A manual of instruction in the principles of prompt aid to the injured : including a chapter on hygiene and disinfection, designed for civil and military use

Front matter

COLUMBIA LIBRARIES OFFSITE

HEALTH SCIENCES STANDARD

HX641 72945 RC87 .D74 A manual of instruct

Preface To Fifth Edition

The fifth edition of this book has been prepared to meet the needs of the more advanced knowledge in medicine and snrgery and also to conform more closely to the principles of modern sanitation. Every effort has been made to introduce material which shall be of practical importance in connection with these subjects with the intent to make the book of special value, not only for home use but also in mining districts, manufactories and other places where many persons are brought together and where accidents frequently occur.

Alvah H. Doty, M. D.

New York City.

Chapter I. Page

Boxi<> : its composition and function — Periosteum and endosteum — Classification of bone — Tlie slieleton — Spine — Bony landmarljs — Slsull — Hyoid bone — Ttiorax — Stex'num and ribs — Scapula — Clavicle — Bones of upper extremity — Pelvis — Bones of lower extremity.

Chapter II

Joints — Cartilage — Ligaments — Synovial Membrane — Mus- ' CLES ......... 23

Joints : their classification and movement — Cartilage — Ligaments — Synovial Membrane — Muscles — Tendons and aponeuroses — Definition of organs — Glands — Mucous and serous membrane — Excretion and secretion.

Burns, Scalds, and Frost-bite ...... 140

Burns and scalds : their classification — Treatment of each degree — Frost-bite, and its treatment.

CHAPTER XIII. Unconsciousness, Shock or Collapse, and Syncope . . 146

Definition of, and treatment.

CONTENTS. Xi

CIIArTER XIV.

PAGE

Concussion and Compression of the Brain — Apoplexy, or Stroke ok I'akalysis— Int(jxication — Epilepsy, Hysteria, AND Heatstroke or Sunstroke . . . 154 Definition of, and treatment.

Baths — Clothing — Food — Water — Air — Exercise.

Chapter XX

Definition — Sulphurous acid gas — Formaldehyde gas — Bichloride of mercury — Special disinfection.

ILLUSTRATIONS.

FIGUEE PAGE

28. Abdominal contents, position of Flint. 50

24. Air-cells and terminal bronchial tubes Flint. 43

G6. Arteries, diagram showing position of important.

Pije, modified. Face 109

70. Artery, brachial, digital compression of Esmarch. 115

69. Artery, brachial, line showing course of Tracy. 114

GT. Artery, common carotid, digital compression of.

Esmarch, modified. 112

73. Artery, femoral, compression by tourniquet. . Esmarch. 118

72. Artery, femoral, digital compression of Esmarch. 117

71. Artery, femoral, line ..showing course of Tracy. 116

68. Artery, subclavian, digital compression of.

Esmarch, modified. 113

84. Artificial respiration : Hall's method : first position.

Original. 171

85. Artificial respiration : Hall's method ; second position.

Original. 171

82. Artificial respiration : Howard's method ; first part.

Original. 169

83. Artificial respiration : Howard's method : second part.

Original. 170

80. Artificial respi*ation : Sylvester's method ; first

movement Original. 168

81. Artificial respiration : Sylvester's method ; sec-

ond movement Original. 168

58. Bandages, cravat, for Land Esmarch, modified. 84

59. Bandages, cravat, for Itnee Esmarch. 84

44. Bandages, four-tailed, for head Esmarch. 75

43. Bandages, four-tailed, for jaw Original. 75

39. Bandages, method of rolling.

Reference Hand-hooTc of Medical Sciences. 69

42. Bandages, knotted Esmarch. 74

4.J, 46. Bandages, large square handkerchief.. Esmarch. 76, 77 41. Bandages, spica of shoulder.

Reference Hand-hooJc of Medical Sciences. 73

40. Bandages, spiral reverse.

Reference Hand-hook of Medical Sciences. 71 xiii

XIV ILLUSTRATIONS.

