9
Ausr. N.Z. J. Surg. (1996) 66, 403-41 1 SURGICAL HISTORY FREDERIC WOOD JONES: THE MISSING MANUSCRIPT B. E. CHRISTOPHERS LOST THEN FOUND (3) In his autobiographical material Wood Jones refers to the In the Wood Jones collection at the Library of the Royal College of Surgeons of England there is lodged a Memorandum of Agreement dated 13 March 1909, made between Dr F. Wood Jones, The Priory, Roehampton, S.W. and Edward Arnold, pub- lisher. This Memorandum pertains to the proposed publication of a manuscript by Wood Jones entitled Anatomy from the Point of View of Function. In the Memorandum this manuscript is described as having about 140 000 words and about 200 illus- trations which were to be black and white drawings supplied free of charge by the author. It was to have been published in the northern autumn of 1910. It was not published, and with the passage of time it seemed it had been lost. When Wood Jones left Melbourne in 1937 he gave a col- lection of his anatomical drawings to a medical student, James Guest (later Mr James Guest). Three of these drawings were reproduced (with the kind permission of Guest) in a paper by the author published in 1992. In that paper the author sug- gested that it was possible that these drawings were part of this missing manuscript. The drawings held by Guest match the text of a document (mainly typewritten and the remainder holograph) by Wood Jones that came into the possession of the author in 1995. There is good evidence that the text held by the author and the drawings held by Guest are ‘the missing manuscript’. Evidence of authenticity Although the manuscript does not bear the signature of Wood Jones, that he was the author is evidenced by the following facts: (1) The text of the manuscript matches the drawings bequeathed by Wood Jones to Guest. (2) The handwriting in the manuscript matches the hand- writing of Wood Jones. (3) Two sheets of letter paper with the name and address of his family home printed as a heading on the sheets were used by him as leaves in this manuscript. (4) Both the literary style and the subject matter of the manu- script are peculiar to Wood Jones. That the manuscript is the ‘missing one’ is evidenced by the following facts: (1) The name Arnold occurs on three out of four title ‘leaves’ of the manuscript. (2) ‘Anatomy of Function’ was the name bestowed by Wood Jones on the found manuscript, and this appears on three of the four title ‘leaves’. -- manuscript as ‘that textbook’, and the found manuscript has the format of a textbook in the making (see Appendix 1). The book which was to have been published by Edward Arnold contained about 140 000 words and about 200 illustrations. The text held by the present author contains about 35 000 words and Guest holds 66 drawings. This represents 25% of the text and 33% of the drawings proposed in the memorandum. The planned textbook was never finished and the material which is in the possession of the author and Guest probably represents all or most of what Wood Jones composed. All but one of the following extracts are from this manu- script. All but two of the illustrations in this paper are from the manuscript, and the legends and the diagrammatic notes of these have not been altered. Fig. 1. Diagram to show the proportions of the body at different periods of life. The figures are reduced to the same total standing height. The relative diminution of the size of the head and the increase in length of the lower limbs is conspicuous (based on the measurements of Stratz). Correspondence: Dr B. E. Christophers. 377 Church Street, Richmond, Vic. 3 12 I, Australia. Accepted for publication I I October 1995. Fig. 2. Seated figures of a mid-term foetus, an infant and an adult reduced to the same scale of sitting height. The diagram illustrates the relative increase in the growth of the lower limbs from foetal to adult life.

FREDERIC WOOD JONES: THE MISSING MANUSCRIPT

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Page 1: FREDERIC WOOD JONES: THE MISSING MANUSCRIPT

Ausr. N.Z. J . Surg. (1996) 66, 403-41 1

SURGICAL HISTORY

FREDERIC WOOD JONES: THE MISSING MANUSCRIPT

B. E. CHRISTOPHERS

LOST THEN FOUND (3) In his autobiographical material Wood Jones refers to the

In the Wood Jones collection at the Library of the Royal College of Surgeons of England there is lodged a Memorandum of Agreement dated 13 March 1909, made between Dr F. Wood Jones, The Priory, Roehampton, S.W. and Edward Arnold, pub- lisher. This Memorandum pertains to the proposed publication of a manuscript by Wood Jones entitled Anatomy f rom the Point of View of Function. In the Memorandum this manuscript is described as having about 140 000 words and about 200 illus- trations which were to be black and white drawings supplied free of charge by the author. It was to have been published in the northern autumn of 1910. It was not published, and with the passage of time it seemed it had been lost.

When Wood Jones left Melbourne in 1937 he gave a col- lection of his anatomical drawings to a medical student, James Guest (later Mr James Guest). Three of these drawings were reproduced (with the kind permission of Guest) in a paper by the author published in 1992. In that paper the author sug- gested that it was possible that these drawings were part of this missing manuscript. The drawings held by Guest match the text of a document (mainly typewritten and the remainder holograph) by Wood Jones that came into the possession of the author in 1995. There is good evidence that the text held by the author and the drawings held by Guest are ‘the missing manuscript’.

