Part 7

Secondly, the “Shoulder-joint” is so made as to permit a great variety and extensive range of movements to take place. We can move the arm forwards or backwards, as in throwing a ball, or, in sword exercise; we can raise it so that the limb points straight upwards; and we can swing it round in any direction. It is owing to the free movement in this joint that we are able to apply the hand to every part of the body, so as to remove sources of irritation. It is interesting to observe how other animals get on without hands, though they are much exposed to what we should consider great annoyance, as from flies, &c. The Cow, for instance, lashes its hide with its tail. The Cat licks itself with its tongue. The Sparrow dusts itself by the road-side. The Pig and the Donkey roll in the mud. And many of them, as the Horse and the Ox, have a thin muscle, called “panniculus carnosus,” spread out under the skin, which effects those sudden twitchings of the skin whereby they are enabled to jerk off anything that troubles them. In Man the hand answers better than all these methods combined; and it is necessary that it should do so, because his skin is more sensitive and less protected by natural covering than that of any other animal.

For this freedom of movement of the arms, so important to the usefulness of the hand, we are much indebted to the “Collar-bones.” These bones, so called because they are placed at the lower part of the _collum_ or neck, extend, horizontally, from the upper edge of the breast-bone, to the processes of the blade-bones which overhang the shoulder-joint. Thus they hold the shoulders apart, and give width to the upper part of the chest. They also steady the shoulder-blades, and afford a _point d’appui_ to the muscles which effect the lateral movements of the arms,--for instance, to the muscles which tend to draw the arms together, as when we hold anything, between the hands, in front of us; and to those which separate the arms from one another, as when we stretch them out at right angles with the body.

Many animals--the ELEPHANT, the RHINOCEROS, the HORSE and the OX--have no collar-bones; and they are only able to swing their fore limbs to and fro. They cannot execute any lateral movements. They cannot throw the limbs out sideways, nor press their fore feet together, so as to hold anything between them. If the horse wants to seize or hold any substance he must do it with his mouth. The Elephant has a special provision for the purpose of prehension in his trunk, which enables him to provide himself with food by pulling down the branches of trees. The LION and the TIGER can press their fore paws together sufficiently to enable them to hold their prey, and fix it upon the ground, while they put the head down to it and pull at it and tear it with their teeth; and they are furnished with rudimentary, or half, collar-bones suspended in the flesh of the upper part of the chest; while the little SQUIRREL, which sits upon its hind legs, and holds up the nuts between its fore paws to be nibbled, has complete collar-bones. So has the flying BAT, the climbing SLOTH and the digging MOLE. In BIRDS the collar-bones (fig. 56, AA) are very large; and, for the purpose of giving them greater strength, they are united together in the middle line just above the breast-bone, forming what is commonly called the “merry-thought;” and, as this is not sufficiently strong to resist the force of the powerful muscles which flap the wings and sustain the animal in the air, there are, in addition, stout “side-bones,” called by anatomists “coracoid bones.” These (B) run, from the breast-bone (D), in the same direction as the collar-bones, one, on either side, to the shoulder-blades (C); and they afford even more efficient support to the shoulders than do the collar-bones. The coracoid bones are peculiar to oviparous animals, or nearly so. In some reptiles, as the CROCODILE, they quite supersede the collar-bones.

These few examples are enough to show that freedom of movement of the arms, especially of lateral movement, is closely associated with, and, indeed, is dependent upon the shoulder-blades being supported and steadied by bones, which extend from the breast-bone to the shoulder-blades, and fasten the one to the other.

But, even the powers and advantages conferred by nature have often some drawbacks; and this free play of the arm at the shoulder in man, of which we are speaking, and the provision for it afforded by the collar-bone, are no exceptions to the remark. It is necessary for so great a range of movement that the socket in the shoulder-blade should be shallow, and that the ligaments which connect the arm-bone with the blade-bone should be loose. Hence the shoulder-joint is weak as regards its ability to resist injury. The collar-bone also causes the shoulder to project so much that it is greatly exposed to injury and often bears the brunt of a fall. A man is thrown from a horse or is knocked down upon the ground, and, if anything prevents the hand being stretched out, the chances are that he falls upon the shoulder. True, the head is saved thereby; but the shoulder suffers. Hence the shoulder-joint is more often dislocated than any other; and no bone is more frequently broken than the collar-bone. Even in little children, in whom, notwithstanding their many tumbles, the other bones usually contrive to escape, the collar-bones are often broken; and in grown-up persons the shoulder is sometimes dislocated by the mere action of the muscles, as in swimming, or throwing, or lifting a weight above the head.