IIGFEE PAGE

47. Bandages, triangular, diagram 77

51. Bandages, triangular, for chest, etc, Esmarch, modified. 80 57. Bandages, triangular, for foot Esmarch, modified. 83

48, 40. Bandages, triangular, :&or head.. Esmarch, modified. 78

56. Bandages, triangular, for hip Esmarch, modified. 83

50. Bandages, triangular, for shoulder, hand, etc.

Esmarch, modified. 79

52. Bandages, triangular, for shoulder, head, etc.

Esmarch, modified. 80 1. Bone, cancellous and compact tissue, arrangement of.

Tracy. 2

33. Brain inclosed in membranes Didama. 59

35. Brain, under surface of Tracy. 61

36. Brain, upper surface of Didama. 62

37. Brain and spinal cord Tracy. 65

0. Clavicle (collar-bone) Original. 14

75. Clavicle, dressing for fracture of Pye, modified. 129

18. Corpuscles of human blood, red and white Flint. 31

76. Femur, fracture of ; gun used for temporary splint.

Esmarch, modified. 133

13. Femur (thigh-bone) Original. 19

15, Foot, bones of ; . Original. 21

11. Forearm (radius and ulna), bones of Original. 16

21. Frog's foot, web of, magnified Flint. 37

12. Hand, bones of , Original. 17

19. Heart Didama. 32

20. Heart and ribs, relation of Flint. 33

10. Humerus (arm-bone) Original. 15

25. Jaws and teeth Didama. 46

31. Kidney, vertical section of Flint. 55

77. Knot, Gerdy's extension 134

63. Knot, granny Bryant. 85

62. Knot, granny, handkerchief Esmarch. 85

60. Knot, reef Bryant. 85

61. Knot, reef, handkerchief Esmarch. 85

64. Knot, surgeon's Bryant. 86

14. Leg, bones of Original. 20

79. Leg, fracture of : pillow for temporary splint. Original. 136

78. Leg, fracture of ; umbrella for temporary splint. Original. 135

29. Liver Tracy. 51

17. Muscular system Tracy. 26

34. Nerves, cerebro-spinal system Tracy. 60

38. Nerves, sympathetic system Tracy. 66

30. Pancreas (sweet-breads) Tracy. 53

16. Patella (knee-cap) Original. 22

7. Rib, a Original. 12

26. Salivary glands Tracy. 47

8. Scapula ( shoulder-blade) Original. 13

ILLUSTRATIONS. XV

FIGURE PAGE

2. Skeleton Tracy. 5

32. Skin, vertical section of Didamu. 50

4. Skull Original. 9

74. Sling, skirt of coat used as a Esmarch, modified. 124

53. Slings, triangular, for arm Esmarch, modified. 81

54. Slings, triangular, for arm Esmarch, modified. 81

55. Slings, triangular, for arm Esmarch, modified. 82

3. Spine, vertical section of Tracy. 6

27. Stomach Didama. 48

65. Suspender, Esmarch's Oriyinal. 108

5. Thorax (chest), anterior view Sappey. 10

6. Thorax (chest), posterior view Sappey. 11

23. Thorax (chest), cavity of, showing position of

heart and lungs Didama. 41

22. Trachea and bronchial tubes Sapper/. 40

PROMPT AID TO THE INJURED.

Chapter I. Bone

Bone is composed of animal and earthy matter ; the former consists chiefly of a material which is converted by boiling- into gelatin, also fat and blood-vessels ; the latter, known as "bone-earth," is composed principally of phosphate of lime. Bone derives its tenacity and elasticity from the animal portion, and the " bone-earth " gives to it the necessary hardness.

When soup is made by boiling a bone, there is simply a liberation of the gelatin or animal matter; the latter may be extracted, by boiling, from bone two or three thousand years old. In early life the animal part forms about one third and the earthy matter two thirds of bone ; later in life, however, the proportion of phosphate of lime is somewhat increased, and the bone also becomes denser. This will explain why the bones of children are so elastic that, when considerable force is applied, they are apt to bend, like a green stick, rather than break, as in the adult bone under similar circumstances.

