Brinker, Piermattei and Flo's
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Brinker, Piermattei,
FIFTH EDITION
Charles E. DeCamp, DVM, MS
Diplomate, American College of Veterinary Surgeons
Professor
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
Michigan State University East Lansing, Michigan
Spencer A. Johnston, VMD
Diplomate, American College of Veterinary Surgeons
James and Marjorie Waggoner Professor
Head, Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
University of Georgia Athens, Georgia
Loïc M. Déjardin, DVM, MS
Diplomate, American College of Veterinary Surgeons
Diplomate, European College of Veterinary Surgeons
Professor
Head of Orthopedic Surgery
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
Michigan State University East Lansing, Michigan
Susan L. Schaefer, MS, DVM
Diplomate, American College of Veterinary Surgeons
Clinical Associate Professor—Orthopedics
Section Head—Small Animal Surgery
Department of Surgical Sciences
School of Veterinary Medicine
University of Wisconsin—Madison Madison, Wisconsin
3251 Riverport Lane
St. Louis, Missouri 63043
BRINKER, PIERMATTEI, AND FLO’S HANDBOOK OF SMALL ANIMAL ORTHOPEDICS AND FRACTURE REPAIR, FIFTH EDITION ISBN: 978-1-4377-2364-9
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To Wade O. Brinker, Don Piermattei, Gretchen Flo, and all the surgeons before us, and to the families behind us.
Many transitions are embedded in publication of the fifth edition of Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. For us, the most significant transition is that Dr. Wade Oberlin Brinker passed away in 2008 at the age of 95. We are heartened that this book is one piece of a legacy that reflects a lifetime of dedication to teaching the principles and procedures of veterinary surgery to generations of students, house officers, and clinicians. Before publication of the fourth edition, Wade explained clearly and firmly that his motivation in founding this book was to establish a solid reference for veterinary students and practicing veterinary surgeons. Through the years we have tried to maintain a balance of information in a straightforward, well-illustrated, and understandable manner that will not only challenge the avid veterinary student but also provide a reasonable, though not exhaustive, reference for the practicing clinical surgeon.
Thirty-three years have passed since publication of the original edition. We note another huge transition in that this is the first time this book will be published without new contributions from the original authors—Dr. Donald Piermattei, Professor Emeritus at Colorado State University, and Dr. Gretchen Flo, Professor Emeritus at Michigan State University. We have endeavored to maintain a balance of new ideas with a deep respect for their previous work that continues to guide our own professional lives. We cannot ever hope to replace Dr. Piermattei’s clarity of thought and Dr. Flo’s diagnostic prowess and surgical courage. It was a huge challenge to go forward without their guidance, and it is here that we must acknowledge the importance and breadth of their previous contributions to this work.
With each edition, we note the introduction of many new concepts and fixation strategies, and these developments continue to validate the same principles that Wade Brinker stressed from the first pioneering days of veterinary surgery. Surgical values of respect for tissue, surgical efficiency, aseptic technique, and appropriate planning will always be relevant to the optimal healing of our patients. With the fifth edition, sections have been expanded to reflect common and accepted improvements with interlocking nails, plate fixations, and minimally invasive surgery. Sections on hip dysplasia, cruciate ligament rupture, and patella luxation reflect continuous progress in treatments of these common conditions.
We are fortunate to have a new biomedical artist, Ted Huff, who has made outstanding contributions to the fifth edition and continues a legacy of quality from our previous artist, F. Dennis Giddings. We are also thankful for all of the work and support provided to us by the staff of our publisher, Elsevier. In particular, Penny Rudolph, Brandi Graham, and Linda Wood have been most helpful and patient in bringing the next edition to life.
Readers will also note the addition of three new authors, Dr. Spencer Johnston, Dr. Loïc Déjardin, and Dr. Susan Schaefer. Each has a deep respect for a place for this text in the future of our profession. We sincerely strive to move this textbook forward in time, and Wade, Don, and Gretch will be with us, every step of the way.
Charles E. DeCamp
Spencer A. Johnston
Loïc M. Déjardin
Susan L. Schaefer
An orthopedic examination must begin with an adequate history and general physical examination. A systemic approach to the examination ensures that multiple problems are discovered. The animal’s general health should be ascertained before focusing on the orthopedic complaint. The entire examination varies with case complexity, a history of recent trauma, the intended use of the animal (e.g., breeding, showing, racing, hunting), and economics dictated by owners. Severely traumatized animals with hemorrhaging wounds and unstable fractures that could become open fractures obviously need different immediate steps; these animals are not discussed in this chapter. This chapter focuses on the examination for orthopedic problems (Table 1-1) and presents some of the diagnostic tools available.
Specific historical information is useful for ruling out categories of orthopedic problems. This information includes breed, age, gender, occurrence of trauma, owner identification of limb(s) involved, description of the lameness or gait abnormality, chronological progression of the problem, efficacy of treatments tried, and variability with weather, exercise, and arising from recumbency. Other features such as fever, inappetance, lethargy, and weight loss may indicate some systemic problem, such as inflammatory joint conditions or internal injury from trauma.
Certain historical facts and deviation from the “normal” presentation of certain orthopedic conditions alert the clinician to investigate further by asking appropriate questions or performing additional tests or procedures. For example, a 10-year-old dog that falls down only two stairs and sustains a fractured radius and ulna should be carefully scrutinized for pathological fracture. Normally, chronic luxating patellas usually do not suddenly cause a carryingleg lameness, and cruciate ligament rupture may have become the more recent problem. Chronic osteoarthritic conditions usually do not cause severe pain. In older animals with severe progressive pain, neoplasia must always be considered. With pelvic fractures, trauma to the chest, abdomen, or spine often occurs. Answers to specific questions help assess concurrent problems. For example, knowing whether the recumbent animal has been eating, voiding large pools of urine, or moving the legs spontaneously is helpful. A good appetite probably does not occur with significant internal injuries. “Urinating” or dribbling small amounts of urine does not mean the bladder is intact, and voluntary leg movement usually means serious thoracolumbar spinal injury has not occurred.