That you may understand the movements of the shoulder a little more fully, I will ask you to contrast the drawing (fig. 58), which shows the position of the blade-bone upon the chest in Man, with the drawing (fig. 57) of the corresponding parts of the Rhinoceros; and you will at once recognise several important differences, besides the presence of the collar-bone in the one and its absence in the other.

In the RHINOCEROS the chest is deep, from the back-bone to the breast-bone, and is flattened at the sides; and the depth of this part of the trunk is increased, slightly, by the breast-bone projecting, keel-like, underneath, and, much more, by the spines of the back-bone running up into a high ridge, above. The blade-bone and the arm-bone are applied against the flat side of the chest, and lie, lengthways, between the spine and the breast-bone, nearly parallel with the broad flat ribs. The blade-bone has no process overhanging the shoulder-joint, and, as before said, there is no collar-bone. The short thick arm-bone descends nearly in a line with the blade-bone, and has huge processes at its upper end for the attachment of muscles. The parts are designed to bear the great weight of the animal, and to carry its ponderous head and horn; but the only movement of which they admit is a sliding of the blade-bone and arm-bone, backwards and forwards, upon the side of the chest.

In animals of similar construction to the Rhinoceros, but of lighter frame, and of greater fleetness, the blade-bone is placed more obliquely, which gives freer and easier movement both to it and to the arm-bone. This, for instance, is the case with the well-bred horse, and if we want a quick-going horse, one that can lift his fore feet well, we should observe whether the shoulder-blade is oblique, and whether the spines of the back rise well above it. Such a horse is said to have “a good shoulder” and to be “well up.” He will carry a saddle well, and is not likely to trip.

In MAN the chest has proportionately less depth and length, and greater breadth, than in any other animal; the breast-bone is quite flat; and the spines of the back are sloped downwards, so that they do not project beyond the level of the ribs and the blade-bones. Hence he can lie easily either upon the stomach or the back--a privilege which is shared with him by very few of the lower animals. Scarcely any of them can lie upon the back, or even upon the stomach without the help of the fore limbs. The donkey enjoys rolling over and over upon a dusty road, but he cannot poise himself for a minute upon his back.

The sides of Man’s chest, moreover, are not _flat_, as in the Rhinoceros and Horse, but _rounded_, so that the blade-bones can revolve upon them to and fro, as well as slide upwards and downwards; and the long arms--comparatively long, that is, from the shoulder to the elbow--hang quite free of the chest and form sharp angles with the blade-bones.

The blade-bones are accommodated to the shape of the chest; for, instead of being elongated in a direction parallel with the ribs, they are prolonged downwards, along the sides of the chest, at right angles with the ribs. This prolongation of the lower part of the blade-bone is very important, inasmuch as it enables the muscles to hold the bone steady upon the wall of the chest, and so gives greater power to those muscles which pass from the blade-bone to the arm and act upon the shoulder-joint. Were it not for this provision the contraction of the muscles intended to raise the arm would quite fail to produce the desired effect, and instead of it would simply cause the shoulder-blade to revolve upon a transverse axis. That is to say, when we endeavoured to raise the arm our effort would merely have the effect of raising the hinder part of the shoulder-blade.

In each of these particulars--in the form of the chest, and in the shape and direction of the shoulder-blade--the Monkey is intermediate between Man and the inferior animals. The Monkey’s chest is broad and round, in proportion to its length, if we compare it with other animals; but this is less marked than in the human chest. And you perceive that the Monkey’s back-bones project, as they do in other animals, beyond the level of the ribs. The blade-bones are also like those of Man in being prolonged downwards, and in being carried, to a certain extent, across the ribs; but their lower angles do not run so far in this direction as they do in the human skeleton.

The movement of raising the arm, as in carrying the hand _outwards_, or pointing upwards, or putting the hand upon the head, is rather a difficult one, and requires the combined action of many muscles. It is, therefore, to be avoided by persons to whom muscular straining is likely to be injurious; and the power of effecting this movement is easily impaired by accident or disease. A long time often elapses even after a slight bruise of the shoulder, before the person recovers the power of putting the hand upon the head.