Evidence of authenticity Although the manuscript does not bear the signature of Wood Jones, that he was the author is evidenced by the following facts:

(1 ) The text of the manuscript matches the drawings bequeathed by Wood Jones to Guest.

(2) The handwriting in the manuscript matches the hand- writing of Wood Jones.

(3) Two sheets of letter paper with the name and address of his family home printed as a heading on the sheets were used by him as leaves in this manuscript.

(4) Both the literary style and the subject matter of the manu- script are peculiar to Wood Jones. That the manuscript is the ‘missing one’ is evidenced by the following facts:

(1) The name Arnold occurs on three out of four title ‘leaves’ of the manuscript.

(2) ‘Anatomy of Function’ was the name bestowed by Wood Jones on the found manuscript, and this appears on three of the four title ‘leaves’.

- - manuscript as ‘that textbook’, and the found manuscript has the format of a textbook in the making (see Appendix 1).

The book which was to have been published by Edward Arnold contained about 140 000 words and about 200 illustrations. The text held by the present author contains about 35 000 words and Guest holds 66 drawings. This represents 25% of the text and 33% of the drawings proposed in the memorandum.

The planned textbook was never finished and the material which is in the possession of the author and Guest probably represents all or most of what Wood Jones composed.

All but one of the following extracts are from this manu- script. All but two of the illustrations in this paper are from the manuscript, and the legends and the diagrammatic notes of these have not been altered.

Fig. 1. Diagram to show the proportions of the body at different periods of life. The figures are reduced to the same total standing height. The relative diminution of the size of the head and the increase in length of the lower limbs is conspicuous (based on the measurements of Stratz).

Correspondence: Dr B. E. Christophers. 377 Church Street, Richmond, Vic. 3 12 I , Australia.

Accepted for publication I I October 1995.

Fig. 2. Seated figures of a mid-term foetus, an infant and an adult reduced to the same scale of sitting height. The diagram illustrates the relative increase in the growth of the lower limbs from foetal to adult life.

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404 CHRISTOPHERS

Harley Lodge. Enf ield.

7y It i v t h i r l a t e growth o r the hind limb ,and i t r ul t l8mtfCroat 1 propondoronoo over t h o f o r 0 limb,that bringr about t h o adult d i f r ~ r m e a

i n t ho d i root ion i n which t he nutrient a r t o r i o r t o t h o 1ij)b boner run t o thoir foramina. A t t h = ond of ho noo-footal porlod tho f r o n t and h i d l imbo r r o of oqurl longth,but from thir pe4.W onward8 tho bind limb ou t r6 r ip r the f o r 0 l i m b A t t h o r t ago at *ioh both Umbr rro of oqual longth t h o nu t r ion t a r t o r i o r rum i n both limb8 towardr tho oon t ra l j o i n t , W 41 growth proooodr i n t h o hind limb i n tho por t ion of bono botwoen t h o e o n t r a l j o i n t and t h o p i h t of ont rmoo of t h o nu t r ion t a r tory , tho d l n e t i o n of tho a r t o r i o r beooror

rrRLT a* * -m---Ud rovor~od,an& from running towar l r tho oont ra l j h n t thoy gradual1

t o run away from 1

a i roa tod towardr t h o knoQ, although tho nu t r ion t a r t o r i o r of t ho t i r i a and fibula havo boon pullo(lAby t&o &;rowing bonor un t i l t h o i r d i root ion har boon rovorrod. Tho growth of tho am i s not 00 rap id , mnd

t h o ) r i . i t i vo d i roo t ion of l t r nu t r ion t a r t o r i o r pe ra i r t r , and in tho rlult tho foramhr. r r o r t i l l diroctod towardm tho olbow. It 11 upon thi r f a o t o r that tho rovorsal of t h o ordor of the junet ion of t h o

/La,& .-# i n i t r rat. of growth.

- ? - . g - F 4cri x; J - . J P - ~ & n & &Z> --At blrtK-tho n u h i o n r r t o r y of tho femy,r tLl l r e

yjL.*

0)i)hyrOr O f tho -8 a d log depOndr~

Fig. 3. Page [ 1 la] of chapter I of the manuscript.

FROM CHAPTER 1 The general growth and proportions of the body:

Position of the umbilicus No better indication of the changes in bodily proportions is to be found than in following the migration of the umbilicus:

Throughout the whole period of growth, both antenatal and post- natal, the umbilicus is shifting its position in the body, becoming ever nearer to the cephalic extremity as growth advances.

In an infant of one year the umbilicus is the mid point of the body, while in the adult it has moved nearer to the cephalic end, and the symphysis pubis becomes the central point of the figure.