Rickets is a disease of childhood representing a diminished amount of earthy matter ; in this condition the bones become bent and distorted, the deformities being particularly marked in the bones of the lower extremity, and in the pelvis and chest. 3

PROMPT AID TO THE INJURED.

A section of bone (Fig. 1) shows it to be composed of two kinds of tissue — compact, which is exceedingly dense and hard like ivory; and cancellated or "spongy" bone,

which is a network of thin plates and columns of bone. The compact tissue constitutes the outer portion of bone, and is very much increased where great strength is required, as in the shaft of the femur or " thigh-bone." The cancellated tissue is internal, and especially abundant where bone expands to form large surfaces for support, as in the extreinities of the bones of the thigh, legs, etc. Cancellated tissue is not only very light, but very strong ; a portion, corresponding in size and shape to a piece of loaf or cut sugar, will support a weight of three or four hundred pounds, while a square inch of compact tissue, about one half inch in thickness, will support a weight of five thousand pounds. Bone is twice the strength of oak.

In the skull, where great strength is necessary to support and protect the brain, we find two layers of compact tissue : the external portion, known as the " outer " table, and the internal as the "inner" table, with a small amount of cancellated tissue, known as the diploe, existing between them.

The long bones are hollow. This condition admits of the proper length, diameter, and strength, while it greatly diminishes the weight.

Tlie " medullary " or " hollow canal " in the shaft, and

Pie. 1.— The right femur, or thigh-bone, sawn in two lengthwise. Showing arrangement of compact and cancellous tissues.

BONE. 3

the cancellated tissue of the extremities of long bones, also the cancellated tissue of other bones throughout the body, contains a substance called marrow or "oil of bone." In the medullary canal it is called yellow marrow, and is composed of about ninety-six per cent of fat, while the "red marrow," which is found in cancellated tissue, is three fourths water and contains but a trace of fat. The medullary canals in the bones of birds communicate with the lungs and contain air instead of marrow, thereby rendering" them very light and properly adapted for flight.

Bone is supplied with nutrition from two sources ; the periosteum^ and the nutrient arteries. The periosteum is a fii'm and resisting fibrous membrane, pinkish in color, which is adherent to the bone, and covers it at all points except where cartilage exists. This membrane is a structure in which blood-vessels divide, subdivide, and pass into minute openings in the compact tissue, supplying it with nutrition. The cancellated tissue and medulla receive their nutrition from larger vessels (nutrient arteries), w^hicli are branches of the main arteries in the vicinity of the bone, and pass through the compact tissue to their destination. When the periosteum is removed from the bone, the compact tissue is deprived of its principal means of nutrition, and death or " necrosis " (corresponding to gangrene in soft tissues) is apt to ensue. This may happen in disease, or as the result of an injury, jDarticularly to superficial bones such as the tibia, bones of the head, etc. A familiar example is a " felon," which demands immediate and special treatment at the hands of the surgeon.

When bone is in the normal condition and properly covered with periosteum, it feels smooth and moist, and when struck with a probe it gives a dull sound ; but when the periosteum is removed, it feels rough and hard, and striking it with a probe produces a metallic sound. It is important to the surgeon to recognize these different conditions, and be thus easily enabled to decide whether the periosteum is present or absent.

The endosteum is a tliin, fragile membrane wliicli corresponds in nutritive function to tlie periosteum, and lines the medullary canal in the long bones.

Bones are supplied with nerv^es and lymphatics or absorbents.

The lymphatics have been known to remove by absorption ivory pegs used to hold in place the broken ends of a bone which would not unite by the natui'al process.

The shape of a bone depends upon the function it performs. Bones ai'e divided into long^ short, flat, and irregular. The long bones, of which the femur or ''thigh-bone " is a type, are composed of a shaft and two extremities, and. with their muscular attachments, act as levers, and also for support. The short bones are found where a number of joints are required for limited motion combined with strength. An example of this class is the carpus or wiist.