The animal should be observed for general thriftiness and relative weight status. Patient disposition and potential lack of animal or owner cooperation should be noted. Sedation
Pelvic Limb
Growing Dog
1. Hip dysplasia
2. Avascular necrosis (Legg-Calvé-Perthes)
3. Avulsion of long digital extensor
4. OCD—stifle
5. OCD—hock
6. Luxating patella complex
7. Genu valgum
8. Panosteitis
Medium to large breeds 5 1, 3-8
Toy to small breeds 51, 2, 6
Chondrodystrophied breeds 5 1, 2, 6, 8
Adult Dog
A. Arthritis (or continuum): 1-7
B. Luxating patella complex
C. Panosteitis
D. Cruciate/meniscal syndrome
E. Inflammatory joint disease
F. Neoplasia
Medium to large breeds 5 A1, A 3-7, B, D, F
Toy to small breeds 5 A2, B, D-F
Chondrodystrophied breeds 5 A1, B, D-F
Forelimb
1. OCD—shoulder
2. Luxation/subluxation shoulder—congenital
3. Avulsion supraglenoid tubercle
4. OCD—elbow
5. UAP
6. FCP
7. UME
8. Elbow incongruity
a. Congenital
b. Physeal injury
9. Radius curvus
10. Retained cartilaginous cores (ulna)
11. Panosteitis
12. HOD
Medium to large breeds 5 1, 4-7, 8b, 9-12
Toy to small breeds 5 2, 8, 9
Chondrodystrophied breeds 5 5, 8a, 8b, 9, 11, 13
A. Arthritis (or continuum): 1-6, 8, 9
B. UME
C. Panosteitis
D. Bicipital tenosynovitis/biceps rupture
E. Calcification of supraspinatus tendon
F. Contracture of infraspinatus or supraspinatus
G. Bone/soft tissue neoplasia
H. Luxation/subluxation—shoulder
I. Inflammatory joint disease
J. HO
Medium to giant breeds 5 A, 7, 11, I, J
Toy to small breeds 5 2, G, H, I, J
Chondrodystrophied breeds 5 A-5, A-8, A-9, C, H, I, J
OCD, Osteochondritis dissecans; UAP, ununited anconeal process; FCP, fragmented coronoid process; UME, ununited medial epicondyle; HOD, hypertrophic osteodystrophy; HO, hypertrophic osteopathy
should not be used if possible, or at least until the area of involvement is known, because tranquilizers may mask detection of painful regions. The animal should be observed for body conformation, decreased weight bearing, trembling, asymmetrical joint or soft tissue swellings, muscle atrophy, and digit and joint alignment. Dogs with tarsocrural osteochondritis dissecans (OCD) tend to be very straight legged in the pelvic limb, whereas dogs with elbow problems tend to have curvature of the forelimbs (Figure 1-1).
Observing the lameness is helpful before examining the limb. It helps confirm or contradict owner complaints. Often in an examination room environment, however, a mild chronic lameness disappears. The gait is observed at a walk and if necessary a trot. Covert lameness may become apparent during tight circles or stair climbing. Abnormalities include a shortened stride, dragging of the toenails, “toeing-in” or “toeing-out,” limb circumduction, hypermetria, stumbling, generalized weakness, ataxia, crisscrossing of the legs, abnormal sounds (e.g., clicks, snaps), and a head “bob,” which is a bobbing motion of the head that occurs with foreleg lameness. The head elevates as the painful leg strikes
FIGURE 1-1. Typical forelimb curvature in a German shepherd dog affected with ununited anconeal process. Note varus angulation of the elbows and valgus of the carpi.
the ground. It is important to record specific observations of lameness for a patient, but there is also value in describing lameness using a known subjective grading system or scale. The use of a lameness scale for standing, walking, and trotting may improve consistency of recorded observations in medical records over time. Numerous subjective lameness scales have been used, and one example of a study of cruciate ligament disease in dogs is presented here (Table 1-2).1,2
With the animal standing as symmetrically as possible, both hands examine the contralateral aspects of the limbs simultaneously, observing for asymmetry produced by trauma, inflammation, neoplasia, degenerative joint changes, or congenital defects. Subtle standing lameness may be observed when the animal unweights a limb consistently while standing still. The suspected affected limb may be gently lifted by the clinician from the ground. A dog easily allows the lame leg to be lifted, whereas it may resist the lifting of the sound limb. This helps the clinician to observe and confirm which leg is lame. Other signs to palpate are swelling, heat, malaligned bony landmarks, crepitus, and muscle atrophy. Muscle atrophy may be palpated directly if the examiner can grasp around a muscle (e.g., gastrocnemius) or indirectly by discerning a more prominent adjacent bone (e.g., acromion, trochanter major). With bilateral conditions, experience or radiography is used to distinguish abnormality.
Specific landmarks to observe in the foreleg are the acromion, spine, vertebral border of the scapula, greater tubercle of the humerus, humeral epicondyles, olecranon, and the accessory carpal bone, which is located at the level of the radiocarpal joint.
Scapulohumeral Region
Trauma and neoplasia affect the scapula. The scapulohumeral region is affected with congenital OCD, mineralization of the supraspinatus muscle, bicipital tendinitis (or rupture), muscular contractures, and joint laxity or luxation. The lateral aspect is palpated. The relative position and size of the greater tubercle of the humerus in relation to the
No lameness noted at a walk or a trot
No lameness at a walk, mild lameness at a trot
Mild lameness at a walk, significant lameness at a trot
Significant lameness at a walk, non–weight bearing at a trot
Non–weight-bearing lameness at a walk and a trot
Normal weight bearing at a stance
Mild decrease in weight bearing at a stance
Significant decrease in weight bearing at a stance
Occasional toe-touching at a stance
Holds limb off the ground at a stance
Readily accepts contralateral limb being held up and bears full weight on affected limb
Offers resistance to elevation of contralateral limb but bears full weight on affected limb for more than 1 minute after contralateral limb is elevated
Offers moderate resistance to elevation of contralateral limb and replaces it after 30 seconds
Offers resistance to elevation of contralateral limb and replaces it after 10 seconds
Refuses to raise contralateral limb
No signs of pain during palpation of affected joint
Signs of mild pain during palpation of affected joint; dog turns head in recognition
Signs of moderate pain during palpation of affected joint; dog pulls limb away
Signs of severe pain during palpation of affected joint; dog vocalizes or becomes aggressive
Dog will not allow examiner to palpate joint
spine and acromium of the scapula are noted; they are altered with shoulder luxation or tumors of the proximal humerus. Muscle atrophy from any chronic (over 3 to 4 weeks) foreleg lameness is often detected as a more prominent acromion. Bicipital muscle pain may be elicited by internally rolling or pressing the belly of the biceps.
Traumatic and congenital joint incongruities, congenitally unstable fragments, fracture, and luxation occur in the elbow. Elbow joint effusion is characteristically a semilunarshaped swelling, noted laterally between the lateral epicondyle of the humerus and the olecranon. Normally, only a thin anconeus muscle lies under the skin. With increased joint fluid, a bulge occurs under this muscle between these two bony landmarks in the weightbearing limb, and it often lessens or disappears when the animal is restrained on its side for recumbent examination. Osteophytes are noted as an extra ridge lying between the epicondyle and the olecranon. The width of the condyles is compared to the opposite side and is increased with condylar fracture, elbow dislocation, or osteoarthrosis. The radius and ulnar regions are palpated for swelling and malalignment.
Carpus and Paw
The carpal and paw regions are affected by fracture, malalignment, subluxation or luxation, joint swelling, and proliferative bony changes. Valgus and external rotation of the carpus are frequently seen with congenital elbow conditions (see Figure 1-1) and with growth plate injuries. The dorsal carpal and metacarpal regions are palpated for swelling. Further examination takes place in the recumbent animal.
A complete neurological exam should be completed as indicated by history and initial physical findings. The complete exam is not described here. Conscious proprioception of the foreleg is performed with the animal standing and the forelegs parallel. The chest is supported while the paw is knuckled over on its dorsal aspect. This is repeated several times. The paw should quickly right itself. A normal animal will usually not even allow the dorsum of the forepaw to be placed on the floor, unlike the rear limb (Figure 1-2). The neck is flexed and extended to elicit a painful response or stimulation of cervical muscle spasms. The dorsal spines of the thoracolumbar regions are pressed downward to elicit pain. In dogs with lumbosacral disease, the pressure in this area may cause a sudden sitting position.