This is well demonstrated in Figs 1 and 2. Although these draw- ings are by Wood Jones, they do not form part of the manu- script. They are taken from the 7th edition of Buchanan’s Manual of Anatomy, of which he was editor and part-author.2

Proportions of upper and lower limbs Commenting on the increasing relative proportions of the lower extremities as compared t o the upper extremities, he wrote:

It is this late growth of the hind limb, and its ultimate great pre- ponderance over the fore limb, that brings about the adult difference in the direction in which the nutrient arteries to the limb bones run to their foramina. At the end of the neo-foetal period the front and hind limbs are of equal length, but from this period onwards the hind limb outstrips the fore limb in its rate of growth. At the stage at which the limbs are of equal length the nutrient arteries run in both limbs towards the central joint. As growth proceeds in the hind limb in the portion ofbone between the central joint and the point of entrance of the nutrient artery, the direction of the arteries becomes reversed, and from running towards the central joint they gradually come to run away from it as their foramina become moved along the shaft away from the central joint. At birth the nutrient artery of the femur is still directed

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FREDERIC WOOD JONES 405

Epidermis - Stratum granulosum

Corpus papillarc

Corium.

h n i c u l u s adiposus

towards the knee, although the nutrient arteries of the tibia and fibula have been pulled upon by the growing bones until their direction has been reversed. The growth of the arm is not so rapid, and so the primitive direction of its nutrient arteries persists, and in the adult the foramina are still directed towards the elbow. It is upon this factor that the reversal of the order of the junction of the epiphyses of the arm and leg depends.

Chapter I ends on a somewhat sombre and inglorious note. One sentence was scribbled in pencil as an afterthought:

It is a humiliating thought that we develop mostly above the umbilicus before birth and below the umbilicus after birth; that we come into the world well equipped with heart and brains and spend our lives perfecting our abdomens and genital organs.

FROM CHAPTER 2 Outer protective layers: The epidermis

The deeper layers of the epidermis (stratum germinativum) are alone in contact with a nutritive supply. for they alone rest upon the mesoderm in which the vascular system has its origin.

The well nourished cells composing the deeper layers there- fore continue to grow and subdivide, and with the formation of each new cell in the deeper layer an older cell lying more super- ficially is pushed nearer to the surface. In this way the more superficial cells become flattened as they approach the outside of the body, and finally, when completely cut off from their blood supply, they die and are cast off as loose particles from the surface of the skin.

The first layer of the embryonic epidermis to be shed is called the epitrichium or periderm, and this, at about the middle of foetal life, becomes one of the constituents of the material known as the vernix caseosa. Since the foetus is enclosed within its membranes, all the shed skin cells and all the products of its skin glands must remain in close contact with its body, for the

Fig. 4. Semidiagrammatic section of skin to show the different layers.

friction to which the skin is subjected in post natal life is not present to effect their removal. The epidermal debris therefore collects, especially in folds of the neck, the groin and the axilla, and forms a greasy layer upon the body of the foetus which doubtless acts to a certain extent as a lubricant during the pro- cesses of labour. Similar products are formed in post natal life whenever shed epithelial scales and skin secretions are pre- vented from being removed from the surface of the body, and the smegma found beneath the prepuce is a substance akin to the vernix caseosa. In cases of severe trigeminal neuralgia, when washing one side of the face is quite prohibited by the pain, a like secretion accumulates upon the skin, but here, owing to the evaporation of the moisture, it causes the formation of hard crusts upon the face. One other process must be mentioned in connection with this normal method of shedding the epidermal cells when finally they have been pushed towards the surface and away from their blood supply. In a great many embryo- logical processes, when the hollowing out of a canal is to be carried out. this method of epidermal desquamation is called in. The anus, the urinary meatus, the prepuce, and in all probability many other orifices are formed by the breaking down of the central cells of an ingrowing mass of epithelium. It is easy to

Fig. 5. Section of foetal skin showing the ingrowth of epidermis at the site of formation of an orifice such as the anus.

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406 CHRISTOPHERS

see that in an ingrowing plug of cells those units which lie towards the centre are those most distant from their blood supply, and they, in the natural course of events are destined to be shed. When the active mass has invaded the deeper tissues as a solid plug these central cells become cut off from their blood suppy and they die; at the proper time the dead cells are shed, and in this way a solid plug is converted into a hollow tube lined by epithelium.

FROM CHAPTER 3 Alimentary system: The mouth

The cavity of the mouth, which is the first chamber of the ali- mentary system, is not devoted only to the function of the inges- tion of food and drink; for it forms in man, and many other animals, an accessory opening for the respiratory system.

Ordinary respiration in normal persons is not carried out by means of the mouth, for the nasal openings are sufficiently free to allow the necessary air to be inspired and expired: it is only when the nasal passages are obstructed, as by the growth of adenoids in childhood, that mouth breathing becomes a habit which stamps its ill effects upon development.

Extraordinary respiratory efforts, however, demand the use of the mouth as a respiratory passage, and the panting of severe and prolonged exertion is a sign that more air is needed for the body than can be admitted by the nasal orifices. This accessory use of the mouth as a respiratory channel is not common to all animals, and it is a familiar fact that a horse, however hard pressed, does not open its mouth to breathe, though it makes great efforts to obtain a free supply of air through its dilated nostri Is.

The mouth has also become an appendage to the respiratory system in connection with the vocal efforts of which many animals are capable, and in man it has come to subserve the all important function of speech.

On yawning Back among the Reptiles in the silent classes of land vertebrates the mouth exercises its primitive functions, and is never opened save for the catching and ingestion of food, or for an occasional yawn.

