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Sectional Anatomy
by MRI and CT
This page intentionally left blank
Sectional Anatomy
by MRI and CT
Fourth Edition
Mark W. Anderson, MD
Harrison Distinguished Teaching Professor of Radiology
Chief, Musculoskeletal Imaging
Professor of Orthopaedic Surgery
University of Virginia
Charlottesville, Virginia
Michael G. Fox, MD
Associate Professor of Radiology and Medical Imaging
Associate Professor of Orthopaedic Surgery
University of Virginia
Charlottesville, Virginia
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
SECTIONAL ANATOMY BY MRI AND CT, FOURTH EDITION ISBN: 978-0-323-39419-2
Copyright © 2017 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further informa-
tion about the Publisher’s permissions policies and our arrangements with organizations such as the
Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.
elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treat-
ment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in eval-
uating and using any information, methods, compounds, or experiments described herein. In using
such information or methods they should be mindful of their own safety and the safety of others,
including parties for whom they have a professional responsibility.
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To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products li-
ability, negligence or otherwise, or from any use or operation of any methods, products, instruc-
tions, or ideas contained in the material herein.
Previous editions copyrighted 2007, 1995, and 1990.
Library of Congress Cataloging-in-Publication Data
Names: Anderson, Mark W., 1957- , author. | Fox, Michael G., author. |
El-Khoury, Georges Y. Sectional anatomy by MRI and CT. Preceded by
(work):
Title: Sectional anatomy by MRI and CT / Mark W. Anderson, Michael G. Fox.
Description: Fourth edition. | Philadelphia, PA : Elsevier, [2017] | Includes
index. | Preceded by Sectional anatomy by MRI and CT / Georges Y.
El-Khoury, William J. Montgomery, Ronald A. Bergman. 3rd ed. 2007.
Identifiers: LCCN 2015049199 | ISBN 9780323394192 (hardcover : alk. paper)
Subjects: | MESH: Anatomy, Regional | Magnetic Resonance Imaging |
Tomography, X-Ray Computed | Atlases
Classification: LCC QM25 | NLM QS 17 | DDC 611/.90222--dc23
LC record available at http://lccn.loc.gov/2015049199
Content Strategist: Robin Carter

Content Development Specialist: Kathryn DeFrancesco
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Daniel Fitzgerald
Designer: Paula Catalano
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Preface
W
ith the explosion of cross-sectional imaging, the New features in this fourth edition include color-coded
accessibility of a high quality anatomic atlas has labeling and a corresponding online version that allows for
become essential and it is with great pleasure easy access anytime/anywhere and provides features such
that we introduce the fourth edition of this classic atlas. as scroll, zoom, and search functions that should further
enhance the user’s experience.
Since it was first published in 1990, it has become a
standard anatomic reference source. The first three edi- We hope that you will find this new edition to be an
tions were masterfully edited by Drs. Georges El-Khoury, integral and valuable addition to your practice.
Ronald Bergman, and William Montgomery, and we are
honored to be able to continue the tradition of excellence Mark W. Anderson, MD
that they established. Michael G. Fox, MD
Acknowledgments
W
e are indebted to Drs. El-Khoury and Bergman from Elsevier for helping to bring this project to fruition.
for their prior efforts in producing and improv- Without their invaluable assistance, it wouldn’t have
ing this text and for allowing us to continue happened!
along the path of excellence they established. We also Mark W. Anderson, MD
thank Robin Carter, Katie DeFrancesco, and Dan Fitzgerald Michael G. Fox, MD
Contents
SECTION I UPPER EXTREMITY SECTION II LOWER EXTREMITY
Chapter 1 M
RI of the Pectoral Girdle and Chest Chapter 9 MRI of the Hip, 221
Wall, 3
Axial, 224
Axial, 4 Sagittal, 233
Sagittal, 14 Coronal, 243
Coronal, 24 Chapter 10 MR Arthrography of the Hip, 250
Chapter 2 MRI of the Shoulder, 34 Axial, 251
Oblique Sagittal, 46 Coronal, 262
Oblique Coronal, 56 Chapter 11 MRI of the Thigh, 267
Chapter 3 MR Arthrography of the Shoulder, 66 Axial, 269
Oblique Sagittal, 72 Coronal, 286
Oblique Coronal, 78 Chapter 12 MRI of the Knee, 294
ABER (Abduction and External Rotation), 84
Axial, 295
Chapter 4 MRI of the Arm, 90 Sagittal, 302
Axial, 92 Coronal, 311
Sagittal, 98 Chapter 13 MRI of the Leg, 321
Coronal, 105
Axial, 324
Chapter 5 MRI of the Elbow, 114 Sagittal, 334
Oblique Sagittal, 125 Chapter 14 MRI of the Ankle, 348
Oblique Coronal, 134
Axial, 349
Chapter 6 MRI of the Forearm, 143 Oblique Axial, 359
Coronal, 162 Chapter 15 MRI of the Foot, 381
Chapter 7 MRI of the Wrist, 170 Axial, 385
Coronal, 189
Chapter 8 MRI of the Hand, 196