The thoracic and abdominal areas are palpated before proceeding to the pelvic limb.
Pelvis
Landmarks to note on the pelvic limb are the iliac crests of the ilium, trochanters major, tubers ischii, extensor mechanism (quadriceps, patella, patellar ligament, and tibial tubercle), femoral condyles, distal tibia, fibular tarsal bone, and Achilles tendon.
Asymmetry of the bones of the pelvis could indicate pelvic fracture, hip dislocation, femoral head or neck fracture, or chronic coxofemoral arthritis. Drawing imaginary lines from the wings of the ilium, trochanters major, and tubers ischii forms a triangle (Figure 1-3). With craniodorsal coxofemoral dislocation, the triangle becomes more acute (Figure 1-4) and the trochanter major more dorsal and prominent. When the rear quarters are elevated from the ground, limb length on the dislocated side appears “shorter” when comparing toes of both limbs. With unilateral ilial fracture with overriding segments, the trochanter major may be closer to the wing of the ilium than to the opposite side. In addition, the lateral musculature is swollen. The muscles of the cranial and caudal thigh and the gastrocnemius muscle are palpated.
FIGURE 1-2. Conscious proprioceptive response is elicited while the dog is standing with the limbs in a normal position. The dog is supported while the toes are turned over and released. A delay or absence of the dog’s quickly returning the toes to a normal position may mean neurological rather than orthopedic problems.
FIGURE 1-3. If imaginary lines are drawn between the wing of the ilium, tuber ischii, and trochanter major, a triangle is formed.
FIGURE 1-4. With hip dislocation, the greater trochanter is displaced in a dorsal direction and the triangular shape becomes altered when compared with the other normal hip of the dog (compare with Figure 1-3).
The stifle joint is frequently affected with degenerative, congenital, and traumatic conditions that include cruciate ligament rupture, patellar luxation, OCD, and physeal fracture. Stifle palpation begins with locating the tibial tubercle and following the patellar ligament proximally. Abnormal deviation of the tubercle from the midline plane occurs with patellar luxation and should be noted. A normal patellar ligament should be taut and approximately pencil thick. The cranial two thirds of the pencil-like ligament can be grasped. With stifle injury, swelling from the joint pushes forward around the caudal and lateral aspects of the patellar ligament, making the ligament less distinct and more bandlike than pencil-like. The patella is found 1 to 4 cm proximal to the tubercle, but it may be better examined in the recumbent animal when joint manipulation is possible. With chronic stifle swelling and osteophyte formation, the diameter of the femoral condylar ridges is enlarged; this is assessed 1 to 2 cm behind the patella. In addition, there may be firm joint swelling medially between the femur and tibia. This firm swelling noted with chronic cruciate disease is commonly referred to as “medial buttress.”
The tarsocrural joint is affected by traumatic and congenital conditions. Swelling of the hock joint is detected in the standing animal by palpating between the distal tibia and the fibular tarsal bone. Normally, only skin, subcutaneous tissue, and bone are present. Joint swelling from increased fluid accumulation or fibrosis is detected as a firm, soft tissue mass between these two landmarks. Additionally, swelling may be detected
cranially or medially. The Achilles tendon is examined above the calcaneus for swelling and continuity.
The animal is placed in lateral recumbency to examine previously noted abnormalities thoroughly. This allows patient restraint and limb manipulations but precludes simultaneous palpation of the opposite side. Most maneuvers discussed here do not produce pain (hyperesthesia) in normal animals. Pain production gives the diagnostician clues about the location of the problem. It may be best to examine the normal side first to relax the animal and to learn individual responses to certain maneuvers. The veterinarian looks for instability, crepitus, painful regions, and altered ranges of motion. Animals usually do not resist gentle manipulation of abnormal areas. Unfortunately, many animals do not indicate when a painful area is manipulated, which creates a diagnostic challenge at times. In general, it is recommended to start examining from the toes and proceed proximally. Known abnormal areas or maneuvers that may produce pain should be examined last to ensure patient cooperation. Maneuvers producing painful responses should be carefully and gently repeated while immobilizing surrounding tissues to reduce the possibility of misinterpreting the origin of the pain.
Crepitus (a sound or palpable friction sensation) occurs when bone rubs bone, cartilage rubs bone, or soft tissues move over air pockets or foreign materials such as wires, pins, or suture material. The sensations palpated are characterized as clicks, snaps, clunks, crackling, grinding, or grating. Normal laxity of the carpal, tarsal, or shoulder regions produces innocent clicks that are mistaken as crepitus. In some thin dogs, elbow flexion produces clicks when the ulnar nerve moves over a prominent humeral epicondyle.
Paw and Elbow
The digits are flexed, extended, and examined for swelling, crepitus, and pain. The interdigital webbing and foot pads are examined for discoloration, abrasions, and other conditions. The proximal sesamoid bones are palpated for swelling on the palmar aspect of the paw at the metacarpophalangeal junction. The carpus is flexed and extended, and a valgus/ varus stress is applied. Palmar stress to the carpus is applied to assess for hyperextension injury and, if present, determine the anatomic location. Swelling detected on the standing examination is better identified when the exact location of the joint space can be identified. This helps to rule out joint problems from distal radial swelling seen with neoplasia or hypertrophic osteodystrophy. The radiocarpal joint space lies at the same level as the base of the accessory carpal bone.
The elbow is similarly placed through a range of motion. Hyperextension of the elbow may produce pain in dogs with an ununited anconeal process, whereas internal and external rotation with digital pressure applied at the medial joint line may produce pain that accompanies conditions such as OCD or a fragmented coronoid process.
Swelling of the shoulder joint unfortunately cannot be appreciated because of its depth under the musculature. The shoulder is examined for pain by flexing and extending the joint while grasping the forearm with one hand and stabilizing the front of the shoulder with the other. In OCD, this maneuver usually produces pain. Bicipital tendonitis or rupture is painful when the tendon is stretched. To produce diagnostic discomfort, the elbow is extended, and the entire limb is pulled caudally along the thoracic wall while digital pressure is applied to the proximal medial humeral region over the tendon (Figure 1-5). With the advent of arthroscopy, tearing of the medial ligaments of the scapulohumeral
FIGURE 1-5. To detect bicipital tendon pain, the tendon is stretched by extending the elbow and bringing the entire limb parallel to the thorax. Digital pressure is applied to the tendon in the proximal medial humeral region.
joint has been documented. Under sedation, laxity from medial ligament injury can be observed as increased abduction of the shoulder, compared to the normal side. With the dog in lateral recumbency, the acromial process is pushed downward while the extended limb is abducted maximally. The limb is maintained approximately perpendicular to the spine during the test. Comparing the abduction angle to that of the other limb helps suggest potential tearing of medial ligaments.
Fractures of the acromion can cause discomfort and possibly crepitus when the acromion is manipulated. Shoulder instability may be appreciated, usually in the sedated or anesthetized patient, by applying a mediolateral or craniocaudal sliding motion at the joint level.