He wrote more on yawning in his book The Matrix of the Minl

It is possible to make a further statement concerning upper motor neuron paralysis for a muscle may be paralysed for a movement and yet be able to perform that same movement if the impulse of initiation originates below the cortical level. The most striking example of this truth is that afforded by upper neuron paralysis affecting the arm and shoulder, and in which the patient when asked to do so, is utterly unable to raise the affected arm from his side. Should such a patient awake in the morning, and, without taking thought, commence to yawn, both arms, in going through the stretching movements that so com- monly accompany yawning, will be raised from his side. The yawning-stretching movement is a reflex. Its object is to force stagnated venous blood out of the abdominal cavity and out of the veins of the limbs back into the heart again in order that it may be aerated. As such a reflex its initiation is sub-cortical. That a man who has his arm completely paralysed by an upper motor neuron lesion may yet raise his arm when he yawns and stretches is a very remarkable thing; i t is apt to be a complete

surprise both to himself and to his attendants, but it should never persuade the clinician into suspecting that the paralysis is not genuine.

Bell’s palsy Like the orbicularis oris. the buccinator derives its nerve supply from the facial nerve, although the older anatomists asserted that the nervus buccinatorius from the mandibular division of the trigeminal nerve was its proper nerve supply. It would not be surprising if this nerve did indeed in part supply the muscle, for it carries motor fibres to some of the muscles of mastication; and the buccinator muscle occupies a functional position between a facial muscle and a muscle of mastication. In Bell’s palsy, in which the facial nerve is alone involved, the buccinator as a rule is paralysed, and in the descriptions of Sir Charles Bell’s original cases one of the commonest complaints made by his patients was that they could neither whistle nor spit properly. actions in which both the buccinators and the orbicularis oris are employed.

The tongue: Tongue tie Like other organs, the tongue does not develop its full adult characteristics until its full adult functions are exercised, and it is not unnatural that the tongue of a baby, used only for extract- ing milk from the breast, should differ in some measure from the tongue of an adult, which plays its complete role of produ- cing articulate speech, and of performing all the complicated movements of guiding the food into, and out of, the dental mill. For the purposes of speech, and for the guidance of food between the teeth, the highly mobile free tip of the tongue is necessary; but until a baby is at least six or seven months old it has not teeth, and takes no solid food; and for another year or so it cannot exercise its tongue in articulate speech. The free, pointed, and highly mobile tip of the tongue is therefore not developed in a new born babe. At birth, the tongue ends off in front as a straight margin, which lies parallel to the alveolar margin, and protrudes but a very little way beyond its frenum. This is the normal condition of the tongue at birth, and it was ignorance of the normal appearance of a baby’s tongue which led to the widely practised operation for the relief of ‘tongue- tie’. So long ago as 1802 John Bell recognised this fact, and pointed out the evil results which at times followed the opera- tion when performed by reason of ‘the obstinate importunity of the nurse or the weakness of the surgeon’: but the conventional shape of the handle of the director (which was designed to lever up the tongue and leave the frenum in the cleft) still serves to remind the student of the frequency with which this operation was performed at a period far more recent than 1802.

d

The papillae of the tongue With the development of the teeth, and the taking of solid food, the tongue assumes its role as an active muscular organ which moves the food within the cavum oris and guides it between the teeth.

The surface of the tongue is rough, its roughness being merely velvety in man, but in the felidae amounting to a degree which serves to make the tongue useful as a rasp for removing flesh from bones. The roughness of a cat’s tongue when it licks the hand is familiar, and is in marked contrast to the smooth slimy feel of a dog’s tongue; and this difference is correlated

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with their different dentition and their different methods of feeding. A dog gnaws a bone, and finally crushes it with its molars: but a cat licks and tears the meat away. The roughness of the tongue is due to the presence of papillae which are not easily visible to the naked eye; and by far the most numerous of these papillae are the slender papillae filiformes which give the pile to the surface of the tongue. It is the mass of the papillae filiformes at which the physician looks when he examines the tongue; and the ‘fur’ which is seen at times on the tongue con- sists of the shed, and un-removed, epithelial debris from these papillae mixed with particles of food and bacteria. Besides the papillae filiformes, others, named the papillae fungiformes, are present upon the surface of the tongue. These are not nearly so numerous as the papillae filiformes, and are situated mostly at the free tip and sides of the tongue; they are conspicuous among the hair-like papillae as bright red shining dots which give the bright colour to the tip of the healthy tongue. In many of the lower animals these numerous papillae upon the dorsum of the tongue assist in breaking up the food by grating it against a series of parallel ridges situated upon the roof of the mouth. These ridges, the plicae palatina transversae, are also present in man, and are, as are a rule, more numerous and more evident in the foetus than in an adult, since they have, in a great measure, lost their primitive functional value. In the foetus as many as seven of these ridges may be counted, but in adults, as a rule, four or five only are seen and in old age they may entirely disappear. They are best marked in front, behind the cutting teeth, becoming smaller further back on the palate where the free tip of the tongue does not play, and where the molar teeth are present as a more powerful mechanism for grinding the food.