The flat bones are used in the construction of cavities and to protect their contents, and are also for muscular attachment, as the bones of the skull, the shoulder-blades (scapulgei. etc.

Examples of the irregular bones are the upper and lower jaw (superior and inferior maxillary), and the vertebrae.

The skeleton (Fig. 2), which represents the bones in their prox)er relations, is the framework to which the soft structui'es of the body ai'e attached. It consists of a central column (the spine) ; four extremities : two upper (the arms), and two lower (the legs); and three bony cavities: (1) the cranium or skull, containing the brain ; (2) the thorax or chest, containing the heart and lungs ; and (3) the iDelvis or basin, containing the pelvic and some of the abdominal organs.

The skeleton is comi^osed of two hundred bones. There are several small bones found in the tendons of muscles, at the union of the skull-bones, and also in the eai% which are not included in this enumeration. This number is divided in the following manner :

Fig. 2.— The skeleton.

PKOMPT AID TO THE INJURED.

The spine or vertebral column.. ,...., 26

Cranium S

Face 14

Os hyoides, sternum, and ribs , 26

Upper extremities 64

Lower extremities 62

The spine (Fig. 3), wliicli is about one third the length of the body, is a jointed column consisting of a series of bones (vertebrae) articulated or joined together, forming three slight curves. It supports the skull and its contents, and protects the spinal cord, which is contained in a canal formed by the union of the bony parts. At its base the column rests upon the upper ]3ortion of the pelvis — betv^^een the "haunch-bones."

A vertebra consists of two important parts — a body, in front, and a posterior portion or vertebral arch.

The bodies are piled one upon the other for support and strength, the arch behind forming, by its junction with the body, a canal for the passage of the spinal cord. Between the bodies of the vertebrae are found layers or pads of a very elastic and flexible substance, known as " intervertebral cartilage," which forms a soft cushion for each vertebra to rest upon.

Its elasticity prevents or diminishes shock, and also tends to restore the column to its erect position. Continued pressure on this substance during the day diminishes its thickness, consequently a person will lose about half an

Fig. 3. — The spine, sawii in two lengthwise.

BONE. 7

inch in height during this period ; the rest and recumbent position of the night restore it to its previous condition.

It is important to remember that leaning too much on one side, as at a desk, will cause a permanent change in the cartilage, so that the vertebral column may be abnormally bent to one side without the bone being primarily involved.

The curves in the vertebral column assist in forming cavities for the reception of important organs. It is said that the curves increase the strength of the column tenfold ; they also aid in destroying shock.

The twenty-six bones comprising the vertebral column are divided in the following manner, viz. :

Cervical or neck 7

Dorsal or back 12

Lumbar or loins 5

The sacrum, which represents five vertebrae (in fcetal

life) fused into a single bone 1

The coccyx or " crupper," which is formed from four

bones 1

The freest movement in the vertebral column is found in the neck or cervical region, and the least movement in the back, between the shoulders, the spine here being connected with the ribs. The weakest part of the spine is at the last dorsal vertebra, and this portion of the vertebral column is very movable.

It is very essential to know that different elevations on the surface of the body (bony prominences, etc.) indicate the situation of certain important internal organs ; thus the vertebral column furnishes valuable information. Rubbing the fingers briskly up and down the spine will produce sufficient friction to redden the skin over the bony prominences known as "spinous processes." These processes are formed by the union posteriorly of the sides of g PROMPT AID TO THE INJURED.

the vertebral arches abeady spoken of. With the bodybent forward and the arms folded across the chest, the spinous processes can be made even more apparent.

The spinous process of the seventh or lowest cervical vertebra is particularly prominent, and has received the name of "vertebra prominens," and should be carefully sought for, as it will aid in locating others.

The lower or inferior angle of the scapula or " shoulder-blade "'' is on a level with the interval between the seventh and eighth dorsal vertebra?.