All areas of the limb are gently squeezed. Long-bone palpation is reserved for the last part of the examination because pain from a bone tumor or panosteitis is exquisite at times. To avoid production of pain from pressing normal muscle, the examiner should find muscle planes where the fingers can reach bone. These locations include the distal radius, the proximal ulna, and the distal and proximal humerus. Once the fingers touch the bone, a gentle pressure is applied.
Neurofibromas or neurofibrosarcomas must be considered in older dogs with severe progressive foreleg lameness and atrophy. In these special cases, deep digital pressure in the axilla may detect a mass and produce exquisite pain. In addition, ocular signs of Horner’s syndrome (unilateral miosis, ptosis, and enophthalmos) may be present.
Paw and Hock
The digits and paw are examined similar to the foreleg. The tarsal region is maximally flexed, extended, and stressed in varus and valgus angles. Plantar stress to the tarsus is applied to assess for hyperextension injury at the middle and distal tarsal joints and to assess function of the Achilles tendon. Instability, pain, and crepitus may be produced by fracture, tendon and ligament breakdown (seen especially in collies and shelties), and OCD of the talus. Achilles tendon continuity is palpated during flexion and extension of the tarsocrural joint.
The stifle joint is often affected by luxating patellas, cruciate ligament disease, and physeal fractures of the distal femur. The stifle is quite swollen in young animals with a history of trauma. Swelling also occurs with inflammatory joint conditions and OCD. Localized swelling occurs with avulsion of the origin of the long digital extensor tendon.
Patellar Luxation. In some animals, there is normal mediolateral movement within the trochlea of the femur. Luxation out of the trochlea is abnormal and can cause lameness. Subluxation (patella rides on the trochlear ridge and “catches” during flexion) occasionally causes lameness. Luxation may be medial, or less often lateral, and occasionally in both directions. Luxation of a patella is normally not a painful maneuver. The examiner should stand caudal to the animal. To begin the examination, the tibial tubercle is located and its position noted. Noting the medial location of the tibial tubercle helps avoid misinterpreting a medial luxation (ectopic) that is replaced into the trochlea (i.e., reduced) as a reduced patella that can be luxated laterally. Tubercles are not as prominent in cats as in dogs. The patella may be found 1 to 4 cm proximally. In small dogs or cats with ectopic patellas, the patella is palpated as a small, pealike bump on the medial (or lateral) femoral condyle. It may or may not move with flexion, extension, and digital pressure. It may or may not be reducible. To luxate a reduced patella medially, the stifle is extended, the toes are internally rotated, and digital pressure is applied to the patella in a medial direction (Figure 1-6). Conversely, to luxate a patella laterally, the stifle is flexed slightly, toes are externally rotated, and pressure is applied in a lateral direction (Figure 1-7). Sometimes an unstable patella may be luxated simply by internally or externally rotating the paw. A patella that has been luxated on examination should be reduced. The stifle should always be examined for cruciate ligament instability, including after the patella has been reduced.
FIGURE 1-6. To luxate the patella medially, the stifle is extended and the toes rotated medially while the patella is pushed medially.
FIGURE 1-7. To luxate the patella laterally, the stifle is partially flexed and the toes are rotated laterally while the patella is pulled laterally.
Cruciate Ligament Instability. Palpation for cruciate ligament instability can produce pain and should be performed gently in the relaxed patient. Sedation may be needed if no abnormality can be detected in the tense animal. Drawer movement is the sliding of the proximal articular surface of the tibia in relation to the distal femur. Normally, there is no cranial or caudal drawer movement in the adult animal. Some large puppies have “puppy” drawer, which lasts up to 10 to 12 months of age because of normal joint laxity. Some rotary motion of the tibia is normal and is occasionally mistaken as drawer movement. In a fresh, fully torn cruciate ligament in a relaxed medium-sized animal, the tibia may slide 5 to 10 mm (grade 4). In relative terms, larger dogs have less drawer movement than small dogs. Other factors that diminish full drawer movement are chronicity, animal tenseness, partial ligament tear, and presence of a meniscal injury. Increased drawer movement occurs with multiple ligament tears in traumatized animals or in dogs with Cushing’s disease. If there is patellar luxation, the patella should be reduced if possible before examining for cruciate instability.
The tibial compression test, or cranial tibial thrust3 (indirect drawer movement), compresses the femur and tibia together, and when there is cranial cruciate ligament incompetence, the tibia slides forward in relation to the femur. This occurs during weight bearing as well, and its surgical elimination is the basis of the tibial plateau leveling procedure for cruciate repair.3 It can be elicited by holding the stifle in a slightly flexed position while the paw is alternately dorsiflexed as far as possible and then relaxed. The index finger of the opposite hand is placed cranial to the femur, patellar ligament, and tibial tubercle to detect the tubercle sliding forward (Figure 1-8). This maneuver is repeated several times quickly but gently.4 Interpretation of this maneuver is more subjective than direct drawer movement but has the advantage of producing minimal pain in animals with ruptured cranial cruciate ligaments.
Direct drawer movement is examined by placing the fingers as close as possible to bone and not soft tissue (Figure 1-9). The index finger of one hand is placed on the cranial proximal patellar region while the thumb is placed caudally on the lateral fabella. The index finger of the opposite hand is placed on the cranial aspect of the tibial crest while the thumb is positioned caudally on the fibular head. With the wrists held straight and not bent, the femur is held stable while the tibia is pushed forward (and not rotated) and
FIGURE 1-8. The tibial compression test produces indirect drawer movement. With the stifle angle held in slight flexion, the metatarsal region is dorsiflexed as far as possible. The index finger of the opposite hand detects the forward movement of the tibial tuberosity if drawer movement is present. It is repeated several times.
FIGURE 1-9. To palpate direct drawer movement, the index finger of one hand is placed on the proximal patellar region while the thumb is placed caudal to the lateral fabella. The index finger of the opposite hand is placed on the cranial aspect of the tibial crest, and the thumb is placed on the caudal aspect of the fibular head. With the femur stabilized, the tibia is pushed forward and then pulled backward. This is repeated several times and is performed gently but quickly to detect 1 to 10 mm of movement of the tibia in relation to the femur.
then pulled backward. This is repeated quickly and gently several times. At first the stifle is held firmly in slight extension, and then the movement is repeated with the stifle held in extension and then in flexion. In large dogs it is helpful to have an assistant or the examiner’s foot (if performed on the floor) support the dog’s foot.
Interpretation of Instability. With cranial cruciate ligament rupture, the cranial end point of drawer motion is “soft,” with no sudden stoppage, because the secondary restraints of the stifle become taut. When the tibia is pulled caudally, a sudden “thud” is palpated as the normal caudal cruciate ligament becomes taut. Conversely, with rare caudal cruciate rupture (usually grade 2 motion or less), when cranial force is applied there is a sudden “thud” that is not present when caudal force is applied. “Puppy” drawer (grade 2 motion or less) has a sudden end point cranially and caudally. It usually disappears by 6 to 9 months of age unless chronic painful conditions of the hip, stifle, or hock exist.