The tongue: Its tactile perception A more homely instance of the fine tactile perceptions of the tongue is furnished by touching it with a pad of cotton wool: elsewhere on the body the pad feels smooth and soft, but the tongue readily detects that the surface of the pad is a broken one, and distinguishes the feeling of hairiness.

The jaws The jaws are bones added to the cranium, the upper one being firmly fused with it, and the lower one hinged to it, to provide a supporting apparatus around the anterior opening of the ali- mentary canal. Between the two jaws the food is grasped; it is cut or torn in pieces, and finally ground down to fit i t for the processes which take place in the subsequent stages of its journey through the body. In order to render the jaws more competent to perform these functions the teeth are added, and the whole development of the human jaws, and therefore, in great part, of the human face, is inseparably bound up with the developmental history of the teeth. The maxilla which carries the upper teeth is one of the most important bones of the face, for in addition to forming a mere fixation point for the teeth it enters into the construction of the bony socket of the eye, and the walls of the upper respiratory passages. The mandible which carries the lower teeth is merely hinged to the skull by the ar- ticulatio mandibularis, and it works upon the fixed basis cranii in all the varied movements connected with mastication.

Since the jaws have two functions to perform, the one of cutting or tearing the food with the incisors and canines, and the other of grinding the harder portions by the molars, it is necessary that the joint by which the mandible articulates with

I Uvula

Fig. 6. The palate and upper dental arch.

f Tubcrculum articulare

Discus atticulds I

Fig. 7. The jaws and teeth.

the skull should allow of two distinct movements. There is much interest in the evolution of the form of the articulatio mandibu- laris, for the particular type which is present in any animal is the functional outcome of the feeding habits of the animal. In the carnivorous animals, which cut and tear their food, the joint acts as a pure hinge, and the lower jaw simply opens and shuts like the lid of a box by a simple rotation of the condyles in the cartilage-lined socket of the temporal bone. In the herbivorous animals, which simply crop or nibble their food, and then chew it for a prolonged period, an additional action is developed by which the flat condyles glide over the surface of the socket, and so produce the side to side, and backward and forward move- ments of the lower jaw. In the human jaw these two movements are combined in response to the necessities of dealing with a mixed diet.

The condyle of the jaw hinges upon the discus articularis interposed between it and the socket, in opening and shutting

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408 CHRISTOPHERS

the mouth in the act of biting; but the condyle and the discus glide on the socket in the movements produced i n the act of chewing. When the mouth is opened the body of the lower jaw drops downwards away from the upper jaw, whilst the ramus swings from the condyle, as its point of movement, and so the angle moves backwards. Yet even in the simple act of opening the mouth the condyle of the jaw does not merely rotate in the mandibular fossa, but as the jaw drops downwards the condyle and discus move forwards so that they ride partly out of the fossa and on to the posterior surface of the tuberculum articu- lare. When the mouth is opened to its widest possible extent the condyle may even move in front of the tuberculum, and, in persons in whom the fibres of the capsule are lax, an actual subluxation of the joint may be produced as the result of a yawn. I t is to allow of this forward movement of the condyle and discus that the fibres of the capsule arise so far forward on the zygoma. an origin which necessitates their running downwards and backwards to the collum mandibulae, a direction which commonly appears to the student the reverse of that which might have been expected.

The opening of the mouth is not however brought about at all times by muscular contraction, for with relaxation of the muscles which keep the mouth closed, the weight of the jaw causes the lower jaw to fall and the mouth to open. This action is seen during sleep, and it may be noted that whereas the lower jaw is moveable and therefore drops to open the mouth, the upper eyelid is most moveable and therefore drops to close the eye during sleep.

The teeth These teeth [the first set] are of very different forms, each shaped according to the functional role it plays in the processes of dealing with the food. The incisors (dentes incisivi) are the front teeth, and their general shape is best described as chisel- like. These are the teeth that John Hunter named from their function the ‘dividers’, and he observed that in all animals the ‘dividers’ were placed external to the ‘grinders’; for their func- tion demanded that the food should come under their influence first; the food being first cut and then ground.

The canines (dentes canini) are the sharp pointed teeth situ- ated lateral to the incisors, and they constitute the ‘holders’ or ‘killers’ of Hunter for they are the teeth by which the carnivo- rous animals catch and hold their prey, and it is they which are specially developed as weapons. The molars (dentes molares) or ‘grinders’ are situated at the back of the mouth, and are broad-topped flat teeth which crush and grind the food between their opposed surfaces.

I t must also be noticed that the teeth of one jaw are not placed accurately in contact with their fellows of the opposite jaw, for the teeth are placed more nearly alternate than oppo- site. The normal upper central incisors are far wider than their fellows in the lower jaw, and so all the teeth of the upper jaw are thrown behind the corresponding teeth below. By this means every tooth in both jaws. except the third upper molars and lower central incisors, bites upon two teeth in the opposite jaw. This arrangement makes the functional value of each indi- vidual tooth greater, and it must be remembered that in extract- ing any single tooth the biting value of the two remaining teeth is impaired.