The exercise of raising the arms above the head is a good one for those in health, and is much, and wisely, recommended by the directors of gymnastics. It brings many muscles into play, not only those of the shoulder, but the muscles all round about the chest, viz. those which pass from the spine and ribs, as well as from the breast-bone, head, and pelvis, to the shoulder-blade and arm; and, thus, it tends to strengthen the spine and the chest, as well as the shoulders and arms. There is, perhaps, no exercise so good as this; and it is much to be regretted that the dress of young ladies, with its paraphernalia of stays and shoulder-straps, interferes so greatly with it. The frequency among them of “pigeon-breast” and “crooked spine” must, partly, be attributed to the confinement of the arms, caused by the mode of dress and the customs of life. One of the few opportunities afforded to the arms of availing themselves of this exercise is in the dressing-room during the process of brushing the hair. I would by all means, therefore, recommend young ladies to give sufficient time and attention to this part of the toilette, and not to delegate it to the lady’s maid. If, in addition, I suggest that it be commonly done with open window, I feel sure that I shall have a deservedly great authority among them--Miss Nightingale--on my side.

The movement at the ELBOW is, merely, that of bending and straightening, in a hinge-like manner; yet there is a slight obliquity in the direction in which it takes place, an obliquity resembling that in the movement at the knee (page 39).

_Pronation and Supination of the Hand._

In the FOREARM and HAND there is a movement with which we have nothing exactly corresponding in the leg. It is called “Pronation and Supination.” In _pronation_ we turn the palm _down_wards, as in picking up any substance from a table; in _supination_ we turn the palm _up_wards, as a boy does when he holds out his hand for a caning, or for the more agreeable purpose of having a shilling put into it.

PRONATION and SUPINATION take place in the following manner. Each of the two bones of the forearm extends from the elbow to the wrist (fig. 53); but one of them--the “ulna”--is chiefly connected with the elbow; and the other--the “radius”--is chiefly connected with the wrist, and, by means of the wrist, with the hand. The two bones are separate from one another, except at their ends. There they touch, and are jointed together in such a manner that the large lower end of the radius can play round, or partly round, the small, button-like, lower end of the ulna; and, in so doing, it carries the hand with it. In this movement the upper end of the radius (A, fig. 60) does not leave its place, but simply revolves, upon its own axis, on the surface of the arm-bone; and its edge turns in a notch cut for it in the upper end of the ulna (B), which remains still.

In the drawings (figs. 61 and 62) the relation of the parts in the supine and in the prone state is shown by the aid of a plumb-line falling from the part of the arm-bone upon which the upper end of the radius revolves. The line traverses the upper end of the radius, then passes along the interval between the two bones, then traverses the lower end of the ulna, and, finally, takes the course of the ring finger. And, provided the limb be held vertically, the line traverses the same parts whatever be the position of the forearm and hand. It does so in complete supination, as shown in fig. 61; it does so in complete pronation, as shown in fig. 62; and it does so in every intermediate position. We may call it, therefore, the axis upon which the radius and the hand turn in pronation and supination; and, according to this representation, the ring finger remains stationary during the movement, while the other fingers and the thumb perform their partial revolutions around it.

I have said there is no movement in the lower limb exactly like the pronation and supination of the forearm and hand. We have, it is true, a power of moving the leg upon the thigh in a somewhat similar manner; but this can only be done when the knee is bent. For instance, when sitting in a chair with the foot upon a fender, or with the toes upon the ground, we can make the foot revolve so as to turn the heel in or out. A little careful observation, however, will prove that this movement takes place, altogether, at the knee, and that _both_ bones of the leg participate equally in it, the _whole_ leg revolving with the foot. Whereas, in the case of the forearm, the movement takes place, partly, at the wrist, and, partly, at the elbow; and _one_ bone (the ulna) remains _still_ while the lower end of the other bone (the radius) revolves around it. Moreover, the pronation and supination of the hand and forearm are much more free than these movements of the foot and leg; and they take place with equal facility and freedom in any position of the limb. We can turn the palm up or down as easily when the elbow is straight as when it is bent.

The movement of which I am speaking is so important to the usefulness of the hand, that I will call your attention to three of the muscles by which it is effected.

And, let me remark, by the way, that all the movements in the solid parts of the body--probably all without exception, even the slight wrinklings of the skin that take place when it is exposed to cold--are the result of muscular action. Muscles are bundles of fibres which have usually a red colour and constitute what is commonly called the “flesh” or “lean meat” of animals. They are endued with the power of contracting or shortening themselves; and it is this property which gives rise to the various movements of animal bodies. At their ends muscles often dwindle into “tendons” or “sinews” which, though occupying much less space, and having no contractile power, are very strong, and serve to connect the muscles with the bones.