Inexperienced palpaters of the stifle can make the following five common mistakes:
1. If the wrists are bent, proper force cannot be applied.
2. If just the fingertips alone touch bone, proper force cannot be applied.
3. If the fingers are placed laterally/medially instead of cranially/caudally, the skin moves and is misinterpreted as drawer movement.
4. If drawer movement is performed slowly, detection of 1 to 2 mm of motion is impossible.
5. Tibial rotary movements, which may be normal or excessive, are misinterpreted as drawer movement.
Collateral Ligament Instability. When the collateral ligaments and joint capsule are torn, the stifle will have medial, lateral, or combined instability. Cutting either of these ligaments alone without cutting the joint capsule does not produce much instability in research animals. The cruciate ligament(s) is (are) invariably torn in clinical cases of collateral instability. To detect this instability, the stifle should be held in “neutral” drawer while a valgus (stifle inward) or varus (stifle outward) force is applied. The thumb is placed on the fibular head while the index finger is placed along the medial joint line to perceive the joint opening abnormally because of its instability.
Meniscal Injury. Meniscal injury is suspected when the owner hears a click when the animal walks or when the animal has a severe three-legged lameness several weeks after acute onset of stifle lameness. In addition, a worsening of lameness several weeks to months after cruciate rupture with or without surgical repair sometimes indicates meniscal involvement. Meniscal injury is suspected when flexion, extension (with and without rotation about the stifle), and direct and indirect drawer manipulations produce a click, snap, clunk, or grating. Definitive diagnosis is made by visualizing the unstable caudal horn or a part of it as malpositioned after arthrotomy (see Chapter 18).
The hip joint and pelvis are often affected by trauma, congenital conditions such as Legg-Calvé-Perthes disease, and hip dysplasia. Manipulations may cause pain, crepitus, and instability. The femur is grasped at the stifle, and the hip is flexed and extended several times. Pain is most often observed at full extension of the hip. If pain or crepitus is not produced, external hip rotation is added to the flexion and extension maneuvers. This maneuver frequently elicits pain in the animal with Legg-Calvé-Perthes disease. Fine crepitus may be heard when the examiner’s ear or stethoscope is placed on the trochanter major during these manipulations. Pressing the femur into the acetabulum accentuates the crepitus (Figure 1-10). This crepitus must be distinguished from hair coat noises. Suspected fracture and dislocation are further evaluated by radiography.
The sacroiliac joint is examined for instability by gentle manipulation of the wing of the ilium. The tuber ischii is pressed to detect instability and crepitus. A rectal examination may detect pubic and ischial fractures.
Hip laxity seen with hip dysplasia may be detected by three methods. First, Ortolani’s sign is a noise or palpable “thud” produced when an unstable hip is replaced into the acetabulum.5 To produce this sound while the dog is in lateral recumbency, the hip is subluxated proximally by grasping the adducted stifle and pushing proximally while the other hand stabilizes the pelvis. Second, when the stifle is abducted, downward pressure is applied across the trochanteric region. A noise is produced as the femoral head glides over the rim into the acetabulum (Figure 1-11). This can also be done bilaterally with the dog in dorsal recumbency. The stifles are adducted, pushed proximally, and then abducted to produce the “thud” (see Chapter 16). A third way to detect this instability is to place
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or S ,
An art among the ancients of raising or calling up the manes or souls of deceased persons, to give intelligence of things to come. The witch who conjured up the soul of Samuel, to foretel Saul the event of the battle he was about to give, did so by Sciomancy.
Was an ancient method of divination, performed by means of rods or staves. St. Jerome mentions this kind of divination in his Commentary on Hosea, chap. vi. 12.; where the prophet says, in the name of God: My people ask counsel at their stocks; and their staff declareth unto them: which passage that father understands of the Grecian Rhabdomancy.
The same is met with again in Ezekiel, xxi. 21, 22. where the prophet says: For the king of Babylon stood at the parting of the way, at the head of the two ways, to use divination; he made his arrows bright; or, as St. Jerome renders it, he mixed his arrows; he consulted with images; he looked in the liver.
If it be the same kind of divination that is alluded to in these two passages, Rhabdomancy must be the same kind of superstition with Belomancy. These two, in fact, are generally confounded. The Septuagint themselves translate םיצח of Ezekiel, by ῥαβδος, a rod; though in strictness it signifies an arrow. So much however is certain, that the instruments of divination mentioned by Hosea are different from those of Ezekiel. In the former it is וצע etso, ולקמ maklo, his wood, his staff: in the latter םיצח hhitism, arrows. Though it is possible they might use rods or arrows indifferently; or the military men might use arrows and the rest rods.
By the laws of the Frisones, it appears that the ancient inhabitants of Germany practised Rhabdomancy. The Scythians were likewise acquainted with the use of it: and Herodotus observes, lib. vi. that the women among the Alani sought and gathered together fine straight wands or rods, and used them for the same superstitious purposes.
Among the various other kinds of divination, not here mentioned, may be enumerated: Chiromancy, performed with keys; Alphitomancy or Aleuromancy, by flour; Keraunoscopia, by the consideration of thunder; Alectromancy, by cocks; Lithomancy, by stones; Eychnomancy, by lamps; Ooscopy, by eggs; Lecanomancy, by a basin of water; Palpitatim, Salisatio, παλμος, by the pulsation or motion of some member, &c. &c. &c.
All these kinds of divination have been condemned by the fathers of the Church, and Councils, as supposing some compact with the devil. Fludd has written several treatises on divination, and its different species; and Cicero has two books of the divination of the ancients, in which he confutes the whole system. Cardan also, in his 4th Book de Sapientia, describes every species of them.
The word oracle admits, under this head, of two significations: first, it is intended to express an answer, usually couched in very dark and ambiguous terms, supposed to be given by demons of old, either by the mouths of their idols, or by those of their priests, to those who consulted them on things to come. The P [36] was always in a rage when she gave oracles.
Ablancourt observes that the study or research of the meaning of Oracles was but a fruitless thing; and they were never understood until they were accomplished. It is related by Historians, that Crœsus was tricked by the ambiguity and equivocation of the oracle.
Κροισος
rendered thus in Latin:—
Crœsus Halym superans magnam pervertet opum vim.
Oracle is also used for the Demon who gave the answer, and the place where it was given. (Vide D .)
The principal oracles of antiquity are that of Abæ, mentioned by Herodotus; that of Amphiarus; that of the Branchidæ, at Didymus; that of the Camps, at Lacedemon; that of Dodona; that of Jupiter Ammon; that of Nabarca, in the Country of the Anariaci, near the Caspian sea; that of Trophonius, mentioned by Herodotus; that of Chrysopolis; that of Claros, in Ionia; that of Mallos; that of Patarea; that of Pella, in Macedonia; that of Phaselides, in Cilicia; that of Sinope, in Paphlagonia; that of Orpheus’s head, mentioned by Philostratus in his life of Appolonius, &c. But, of all others, the oracle of Apollo Pythius, at Delphi, was the most celebrated; it was, in short, consulted always as a dernier ressort, in cases of emergency, by most of the princes of those ages.—Mr. Bayle observes, that at first, it gave its answers in verse; and that at length it fell to prose, in
consequence of the people beginning to laugh at the poorness of its versification.