Upper molar

Vestibulum ons

Lower molar

Cavum oris

Fig. 8. Diagrammatic section across an upper and a lower molar to show the manner in which the cusps engage in the normal bite.

The oral glandular system The oral glandular system is developed in all land-living ver- tebrates; but in fishes i t is absent, and it is doubtless the change from taking all food admixed with water to taking of dry food upon the land which calls forth the development of the glands. Among the Mammals the oral glands are present in all forms except those of an entirely aquatic habit such as the Cetacea.

When they first make their appearance in the animal series these glands are of a simple unspecialised type, and their only function is to secrete a simple slimy fluid the sole purpose of which is the moistening of the mucous membrane of the mouth and upper digestive tract. It is late in their evolution that their role of secreting a digestive enzyme is added. In those reptiles provided with poison fangs the oral glands have become further specialised, for their secretion contains the poison which is injected into the wound caused by the bite of the animal’s hollow teeth. In the poisonous snakes it is the superior labial gland which subserves this special function, but in Heloderma (the Mexican poisonous lizard) the sublingual gland furnishes the poison.

In man some of the glands retain their original function of secreting mucus for the mere moistening of the mouth, and some are specialised for the secretion of the digestive enzyme; the first set are usually termed mucous glands and the second the salivary glands proper.

Trial by ordeal Not only may an increased flow be produced by psychical factors altogether apart from any mechanical stimulation; but an absolute arrest of secretion may be brought about i n the same manner. Anxiety and embarrassment produce the dry mouth and throat of nervous speakers by checking the normal secretion of saliva, and necessitate the customary glass of water on the chair- man’s table. The parching of the mouth and throat produced by great fear is the phenomenon which underlay the old method of trial by ordeal. The innocent, and unafraid, man would take the dry bread, and when it was properly moistened by his saliva would swallow i t in the normal way; but the terrified guilty person, whose faith in the test was implicit, was unable to moisten the bread, and attempting to swallow the dry particles hurriedly was apt to choke.

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FREDERIC WOOD JONES 409

The valvula coli The result of the movements of the small intestine is to drive the contents towards the valvula coli which guards the entry into the large intestine. The valvula coli possesses the distinc- tion of being one of the most simple mechanical contrivances in the body, and at the same time one of the most functionally competent valvular structures. Its essential features are produced by what is practically a partial prolapse of the ileum into the caecum; it is in fact normally the site of an anatomical condition which needs but little exaggeration to become pathologically an intussusception.

The valvula coli functions more as a pure valve than as a regulating sphincter which controls the intake of the contents of the ileum into the caecum; the sphincter action is probably dis- charged by the thickening of the circular muscular fibres about the ileo-caecal junction.

Looked at from the caecal side the terminal portion of the ileum, which constitutes the valve, appears as two pouting lips (an upper and a lower) which are joined at their two extremities

Fig. 9. Section of the terminal portion of the ileum and wall of caecum to show the structure of the lips of the valvula coli.

/Orifice of processus vermiformes

Fig. 10. The interior of the caecum to show the valvula coli and the orifice of the processus vermiformis.

very much after the manner of the lips of the mouth and pro- longed round the wall of the caecum by the frenula valvulae. I t must be remembered that in the primitive and foetal condition, the ileum joins the colon from its cephalad aspect, and that with the coiling of the intestinal tract this condition becomes reversed, the ileum running obliquely cephalad to join the colon.

In this way the ileum comes to lie almost at right angles to the line of the colon, but the evidence of the primitive condition is readily detected in the adult, for the wall of the ileum which forms the lower lip of the valve is bound to the wall of the colon over a considerable interval. It is by this arrangement that the lower lip of the valve constitutes a common wall to both the ileum and the caecum.

Defaecation: The pursuer and the pursued As side issues of its [the large intestine’s] main role in the animal economy, other duties are performed, and the most important of these is the abstraction of fluid from the food debris passed into it from the ileum. We have seen that the food mass which reaches the valvula coli is in quite as fluid a state as it was when it first entered the duodenum; even though fluid had been absorbed from it in its journey down the jejuno-ileum, this loss had been made good by secretion from the intestinal walls. The contents of the caecum are fluid, but as the mass is passed round the 6 foot coil of large intestine it steadily becomes of a thicker consistency, until in the colon iliacum and colon pelvinum it has attained the relatively dry condition char- acteristic of the faeces. The extent to which this abstraction of water goes on normally, with a resulting alteration in the con- sistency of the faeces, varies greatly in different species of animals and in the same animal with varying diet and in varying states of health. Even i n this, the resulting form and consistency of the faeces, the mechanism of the colon is modified in special relation to the environmental needs of the animal. Some animals, especially those which are unprotected from enemies and depend on their swiftness of foot for their safety, cannot afford to be hindered in their activities by the passage of bulky faeces; the pause for defaecation might well be fatal to them.