Axial, 198
Sagittal, 205
Coronal, 214
viii CONTENTSviii
SECTION III SPINE AND BACK Chapter 21 MRI of the Abdomen, 493
Chapter 16 MRI of the Thoracic Spine, 411 Axial, 494
Sagittal, 502
Sagittal, 417
Coronal, 420
SECTION VI PELVIS
Chapter 17 MRI of the Lumbar Spine, 424
Chapter 22 CT of the Male Pelvis, 521
Axial, 425
Sagittal, 429 Axial, 522
Coronal, 432 Sagittal, 528
Coronal, 531
SECTION IV THORAX Chapter 23 CT of the Female Pelvis, 537

Chapter 18 CT of the Thorax, 441 Axial, 538
Sagittal, 543
Sagittal, 449
Coronal, 453 Chapter 24 MRI of the Male Pelvis, 552
Chapter 19 MRI of the Heart, 459 Axial, 553
Sagittal, 559
Sagittal, 464
Coronal, 467 Chapter 25 MRI of the Female Pelvis, 571
Axial, 572
SECTION V ABDOMEN Sagittal, 576
Coronal, 580
Chapter 20 CT of the Abdomen, 473
Axial, 475 Index, 585
Sagittal, 481
Coronal, 487
I
Section
Upper Extremity
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1
Chapter
MRI of the Pectoral Girdle

and Chest Wall
4 UPPER EXTREMITY: MRI OF THE PECTORAL GIRDLE AND CHEST WALL
AXIAL
Figure 1.1.1 Internal jugular v Platysma m Infrahyoid m Thyroid cartilage
Inferior constrictor m
Sternocleidomastoid m Carotid a
C5-6 disc level

Anterior scalene m Vertebral a
Middle scalene m
Posterior scalene m
Levator scapulae m
Multifidus m
Trapezius m artery = a
arteries = aa
vein = v
veins = vv
muscle = m
muscles = mm
tendon = t
tendons = tt
nerve = n
nerves = nn
ligament = lig
Splenius cervicis Semispinalis cervicis ligaments = ligs
and splenius capitis mm and semispinalis capitis mm nerve &
vessels
bone
Figure 1.1.2 Platysma m

Anterior
scalene m
Internal
jugular v
Sternocleido-
mastoid m Infrahyoid m
Trachea
Internal
carotid a
Longus
colli m
Middle
scalene m C6-7
disc level
Posterior
scalene m
Semispinalis
Trapezius m cervicis and
semispinalis
capitis mm
Levator Splenius cervicis Multifidus m

scapulae m and splenius capitis mm
UPPER EXTREMITY: MRI OF THE PECTORAL GIRDLE AND CHEST WALL 5
Figure 1.1.3 Distal

clavicle Supraspinatus m
Middle
scalene m
Anterior
scalene m
Sternocleido-
mastoid m
Anterior
jugular v
Trachea
Thyroid
gland
Esophagus
Longus
colli m
C7 vertebral
body
Posterior
scalene m
Trapezius m Transverse cervical Levator Splenius m Rhomboid

vessels scapulae m minor m
Figure 1.1.4 Middle

scalene m
Internal
jugular v
Acromioclavicular Externa Serratus Anterior Sternocleido-

joint jugular v anterior m scalene m mastoid m
Thyroid
Trachea
Common
carotid a
Longus
colli m
Posterior
scalene m
Acromion Multifidus m
Semispinalis
capitis m
Clavicle
Splenius
capitis and
splenius
cervicis mm
Scapular Supraspinatus m Trapezius m Levator Serratus posterior
spine scapulae m superior m
Figure 1.1.5 Supraspinatus m