Having located the spinous processes of the different vertebrae, the following points are to be remembered, viz. :

Interval between Sixth and Seventh Cervical Spines. — (Esophagus and trachea begin.

Seventh Cervical. — Apex or upper part of lung ; consequently a knife, or bullet wound, above this line, unless carried downward, would not injure the lung.

Third Dorsal. — Upper border of arch of aorta.

Fourth Dorsal. — Arch of aorta ends ; upper level of heart ; division of trachea into two portions ; right and left bronchus.

Eighth Dorsal. — Left side, lower level of heart.

Ninth Dorsal. — Left side, lower end of oesophagus, passing through diaphragm ; upper or cardiac opening of stomach and upper edge of spleen.

Tenth Dorsal. — Left side, lower level of lung.

First Lumbar. — About the middle of kidneys ; lower edge of spleen.

The skull (Fig. 4) is the case for the lodgment and protection of the brain and its membranes, and important blood-vessels and nerves. It is composed of twenty-two bones, enumerated in the following manner :

Face (14 bones).— Nasal, 2 ; superior maxillary, 2 ; lachrymal, 2; malar, 2; palate, 2; inferior turbinated, 2; vomer, 1 ; inferior maxillary, 1.

The cranial bones protect the brain, and are uniformly

BONE.

Occipital.

Fig. 4.— The skull.

strong and compact; while the hones of the face contain principally the organs of special sense, and give the proper symmetry to this portion of the skull, some of them are extremely thin, and are readily broken. The different bones of the skull are connected by sutures or " seams," and the overriding of these bones lessens the size of the head during birth, and x^ermits variations, in size, for some little time afterward.

The f ontanelles, or " soft spots " on an infant's head, correspond to the subsequent points of union of two or more bones of the cranium, which have not become fully hardened or ossified, but still retain the character of the mem-

PROMPT AID TO THE INJURED.

brane or soft structure from whicli the cranial bones are originally developed. These spots disappear when the bone becomes f ull^^ develox3ed or ossified, which generally occurs within one and a half or two years after birth.

A large opening exists at the base of the skull in the occipital bone, called the " foramen magnum," for the transmission of the spinal cord from the brain to the canal in the spinal column. Other and smaller openings are found in the skull which transmit blood-vessels and nerves.

The skull is supported by the vertebral column. The first cervical vertebra is firmly attached to the base of ihe skull at the " foramen magnum," while the second

cervical acts as a pivot, having a vertical or upright portion, called the " odontoid " process, which fits into the first cervical vertebra, and around which the head rotates.

The hyoid bone is an arch, something like a horseshoe, which is placed above the prominence on the front of the neck called the pomum Adami, or " Adam's apple," and aids in supporting the tongue, and gives attachment to certain muscles.

The thorax or

chest (Figs. 5 and

6) is the bony frame-work which contains the heart, lungs,

and important blood-vessels and nerves, It is formed

Fig. 5.— Thorax, anterior view (Sappey). 1, 2, 3. Pternum : 4. circumference of the upper portion of the thorax : 5. circumference of the base of the thorax ; 6. first rib ; 7, second rib ; 8, last two, or floating ribs ; 9, costal cartilages.

BONE.

by the sternum in front, and the ribs and vertebrae at the side and back, and is separated from the abdominal cavity by a muscular partition known as the diaphragm or "midi-iff."

The sternwn or '■ breast - bone " is a fiat and narrow bone about seven inches long, situated in the front of the chest, and supporting the clavicles or '' collar-bones " and the ribs, with the exception of the last two ribs.