The case of the Rodents and the minor members of the sub- family Pecora will instantly come to mind; for the ‘pellet’ faeces of the rabbit and the goat are familiar to everyone. The carnivo- rous animals as a rule have to pause, sometimes for a protracted interval, during defaecation; while the defenceless herbivorous animals which they pursue may freely defaecate while running at full speed. The case of the dog on the one hand and the rabbit on the other, or of the cat and the mouse, will furnish homely illustrations of this handicap imposed by Nature by which the pursuer must stop to defaecate while the pursued may defaecate when in full flight; the lion defaecates at his leisure but the lamb defaecates in his haste.

Defaecation: Diaphragm as a piston The diaphragm has a curious history which is dealt with else- where, one of its most important functions being the raising of visceral pressure for the purpose of expelling abdominal con- tents. The functional role of the diaphragm varies greatly in different animals; in the carnivora a higher abdominal pressure, and more straining, is produced than in the herbivora, where intestinal, and accessory intestinal, musculature are more pow- erful. In man the diaphragm is an important muscle of defae- cation; it descends as a piston on the contents of the abdomen

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410 CHRISTOPHERS

and so tends to drive them out of the posterior visceral orifice. But to be properly efficient its descent must be accompanied by a hardening of the abdominal muscles in order to prevent the abdominal wall yielding before the increased pressure. The abdominal muscles do not contract and squeeze the abdominal contents, as is so often imagined, but they become taut, and their fibres by running in varied directions insure a resisting wall to meet the internal pressure. They are the highly devel- oped guardians of the ribless abdominal wall as the intercostal muscles are of the ribbed thoracic wall, and their contraction is not brought about to increase, but to resist, internal pressure.

In those animals which defaecate with a high abdominal pres- sure some studied attitude is usually assumed to assist the abdominal muscles in carrying out their function. Most carni- vora have a characteristic attitude of defaecation, an attitude which for the most part is directed to giving the diaphragm full play in emptying the abdominal cavity, and also to assisting the abdominal muscles to resist the pressure created within. Man, in a normal unrestrained condition, squats to defaecate; and so approximates his thighs to his abdominal walls, thus lending them an added support. The extreme flexion of the thighs i n this, the natural position of defaecation. supports the weakest portion of the abdominal walls, and it is highly probable that the abandonment of this natural attitude has contributed to the frequency of hernia, an accident directly associated with an increased abdominal pressure and a yielding abdominal wall.

LUNCH WITH EDWARD ARNOLD Time plays havoc with the total of what one remembers. This is demonstrated by an extract from Wood Jones’s autobio- graphical material written about 1952:

Early in 1915, Edward Arnold asked me to lunch at the Trav- ellers’ Club and over a very pleasant meal he outlined a pro- posal for me to undertake the preparation of an entirely new book of Human Anatomy. He wanted a one-man book and he wanted it to be entirely original. He offered me what seemed to be generous terms and, after thinking the matter over for some time. I agreed to try my hand at it. All through 1915 I worked at that text book whenever I could spare time from work that gave me more satisfaction and by the end of the year I had made some progress both with the illustrations and the text. But little by little the time I gave up to it grew less and every time I came back to it I disliked it the more. I felt I must get ahead with the line of research that I had set myself to take and I resented the time spent in re-arranging facts that had, for the most part, been well known for centuries. The thing became an incubus and I sought to escape from it by applying to the College of Surgeons for permission to give another Arris and Gale lecture. This time I was given all three lectures and so I had a legitimate excuse for letting the work on the text book fall into arrears. I was now in a position to weave together a fairly complete story concerning the origin of man’s outstanding structural peculiarities. I gave lectures during February and March, 1916 and. after writing the story as simply and as briefly as I could, had another lunch with Arnold. I offered to arrange

the whole thing so that he could publish it in book form on condition that, if he accepted it, he would absolve me from my promise to write an orthodox text book of anatomy. He agreed to this and published it under the title ‘Arboreal Man’ on October 1 Ith 1916.

HIS DECISION VINDICATED The first sentence of this extract is incorrect. A written agree- ment to write a ‘new text book of Human Anatomy’ was signed by Wood Jones in 1909 and the book was to have been pub- lished in the northern autumn of 1910.

It is likely that what happened at the first lunch with Edward Arnold in 1915 was that Wood Jones was asked how the text- book was progressing and was encouraged to complete it. Reluctantly it would seem, he agreed to d o this. Chapter 4 (Genital System), the final chapter, certainly bears the stamp of this reluctance. It is not an anatomy of function; it is an anatomy of structure. Clearly the writing of this chapter was not a labour of love.

By 1916 Wood Jones had finally decided that the textbook was not his scene. For that decision we must be eternally grate- ful. What was published in lieu of the manuscript was the book Arboreal Man. Here he wove together a story concerning the origin of man’s ‘outstanding structural peculiarities’. One high- light of the book is an explanation of the genesis of the greatest (apart from the brain) of man’s structural peculiarities: the hand. This book was undoubtedly a prelude to his more detailed study of the hand. That study resulted in the classic The Prin- ciples of Anatomy as Seen in the Hand. His decision to forgo the completion of the manuscript was vindicated.