Among the more learned, it is a pretty general opinion that all the oracles were mere cheats and impostures; calculated either to serve the avaricious ends of the heathen priests, or the political views of the princes. Bayle positively asserts, they were mere human artifices, in which the devil had no hand. In this opinion he is strongly supported by Van Dale, a Dutch physician, and M. Fontenelle, who have expressly written on the subject.
There are two points at issue on the subject of oracles; viz. whether they were human or diabolical machines; and whether or not they ceased upon the publication and preaching of the Gospel?
Plutarch wrote a treatise on the ceasing of some oracles: and Van Dale has a volume to prove that they did not cease at the coming of Christ; but that many of them had ceased long before the coming of that time, and that others held out till the fall of Paganism, under the Empire of Theodosius the Great, and when it was dissipated, these institutions could no longer resist.
Van Dale was answered by a German, one Mœbius, professor of Theology, at Leipsic, in 1685. Fontenelle espoused Van Dale’s system, and improved upon it in his history of oracles; wherein he exposed the weakness of the argument used by many writers in behalf of Christianity, drawn from the ceasing of oracles.
Balthus, a learned Jesuit, answered both Van Dale and Fontenelle. He labours to prove, that there were real oracles, and such as can never be attributed to any artifices of the Priests or Priestesses; and that several of these became silent in the first ages of the Church, either by the coming of Jesus Christ, or by the prayers of the Saints. This doctrine is confirmed by a letter from Father Bouchet, missionary to Father Balthus; wherein it is declared, that what Father Balthus declares of the ancient oracles, is experimented every day in the Indies.
It appears, according to Bouchet, that the devil still delivers oracles in the Indies; and that, not by idols, which would be liable to imposture, but by the mouths of the priests, and sometimes of the bye-standers; it is added that these oracles, too, cease, and the devil becomes mute in proportion as the Gospel is preached among them.
It was Eusebius who first endeavoured to persuade the christians that the coming of Jesus Christ had struck the oracles dumb; though it appears from the laws of Theodosius, Gratian, and Valentinian, that the oracles were still consulted as far back as the year 358. Cicero says the oracles became dumb, in proportion as people, growing less credulous, began to suspect them for cheats.
Two reasons are alleged by Plutarch for the ceasing of oracles: the one was Apollo’s chagrin, who, it seems, “took it in dudgeon,” to be interrogated about so many trifles. The other was, that in proportion as the genii, or demons, who had the management of the oracles, died and became extinct, the oracles must necessarily cease. He adds a third and more natural cause for the ceasing of oracles, viz. the forlorn state of Greece, ruined and desolated by wars. For, in consequence of this calamity, the smallness of the gains suffered the priests to sink into a poverty and contempt too bare to cover the fraud.
Most of the fathers of the church imagined it to be the devil that gave oracles, and considered it as a pleasure he took to give dubious and equivocal answers, in order to have a handle to laugh at them. Vossius allows that it was the devil who spoke in oracles; but thinks that the obscurity of his answers was owing to his ignorance as to the precise circumstances of events. That artful and studied obscurity, wherein, says he, answers were couched, shew the embarrassment the devil was under; as those double meanings they usually bore provided for the accomplishment. When the thing foretold did not happen accordingly, the oracle, forsooth, was always misunderstood.
Eusebius has preserved some fragments of a Philosopher, called Oenomaus, who, out of resentment for having been so often fooled by the oracles, wrote an ample confutation of all their impertinences, in the following strain: “When we come to consult thee,” says he to Apollo, “if thou seest what is in the womb of futurity, why dost thou use expressions that will not be understood? if thou dost, thou takest pleasure in abusing us: if thou dost not, be informed of us, and learn to speak more clearly. I tell thee, that if thou intendest an equivoque, the Greek word whereby thou affirmedst that Crœsus should overthrow a great Empire, was ill-chosen; and that it could signify nothing but Crœsus’ conquering Cyrus. If things must necessarily come to pass, why dost thou amuse us with thy ambiguities? What
dost thou, wretch as thou art, at Delphi; employed in muttering idle prophesies!”
But Oenamaus is still more out of humour with the oracle for the answer which Apollo gave the Athenians, when Xerxes was about to attack Greece with all the strength of Asia. The Pythian declared, that Minerva, the protectress of Athens, had endeavoured in vain to appease the wrath of Jupiter; yet that Jupiter, in complaisance to his daughter, was willing the Athenians should save themselves within wooden walls; and that Salamis should behold the loss of a great many children, dead to their mothers, either when Ceres was spread abroad, or gathered together. At this Oenamaus loses all patience with the Delphian god: “This contest,” says he, “between father and daughter, is very becoming the deities! It is excellent, that there should be contrary inclinations and interests in heaven! Poor wizard, thou art ignorant who the children are that shall see Salamis perish; whether Greeks or Persians. It is certain they must be either one or the other; but thou needest not have told so openly that thou knewest not which. Thou concealest the time of the battle under these fine poetical expressions, either when Ceres is spread abroad, or gathered together: and thou wouldst cajole us with such pompous language! who knows not, that if there be a seafight, it must either be in seed-time or harvest? It is certain it cannot be in winter. Let things go how they will, thou wilt secure thyself by this Jupiter, whom Minerva is endeavouring to appease. If the Greeks lose the battle, Jupiter proved inexorable to the last; if they gain it, why then Minerva at length prevailed.”
The name of an imaginary set of magicians in the island Gromboccanore, in the East Indies.
The word implies men-devils; these people, it seems, having the art of rendering themselves invisible, and passing where they please, and, by these means, doing infinite mischief; for which reason the people hate and fear them mortally, and always kill them on the spot when they can take them.
In the Portuguese history, printed 1581, folio, there is mention of a present made by the king of the island to a Portuguese officer, named Brittio, ourans, with whom, it is pretended, he made incursions on the people of Tidore, killed great numbers, &c.
To try whether in effect they had the faculty ascribed to them, one of them was tied by the neck with a rope, without any possibility of disengaging himself by natural means; yet in the morning it was found he had slipped his collar. But that the king of Tidore might not complain that Brittio made war on him with devils, it is said he dismissed them at length, in their own island.
The art of foretelling future events by dreams, is called
Macrobius mentions five sorts of dreams, viz. 1st, vision; 2d, a discovery of something between sleep and waking; 3d, a suggestion cast into our fancy, called by Cicero, Vesum; 4th, an ordinary dream; and 5th, a divine apparition or revelation in our sleep; such as were the dreams of the prophets, and of Joseph, as also of the magi of the East.
The fictitious art of interpreting dreams, had its origin among the Egyptians and Chaldeans; countries fertile in superstitions of all kinds. It was propagated from them to the Romans, who judging some dreams worthy of observation, appointed persons on purpose to interpret them.
The believers in dreams as prognostics of future events, bring forward in confirmation of this opinion, a great variety of dreams, which have been the forerunners of very singular events:—among these are that of Calphurnia, the wife of Julius Cæsar, dreaming the night before his death, that she saw him stabbed in the capitol: that of Artorius, Augustus’s physician, dreaming before the battle of Philippi, that his master’s camp was pillaged; that of the Emperor Vespasian dreaming an old woman told him, that his good fortune would begin when Nero should have a tooth drawn, which happened accordingly.