The ribs (Fig. 7) are twenty - four in number, twelve on each side, and are numbered from above downward. They articulate posteriorly with the dorsal vertebrae, and the upper ten connect in front with the sternum by means of cartilages (costal cartilages), which are interposed between the ends of the ribs and the sternum, and allow of greater motion and elasticity. The two lower ribs, the eleventh and twelfth, are simply connected with the vertebrae, and are known as "floating" ribs, as they have no attachment in front. The peculiar arrangement and attachment of the ribs render them a very important element in respiration ; during this act the ribs are elevated and depressed bj^ the action of the respiratory muscles. When the ribs are elevated during inspiration, the thorax or chest is enlarged and air passes into the lungs ; in expiration the ribs are de-

FiG. 6.— Thorax, posterior view (Sappey). 1, 1, spinous processes of the dorsal vertebrae ; 2, 2, laraiiiifi of the vertebrae ; 3, 3, transverse processes ; 4, 4, dorsal portions of the ribs ; 5, 5, angles of the ribs.

pressed, the cavity diminislied in size, and the aii' in the lungs is expelled. The elasticity of these bones is illustrated by the fact that children in Arabia use the ribs of camels for bows.

Upper extremities. — Each upper extremity is composed of thirty-two bones, and includes the following : scapula, clavicle, humerus, radius, ulna, eight carpal bones, five metacarpal bones, and fourteen phalanges.

The scapifZce, or "shoulder-blades" (Fig. 8), are thin, flat, and triangular bones, which have on their posterior and upper part an elevation or ridge knowTi as the " spine " ; the external extremity of the spine is the acromion process, which connects with the outer end of the clavicle. The outer and upper portion of the scapula forms the glenoid cavity or "socket" which receives the ballshaped head of the humerus or " arm-bone." The scapula, in this manner, assists in the formation of the shoulder-joint. It also furnishes broad surfaces for the attachment of muscles, and aids in protecting the contents of the thorax.

The clavicles or "collar-bones" (Fig. 9), shaped something like the italic letter /, are on the anterior and upper part of the chest, and extend from the upper }3ortion of the sternum or "breast-bone" to the acromion processes of the shoulder-

BONE. 13

blades referred to above ; they hold the shoulders upward, backward, and outward. When a clavicle is broken the

Fig. 8.— Left scapula, or shoulder-blade.

arm drops downward, forward, and inward, its support being gone. Manual labor increases the size, strength, and curvature of the clavicle. The collar-bone is less curved in women than in men.

l_j. PROMPT AID TO THE IXJURED.

The humerus or "arm-bone '' (Fig. 10) is the longest and strongest bone of the upper extremity. It has a shaft and two extremities : the upper extremity is the largest part of

Fig. 9. — Anterior surface of left clavicle, or collar-bone.

the bone, and consists of a head joined to the shaft by a very short and constricted x^ortion called the "anatomical" neck. The head is globular in form, covered with cartilage, and articulates with the glenoid cavity of the scapula, already spoken of, forming with it a ball-andsocket joint. The cartilage covering the head protects it and prevents undue friction in the joint. At the point where the anatomical neck joins the shaft are found two rough eminences called tuberosities, which are for muscular attachment. Just below the tuberosities is another constriction — the " surgical " neck — so called from the fact that it is the most common site of fracture of the upper extremity. The shaft is partly cylindrical, prismatic, and flattened, and roughened for the attachment of muscles. The lower extremity is a broad and flattened (from before backward) portion of the bone which articulates with the ulna principally, and to a certain degree, with the radius of the forearm, these three bones forming the elbow-joint. The humerus has a greater range of motion than any other bone in the body, and is oftener dislocated.

The radius and ulna (Fig. 11) are the bones that constitute the forearm.

The radius, so called from its fancied resemblance to

BONE, the spoke of a wheel, is the external bone lying parallel with the ulna when the palm of the hand is turned upward. It resembles other long- bones in having a shaft and two extremities. The upper or lesser extremity forms only a small portion of the elbow-joint, while the lower extremity, w^hich is broad, forms the wrist-joint by articulating with two of the carpal or wrist bones. The low^er end also articulates with the corresponding portion of the ulna. The shaft of the radius is more or less irregular and rough for the origin and insertion of muscles. The ease with which the forearm and hand may be turned with the palm down (" pronation "), and with the palm up ("supination "), is due to the peculiar articulation of the upper end of the radius with the ulna. The upper end of the radius (or head) is somewhat knob-shaped,with a depression or excavation on its ux^per surface ; the excavation articulates with a small portion of the lower extremity of the humerus, and represents the limited part it takes in the formation of the elbow-joint.

f.V:

A^y o— i

Trochlea. Radial Head.