ACKNOWLEDGEMENTS I would like to thank Mr James Guest for his permission to reproduce the drawings from ‘the missing manuscript’ and also the Royal College of Surgeons of England for permission to use material from its library. Acknowledgement is due to Bail- liere, Tindall and Cox for permission to reproduce material from a book by Wood Jones. Dr Allen Christophers word- processed the manuscript and made helpful suggestions regard- ing its final presentation.

REFERENCES 1 . Christophers BE. Frederic Wood Jones, artist and illustrator.

Aust. N.Z. J. Surg. 1992; 62: 60-9. 2. Wood Jones F (ed.). Buchanan’s Manual of Anatomy, 7th edn.

London: Bailliere, Tindall and Cox, 1946. 3. Wood Jones F, Porteus SD. The Matrix of the Mind. Honolulu:

University Press Association, 1928. 4. Wood Jones F. Autobiographical material (circa 1952). Original

manuscript lodged in the Wood Jones Collection in the Library of the Royal College of Surgeons of England.

5. Wood Jones F. Arboreal Man. London: Edward Arnold, 1916. 6. Wood Jones F. The Principles of Anatomy as Seen in the Hand.

London: J & A Churchill, 1920.

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FREDERIC WOOD JONES 41 1

Appendix 1. A bibliographic description of the manuscript: Anatomy from the Point of View of Function.

In order to save space, a stroke has been used to signify what would normally be the beginning of a new line. Two strokes have been inserted to denote the end of a chapter.

The text [CONTENTS]: / Chapter I. The general growth & proportions of the body.// Ch[apter] 11. Outer protecting layers.// [Chapter 1111. Alimentary System [part I] [From mouth to cardia]; [part] I1 From Stomach downwards.// [Chapter IV].Genital System [part] I [Male]; [part] I1 Female. // [Chapter V]. Respiratory [System].// Chapter I: title leaf (330 mm X 207 mm) Arnold / General growth & bodily proportions / Should constitute Chap I / holograph with holograph notes + 22 {(I-7) + [7a] + [7b] + (8-11) + [ I la ] + (12-16) + ([17]-[19])), pages (1-7) leaves (280 mm X 222 mm) typed with holograph corrections and additions, page [7a] leaf (260 mm X 260 mm) typed with holograph corrections, page [7b] leaf (90 mm X 206 mm) typed, pages (8-1 1) leaves (280 mm X 222 mm) typed with holograph corrections and additions, page [ 1 la] leaf (255 mm X 203 mm) typed with holograph corrections on verso of a letterhead of Wood Jones’ family home Harley Lodge, Enfield, pages (12-16) leaves (280 mm X 222 mm) typed with holograph corrections, page [ 171 (255 mm X 203 mm) typed with holograph corrections on leaf as per [ I la], pages ([ 18]-[ 191) leaves (265 mm X 217 mm) holograph with a correction in ink except that last sentence is in pencil.// Chapter 11: title leaf (264 mm X 204 mm) Arnold / Anatomy of function / Ch I1 outer protecting layers holograph + 12 leaves (280 mm X 222 mm) typed with holograph corrections and additions.// Chapter I11 part I: title leaf (330 mm X 204 mm) Arnold/ Anatomy of Function / Alimentary System holograph with holograph notes + 32 leaves (330 mm X 203 mm) typed with holograph corrections and additions; part 11: title leaf (330 mm X 207 mm) Arnold / Alimentary System / I1 / From stomach downwards / holograph with a holograph note + 46 pagination (33-78) leaves (330 mm X 203 mm) typed with holograph corrections and additions.// Chapter IV part I: no text extant; part 11: title leaf (285 mm X 223 mm) Arnold / Reproductive System / fact[s] relating to / holograph + 24 [ 1 + (2-9) + 10 + ( 1 1-12) + 13 + (14-24)), page 1 two pages glued together and trimmed resultant leaf (385 mm X 202-222 mm) typed with holograph corrections and additions, pages (2-9) leaves (285 mm X 222 mm) typed with holograph corrections and additions, page 10 two pages glued together and trimmed resultant leaf (325 mm X 203 mm) typed with holograph corrections, pages ( I 1-12) leaves (262 mm X 203 mm) typed with holograph corrections and a holograph addition, pages (13-24) leaves (285 mm X 203 mm) typed with holograph corrections and a holograph addition.// Chapter V: no text extant.

The illustrations All the illustrations of the manuscript are drawn in ink (22-218 mm X 35-164 mm) on paper boards which are mounted on leaves (263 mm X 204 mm) drawings are covered by transparent paper on which are holograph diagrammatic notes./ Chapter I: 3 drawings, all have legends and 1 is labelled.// Chapter 11: 6 drawings all have legends and 2 are labelled.// Chapter 111 part I: 21 drawings all have legends and 15 are labelled;/ part 11: 7 drawings all have legends and 2 are labelled.// Chapter IV part I: 14 drawings all have legends in all but one labelling is either absent or uncompleted; part 11: 10 drawings all have legends and 8 are labelled. // Chapter V: 5 drawings 4 have legends and none are labelled.