16] the neck in an easy position, the distance is barely one inch and a half. When the neck is well stretched, about three-quarters of an inch more is gained. Thus, we have (generally) not more than seven or eight rings of the trachea above the sternum. None of these rings can be felt externally. The second, third, and fourth are covered by the isthmus of the thyroid gland. ”

“ The approaches to the organs of the senses, their ever-varying expression, their numerous muscles, and their rich profusion of vessels and nerves, give the face great anatomical importance, which has a most valuable bearing, not only on the practice of surgery, but on the physiognomy of health, and in the diagnosis of disease. ”

“ When the mouth is wide open, the pterygo-maxillary ligament forms a prominent fold readily seen and felt beneath the mucous membrane, behind the last molar teeth. A little below the attachment of this ligament to the lower jaw we can easily feel the gustatory nerve, as it runs close to the bone below the last molar tooth. The exact position of the nerve can be ascertained in one’s own person by the acute pain on pressure. A division of the nerve, easily effected by a small incision, gives much temporary relief in cases of advanced carcinoma of the tongue. ”

“ In manipulating the abdomen we should not use the tips of the fingers. This is sure to excite the contraction of the muscles. The flat hand should be gently pressed upon it, and with an undulating movement.
76. It is well to bear in mind that the central tendon of the diaphragm is about the level of the lower end of the sternum at its junction with the seventh costal cartilage; that the right half of the diaphragm rises to about the level of the fifth rib—that is, about an inch below the nipple; that the left half does not rise quite so high. ”

“ By holding the lips between the finger and thumb the coronary arteries are felt under the mucous membrane. The facial vein does not accompany the tortuous artery, but runs a straight course from the inner angle of the eye to the front border of the masseter, just behind the artery.
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14. Eyelids and eyes.—The opening between the eyelids varies in size in different persons; hence more of the eyeball is seen in some than in others, and the eye appears larger. Although human eyes do vary a little in size, yet the actual difference is by no means so great as is generally supposed. ”

“ In all cases it is situated above the centre of a man’s height. It is a vulgar error to say that when a man lies with legs and arms outstretched, and a circle is drawn round him, the umbilicus lies in the centre of it. This central point is in most persons just above the pubes.
In very corpulent persons two deep transverse furrows run across the abdomen. One runs across the navel and completely conceals it. The other is lower down, just above the fat of the pubes. In tapping the bladder above the pubes in such a case, the trochar should be introduced where this line intersects the linea alba. ”

“ The elevator and depressor muscles draw the trachea and larynx up and down with a rapidity and a force which may bring the cricoid cartilage within half an inch of the sternum. The great thyroid veins which descend in front of the trachea are sure to be distended. There may be a middle thyroid artery. In children the lobes of the thymus may extend up in front of the trachea, and the left vena innominata may cross it unusually high. ”

“ This density often obscures the diagnosis of tumours on the cranium. A tumour growing upon the head may be either above or below the aponeurosis of the scalp. If below, it will have a firm resisting feel, being bound down by the aponeurosis. Nevertheless its firmness and resistance may depend not simply on its confinement beneath the aponeurosis, but on its having its origin within the skull. Look with suspicion, then, on every tumour on the head that will not readily permit you to move it about, so as to be sure of its connections prior to an attempt at extirpation. ”

“ Pressing the tongue downwards, provided it be done very gently, is also of advantage. Rude treatment the tongue at once resists. The forefinger can be passed into the throat, beyond the epiglottis, as low as the bottom of the cricoid cartilage, and thus search the pharynx down to the top of the œsophagus, and the hyoid space (on each side) where foreign bodies are so apt to lodge. ”

“ Contrast the narrow fissure of the Chinese and Mongolian races, and the apparent smallness of their eyes with those of Europeans. As a rule the external angle of the lid is higher than the internal. When not exaggerated, it gives the face an arch and pleasing expression. ”

“ Immediately behind the prostate, the vesiculæ 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 easily recognised, when moderately distended, as a soft fluctuating 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 well be defined when the bladder is empty. ”

“ In clinical teaching, we often have occasion to point out, on the surface of the living body, what may be called ‘medical and surgical landmarks.’ By ‘landmarks’ we mean surface-marks, such as lines, eminences, depressions, which are guides to, or indications of, deeper-seated parts. ”

“ From an examination of many skulls in the Hunterian Museum, I find that the absence of the ‘bumps,’ even in middle age, does not necessarily imply the absence of the sinuses, since they may be formed by a retrocession of the inner wall of the skull. In old persons, as a rule, when the sinuses enlarge, it is by the encroachment of the inner table on the brain case. ”

“ They drop fibres into the skin all along their course, so that there is hardly a point of the face which has not its little fibre to move it. The habitual recurrence of good or evil thoughts, the indulgence in particular modes of life, call into play corresponding sets of muscles which, by producing folds and wrinkles, give a permanent cast to the features, and speak a language which all can understand, and which rarely misleads. ”