Fig. 10. — T.ef t humerus, or arm-boue

PROMPT AID TO THE INJURED.

Artie, with Semi-lunar and Scaphoid of Carpus.

Fig. 11. — Left radius and ulna, or bones of the fore-arm.

Below tlie portion of the radius just described is a constricted portion, called tlie neck ; a ligament in the form of a loop, named the orbicular ligament, is thrown around this part, and attached to the outer side of the ulna ; this ligament, while it holds the radius in position, allows the neck of the radius, which it encu'cles, to freely rotate.

The ulna, which is composed of a shaft and two extremities, is the companion of the radius, and situated internal to it ; the lower extremity is very small, and, although connected with the radius, has no articulation with tlie carpal or wrist bones, consequently it does not enter into the formation of the wrist-joint ; but the upper end is large, and contains a depression or cavity which receives the lower extremity of the humerus. The prominent point of the elbow is the extreme end of the ulna, and is known as the "olecranon process" of

BOXE.

Articulate with Radius forming Wrist-Joint.

Ctrpua.

Metacarpus

Phalanges

Fig. 12.— Bones of the left hniid. Palmar surface.

18 PROMPT AID TO THE IXJUREB.

the ulna or " funny-bone," so called from tlie peculiar sensation experienced wlien the ulnar nerve, which is closely associated with the inner border of this process, is struck. The upper extremity of the ulna and the lower extremity of the humerus make up the elbow-joint — that is, the principal part of it ; while, as already described, the upper end of the radius articulates with a small and less important part of the lower extremity of the humerus.

The carpus or wrist (Fig. 12) consists of the following small and irregular bones, arranged in two rows : the upper, composed of the scaphoid, semi-lunar, cuneiform, and pisiform, and the lower row, of the trapezium, trapezoid, OS magnum, and unciform. The large number of bones constituting the carpus, and having so many small joints, increases its strength, motion, and elasticity. They also diminish shock and the tendency to fracture, which would be frequent if the wrist were composed of one bone. The carpus supports the hand and preserves its symmetry.

The metacarpus (Fig. 12) consists of five long bones (metacarpal), connecting the carpus with the bones of the fingers and thumb ; they form the bony framework of the palm and back of the hand.

The phalanges (Fig. 12) are miniature long bones, having a shaft and two extremities, and are foui'teen in number, three for each of the fijigers and two for each thumb ; their position can be easily demonstrated by bending the fingers. The bases of the fii^t row of phalanges articulate with the heads of the metacarpal bones ; the remaining phalanges articulate with each other. "When the hand is open, the fijigers do not correspond in length ; but when closed, in grasping an object, there is no apparent difference. If the fijigers when closed were uneven, the grasping power would be diminished. The thi'ee rows of phalanges grow progressively smaller toward the end of the fingers.

The pelvis or " basin " supports the trunk and protects the pelvic, and a portion of the abdominal organs. It is

BONE composed of the two innominate or "haunch" bones, the sacrum, and the coccyx ; the last two have been described with the spinal column.

The innominate bones (Fig. 2) are situated one on each side and in front, and form the greater portion of the pelvis, while the sacrum and coccyx form the posterior portion. On the outer side of an innominate bone is found a depression or socket, known as the cotyloid cavity or acetabulum, corresponding in function to the glenoid cavity of the scapula, which receives the head of the femur or "thigh-bone."

The femur (Fig. 13) is the longest and strongest bone in the body ; its length is characteristic of the human skeleton. In the erect position, the tips of the fingers reach to about the middle of the thigh, while in the orangoutang, the fingers reach to the ankle. This depends also on the comparative shortness of the arm in the human skeleton.