One of the three muscles just mentioned (A, fig. 61) passes from a projecting process on the inner side of the arm-bone, at its lower end, to the outer edge of the middle of the radius. Its contraction causes the radius to roll over, or in front of, the ulna. It thus pronates the hand, and is called a “_Pronator_” muscle. Another muscle (B, fig. 62) passes, from a projecting process on the outer side of the arm-bone, to the inner edge of the radius near its upper part. It runs, therefore, in an opposite direction to the former muscle and produces an opposite effect, rolling the radius and the hand back into the position of supination. Hence it is called a “_Supinator_” muscle.

The third is a very powerful muscle. It is called the “_Biceps_” muscle (fig. 63), because it has _two_ points of attachment to the shoulder-blade. It descends along the front of the arm, and, bulging there, forms a conspicuous feature, to which athletic persons are proud to point in evidence of their muscular development. Its tendon crosses over the front of the elbow, and is inserted into the hinder edge of a stout tubercle which is seen on the inner side of the radius near its upper end. The chief effect of this muscle is to bend the elbow; but it also rotates the radius so as to supinate the hand; and it gives great power to that movement. When we turn a screw, or drive a gimlet, or draw a cork, we always employ the _supinating_ movement of the hand for the purpose; and all screws, gimlets, and implements of the like kind, are made to turn in a manner suited to that movement of the right hand, because mechanicians have observed that we have more power to supinate the hand than to pronate it, though they are, probably, not aware that the preponderating influence of the _biceps_ muscle is the cause of the difference.

The movement of which I am speaking is performed to its full extent only by Man. Monkeys cannot completely supinate the hand; and in most of the lower animals the part corresponding with the hand remains nearly, or quite, fixed in a state of pronation. Even in Man, complete supination is rather a constrained and awkward position. It is not a position which is habitual or natural to us. When we see any one sitting or walking with the palms turned forward it strikes us as strange, and the idea is suggested to us that the individual must be strange too, that, possibly, his head may be a little turned as well as his hands. In a state of ease the hand is naturally more or less prone; so that when it is desired to place the forearm or hand at rest, as in case of disease or injury, the prone position is usually selected. If the forearm be broken, for instance, the surgeon sets the fracture and fixes the limb with the hand prone or semiprone. This is, also, the position of greatest strength, as well as of most ease. Hence, in striking a blow, or carrying a weight, or making any strong muscular effort, the palm is always kept more or less inturned.

_The Wrist._

This drawing (fig. 64) represents what is seen when a section has been made, from side to side, through the wrist and lower part of the forearm. It gives an idea of the mode in which the several bones of the wrist are adapted to one another and held together by ligaments. The upper three wrist-bones (C, E, D) are joined together, so as to present a convex surface, which is received into a wide cup, or socket, formed by the end of the radius (A) and a ligament passing from the radius to the ulna (B); and, in pronation and supination, the end of the radius, together with this ligament and the wrist-bones, revolves upon the end of the ulna.

All the bones here represented are so well fitted to one another, and so strongly bound together, that, as I have before said, displacement very rarely occurs among them. We sometimes _hear_ of a dislocation of the wrist, but very seldom _see_ one. The wrist is often bruised, or its ligaments strained, by falls upon the hand; or, what very often happens, especially after the middle period of life, the bones of the forearm are broken a little above the wrist.

You might think that, in such an accident, the radius only would suffer, inasmuch as it is especially connected with the wrist-bones, and so receives the force directly from the hand. But, if you observe the line of contact of the radius and ulna (running from F), you will see that it is oblique, and that its direction is such as to cause the ulna to support the radius, and to receive some of the force from it; and this disposition, which makes the ulna share the duties of the radius, makes it, also, share the dangers; hence, it is very frequently involved with the radius in fracture of the forearm.

By the joints of the wrist we are enabled to move the hand backwards and forwards, and also slightly sideways.

_The Movements of the Hand._

I come now to speak more particularly of the movements that take place in the Hand. I have already said that the mobility of the thumb is the chief characteristic of the hand as distinguished from the foot. Another important distinction between the hand and the foot is the greater length and mobility of the fingers as compared with the toes. The toes are short; and our power of moving them is, under any circumstances, slight. They constitute a small, and, comparatively, unimportant, part of the foot. The fingers, on the contrary, are long; they form a half, and, including the thumb, the more important half, of the hand. Without them the rest of the hand, indeed the rest of the limb, would be comparatively useless. Their movements are varied and free, and take place with singular facility and rapidity. We can bend them quite down upon the palm, and can extend them beyond the straight line; we can separate them from one another to a considerable extent; and we can bring them together with some force, as a waiter does when he carries a number of wine-glasses between his fingers; and persons who have lost the thumb contrive to hold a pen, a knife or fork, or other things, between the fingers.

Let me endeavour to give you an idea of some of the muscles which are concerned in executing these movements.