Cæsar dreaming that he was committing incest with his mother, was crowned Emperor of Rome; and Hippias the Athenian Tyrant, dreaming the same, died shortly after, and was interred in his mother earth. Mauritius the Emperor, who was slain by Phocas, dreamed a short time previous to this event, that an image of Christ that was fixed over the brazen gate of his palace, called him and reproached him with his sins, and at length demanded of him whether he would receive the punishment due to them in this world or the next; and Mauritius answering in this, the image commanded that he should be given, with his wife and children, into the hands of Phocas. Whereupon Mauritius, awakening in great fear, asked Phillipus, his son-in-law, whether he knew any soldier in the army called Phocas, he answered that there was a commissary so called; and Phocas became his successor, having killed his wife and five children. Arlet, during her pregnancy by William the Conqueror, dreamed that a light shone from her womb, that illumined all England. Maca, Virgil’s mother, dreamed that she was delivered of a laurel branch.
The ridiculous infatuation of dreams is still so prominent, even among persons whose education should inform them better, and particularly among the fair sex, that a conversation seldom passes among them, that the subject of some foolish inconsistent dream or other, does not form a leading feature of their gossip. “I dreamed last night,” says one, “that one of my teeth dropped out.”—“That’s a sign,” replies another, “that you will lose a friend or some of your relations.”—“I’m afraid I shall,” returns the dreamer, “for my cousin (brother, or some other person connected with the family or its interests,) is very ill,” &c.
Avicen makes the cause of dreams to be an ultimate intelligence moving the moon in the midst of that light with which the fancies of men are illuminated while they sleep. Aristotle refers the cause of them to common sense, but placed in the fancy. Averroes places it in the imagination. Democritus ascribes it to little images, or representations, separated from the things themselves. Plato, among the specific and concrete notions of the soul. Albertus to the superior influences which continually flow from the sky, through many specific mediums. And some physicians attribute the cause of them to vapours and humours, and the affections and cares of persons predominant when awake; for, say they, by reason of the abundance of vapours, which are exhaled in consequence of immoderate feeding, the brain is so stuffed by it, that monsters and strange chimera are formed, of which the most inordinate eaters and drinkers furnish us with sufficient instances. Some dreams, they assert, are governed partly by the temperature of the body, and partly by the humour which mostly abounds in it; to which may be added, the apprehensions which have preceded the day before; which are often remarked in dogs, and other animals, which bark and make a noise in their sleep. Dreams, they observe, proceeding from the humours and temperature of the body, we see the choleric dreams of fire, combats, yellow colours, &c.; the phlegmatic, of water, baths, of sailing on the sea, &c.; the melancholics, of thick fumes, deserts, fantasies, hideous faces, &c.; the sanguines, of merry feasts, dances, &c. They that have the hinder part of their brain clogged with viscous humours, called by physicians ephialtes incubus, or, as it is termed, night-mare, imagine, in dreaming, that they are suffocated. And those who have the orifice of their stomach loaded with malignant humours, are affrighted with strange visions, by reason of those venemous vapours that mount to the brain and distemper it.
Cicero tells a story of two Arcadians, who, travelling together, came to Megara, a city of Greece, between Athens and Corinth, where one of them lodged in a friend’s house, and the other at an inn. After supper the person who lodged at the private house went to
bed, and falling asleep, dreamed that his friend at the inn appeared to him, and begged his assistance, because the innkeeper was going to kill him. The man immediately got out of bed much frightened at the dream but recovering himself and falling asleep again, his friend appeared to him a second time, and desired, that as he would not assist him in time, he would take care at least not to let his death go unpunished; that the innkeeper having murdered him, had thrown his body into a cart and covered it with dung; he therefore begged that he would be at the city gate in the morning, before the cart was out. Struck with this new dream, he went early to the gate, saw the cart, and asked the driver what was in it; the driver immediately fled, the dead body was taken out of the cart, and the innkeeper apprehended and executed.
Fate, in a general sense, denotes an inevitable necessity, depending on some superior cause. It is a term much used among the ancient philosophers. It is formed a fando, from speaking; and primarily implies the same with effatum, i. e. a word or decree pronounced by God; or a fixed sentence, whereby the deity has prescribed the order of things, and allotted every person what shall befal him. The Greeks called θμαρμενη, quasi, θρμος, nexus, a change, or necessary series of things, indissolubly linked together; and the moderns call it P . But independent of this sense of the word, in which it is used sometimes to denote the causes in nature, and sometimes the divine appointment, the word Fate has a farther meaning, being used to express some kind of necessity or other, or eternal designation of things, whereby all agents, necessary as well as voluntary, are swayed and directed to their ends.
Some authors have divided Fate into Astrological and Stoical.
A , denotes a necessity of things and events, arising, as is supposed, from the influence and positions of the heavenly bodies, which give law to the elements and mixed bodies, as well as to the wills of men.
S , or FATALITY, or FATALISM, is defined by Cicero, an order or series of causes, in which cause is linked to cause, each producing others; and in this manner all things flow from the one prime cause. Chrysippus defines it a natural invariable succession of all things, ab eterno, each involving the other. To this fate they subject the very gods themselves. Thus the poet observes, that the “parent of all things made laws at the beginning, by which he not only binds other things, but himself.” Seneca also remarks, Eadem necessitas et deos alligat. Irrevocabilis divina pariter et humana cursit vehit. Ipse ille omnium conditor et rector scripsit quidam
fata, sed sequitur; semel scripsit, semper paret. This eternal series of causes, the poets call μοιραι, and parcæ, or destinies.
By some later authors Fate is divided into Physical and divine.
The first, or Physical fate, is an order and series of physical causes, appropriated to their effects. This series is necessary, and the necessity is natural. The principal or foundation of this Fate is nature, or the power and manner of acting which God originally gave to the several bodies, elements, &c. By this Fate it is that fire warms; bodies communicate motion to each other; the rising and falling of the tides, &c. And the effects of this Fate are all the events and phenomena in the universe, except such as arise from the human.
The second, or divine Fate, is what is more commonly called Providence. Plato, in his Phædo, includes both these in one definition; as intimating, that they were one and the same thing, actively and passively considered. Thus, Fatum Est ratio quædam divina, lexque naturæ comes, quæ transiri nequeat, quippe a causa pendens, quæ superior sit quibusvis impedimentis. Though that of Bœtius seems the clearer of the two:—Fatum, says he, est inhærens rebus molilibus despositio per quam providentia suis quæque nectet ordinibus.
There seems to be something in Physiognomy, and it may perhaps bear a much purer philosophy than these authors (see Note,) were acquainted with. This, at least, we dare say, that of all the fanciful arts of the ancients, fallen into disuse by the moderns, there is none has so much foundation in nature as this. There is an apparent correspondence, or analogy between the countenance and the mind; the features and lineaments of the one are directed by the motions and affections of the other: there is even a peculiar arrangement in the members of the face, and a peculiar disposition of the countenance, to each particular affection; and perhaps to each particular idea of the mind. In fact, the language of the face (physiognomy,) is as copious, nay, perhaps, as distinct and intelligible, as that of the tongue, (speech.) Thanks to bounteous nature, she has not confined us to one only method of conversing with each other, and of learning each other’s thoughts; we have several:—We do not wholly depend on the tongue, which may happen to be bound; and the ear, which may be deaf:—but in those cases we have another resource, viz. the Countenance and the Eye, which afford us this further advantage, that by comparing the reports of the tongue, (a member exceedingly liable to deceive,) with those of the face, the prevarications of the former may be detected.
The foundation of Physiognomy is the different objects that present themselves to the senses, nay, the different ideas that arise on the mind, do make some impression on the spirits; and each an impression correspondent or adequate to its cause,—each, therefore, makes a different impression. If it be asked how such an impression could be effected, it is easy to answer; in short, it is a consequence of the economy of the Creator, who has fixed such a relation between the several parts of the creation, to the end that we may be apprized
of the approach or recess of things hurtful or useful to us. Should this not be philosophical enough for our purpose, take the manner of the Cartesian language, thus: the animal spirits moved in the organ by an object, continue their motion to the brain; from whence that motion is propagated to this or that particular part of the body, as is most suitable to the design of nature; having first made a proper alteration in the face by means of its nerves, especially the P and M O . See Dr. Gurther’s work, anno 1604.
The face here does the office of a dial-plate, and the wheels and springs, inside the machine, putting its muscles in motion, shew what is next to be expected from the striking part. Not that the motion of the spirits is continued all the way by the impression of the object, as the impression may terminate in the substance of the brain, the common fund of the spirits; the rest Dr. Gurther imagines, may be effected much after the same manner as air is conveyed into the pipes of an organ, which being uncovered, the air rushes in; and when the keys are let go, is stopped again.
Now, if by repeated acts, or the frequent entertaining of a private passion or vice, which natural temperament has hurried, or custom dragged on to, the face is often put in that posture which attends such acts; the animal spirits will make such passages through the nerves, (in which the essence of a habit consists,) that the face is sometimes unalterably set in that posture, (as the Indian religious are by a long continued sitting in strange postures in their pagods,) or, at least, it falls, insensibly and mechanically, into that posture, unless some present object distort it therefrom, or some dissimulation hide it. This reason is confirmed by observation: thus we see great drinkers with eyes generally set towards the nose; the abducent muscles (by some called bibatorii, or bibatory muscles,) being often employed to put them in that posture, in order to view their beloved liquor in the glass, at the time of drinking. Thus, also, lascivious persons are remarkable for the oculorum mobilis petulantia, as Petronius calls it. Hence also we may account for the Quaker’s expecting face, waiting the spirit to move him; the melancholy face of most sectaries; the studious face of men of great application of mind; revengeful and bloody men, like executioners in the act; and though silence in a sort may awhile pass for wisdom, yet
sooner or later, St. Martin peeps through the disguise to undo all. “A changeable face,” continues Dr. Gurther, “I have observed to show a changeable mind, but I would by no means have what has been said be understood as without exception; for I doubt not but sometimes there are found men with great and virtuous souls under very unpromising outsides.”
“Were our observations a little more strict and delicate, we might, doubtless, not only distinguish habits and tempers, but also professions. In effect, does there need much penetration to distinguish the fierce looks of the veteran soldier, the contentious look of the practised pleader, the solemn look of the minister of state, or many others of the like kind?”
A very remarkable physiological anecdote has been given by De La Place, in his “Pièces Interrestantes et peu connues.” Vol. iv. p. 8.
He was assured by a friend that he had seen a voluminous and secret correspondence which had been carried on between Louis XIV. and his favourite physician De la Chambre on this science: the faith of the monarch seems to have been great, and the purpose to which this correspondence tended was extraordinary indeed, and perhaps scarcely credible. Who will believe that Louis XIV. was so convinced of that talent, which De la Chambre attributed to himself, of deciding merely by the physiognomy of persons, not only on the real bent of their character, but to what employment they were adapted, that the king entered into a secret correspondence to obtain the critical notices of his physiognomist. That Louis XIV. should have pursued this system, undetected by his own courtiers, is also singular; but it appears by this correspondence, that this art positively swayed him in his choice of officers and favourites. On one of the backs of these letters De la Chambre had written, “If I die before his majesty, he will incur great risk of making many an unfortunate choice.”
This collection of Physiological correspondence, if it does really exist, would form a curious publication. We, however, have heard nothing of it.
De la Chambre was an enthusiastic physiognomist, as appears by his works: “The Characters of the Passions,” four volumes in quarto; “The art of Knowing Mankind;” and “the Knowledge of Animals.”
Lavater quotes his “vote and interest” in behalf of his favourite science. It is no less curious, however, to add, that Phillip Earl of Pembroke, under James I., had formed a particular collection of portraits, with a view to physiognomonical studies.
The great Prince of Condé was very expert in a sort of Physiognomy which shewed the peculiar habits, motions, and positions of familiar life, and mechanical employments. He would sometimes lay wagers with his friends, that he would guess, upon the Pont Neuf, what trade persons were of that passed by, from their walk and air.
The celebrated Marshal Laudohn would have entered when young, into the service of the great Frederick, King of Prussia; but that monarch, with all his penetration, formed a very erroneous judgment of the young officer, (as he himself found in the sequel,) and pronounced that he would never do; in consequence of which Laudohn entered into the service of the Empress-Queen, Maria Theresa, and became one of the most formidable opponents of his Prussian Majesty. Marshal Turrene was much more accurate in his opinion of our illustrious John Duke of Marlborough, whose future greatness he predicted, when he was serving in the French army as Ensign Churchill, and known by the unmilitary name of the “handsome Englishman.”
In the fine arts, moreover, we have seen no less accurate predictions of future eminence. As the scholars of Rubens were playing and jesting with each other, in the absence of their master, one of them was accidentally thrown against a piece on which Rubens had just been working, and a considerable part of it was entirely disfigured. Another of the pupils set himself immediately to repair it, and completed the design before his master returned. Rubens, on reviewing his work, observed a change, and a difference that surprised and embarrassed him. At last, suspecting that some one had been busy, he demanded an explanation; adding, that the execution was in so masterly a manner, that he would pardon the impertinence on account of its merit. Encouraged by this declaration, the young artist confessed, and explained the whole, pleading, that his officiousness was merely to screen a comrade from his master’s anger. Rubens answered, “if any one of my scholars shall excel me, it will be yourself.” This pupil was the great Vandyck.
Lavater, who revived physiognomy, has, unquestionably, brought it to great perfection. But it may justly be doubted whether he is not deceived in thinking that it may be taught like other sciences, and whether there is not much in his system that is whimsical and unfounded. Every man, however, has by nature, something of the science, and nothing is more common than to suspect the man who never looks his neighbour in the face. There is a degree of cunning in such characters, which is always dangerous, but by no means new. “There is a wicked man that hangeth down his head sadly; but inwardly he is full of deceit. Casting down his countenance, and making as if he heard not. A man may be known by his look, and one that hath understanding, by his countenance, when thou meetest him.”—In several of Lavater’s aphorisms, something like the following occurs: “A man’s attire, and excessive laughter, and gait, shew what he is.”