Anterior
deltoid m Clavicle
External
jugular v
Sternocleidomastoid m, Sternocleidomastoid m,
clavicular head sternal head
Anterior scalene m
Anterior
jugular v
Common
carotid a
Internal
jugular v
Middle Longus
deltoid m colli m
Middle
scalene m
Serratus
Posterior anterior m
deltoid m
Semispinalis
capitis m
Splenius capitis
and splenius
cervicis mm
Supraspinatus t Scapular Trapezius m Levator Trapezius m Rhomboid

spine scapulae m minor m
Figure 1.1.6 Thoracoacromial a,

acromial branch Subclavius m
Anterior
scalene m
Sternocleidomastoid m,
clavicular head
Deltoid m, Serratus Sternocleidomastoid m,
anterior head Coracoid Subscapularis m Clavicle anterior m sternal head
Anterior
jugular v
Greater Sternohyoid m
tuberosity
of humerus Common
carotid a
Humeral Internal
head jugular v
Deltoid m
Costovertebral
joint
Subclavian a
Costotransverse
Glenoid joint
Rib
Infraspinatus m
Scapular Supraspinatus m Trapezius m Rhomboid Splenius capitis Semispinalis

spine minor m and splenius cervicis mm capitis m
Figure 1.1.7 Conjoined t of

Pectoralis
minor t Subscapularis m Clavicle
Anterior
scalene m
coracobrachialis m
and biceps brachii m, Coracoid Sternocleidomastoid m,
short head process Cephalic v Subclavius m Cephalic v sternal head
Sternohyoid m
Deltoid m,
Anterior jugular v
anterior head
Sternothyroid m
Biceps Common
brachii t, carotid a
long head
Subclavian a
Greater Thoracoacromial a
tuberosity
of humerus Semispinalis
thoracis m
Humeral
head Semispinalis
capitis m
Glenoid
Splenius capitis
and splenius
cervicis mm
Posterior
deltoid m
Rhomboid major m
Suprascapular neurovascular Infraspinatus m Scapular Serratus Trapezius m

bundle in suprascapular notch body anterior m
Figure 1.1.8 Humeral

head
Coracobrachialis t
Pectoralis Axillary v
Biceps major m,
Biceps brachii t, brachii t, Pectoralis clavicular
long head short head Cephalic v minor m head Clavicle Subclavius m
sternal head
Anterior jugular v
Sternohyoid m
Brachiocephalic a
Brachiocephalic v
Deltoid m
Trachea
Subclavian v
Axillary a
Right lung
Semispinalis
thoracis m
Glenohumeral
joint Rhomboid
major m
Trapezius m
Glenoid
Infraspinatus m Suprascapular Infraspinatus m Subscapularis m Trapezius m Serratus

a and n in anterior m
spinoglenoid notch
Figure 1.1.9 Lesser

Pectoralis minor m
Subscapularis m
Pectoralis major m, Sternocleidomastoid m,
tuberosity Biceps brachii t, Coracobrachialis m clavicular head
of humerus short head Axillary a Axillary v sternal head
Biceps
brachii t,
long head Clavicle
Sternothyroid m
Sternohyoid m
Brachiocephalic a
Brachiocephalic v
Right lung
Deltoid
Rib
Greater Erector spinae m

tuberosity
of humerus
Semispinalis
thoracis m
Trapezius m
Splenius capitis
and splenius
cervicis mm
Infraspinatus m Glenoid Serratus Scapular body, Serratus Trapezius m Rhomboid
anterior m medial border anterior m major m
Figure 1.1.10 Deltoid m,

Coracobrachialis m and
Biceps brachii t,
biceps brachii m,
Pectoralis
major m, Pectoralis
anterior head short head Axillary a clavicular head minor m
Biceps short head
brachii t, Sternoclavicular
long head joint
Left
Surgical neck brachiocephalic v
of humerus
Brachiocephalic a
Right
brachiocephalic v
Trachea
Deltoid m Axillary v
Costovertebral
joint
Quadrangular Rib
space
Semispinalis
thoracis m
Posterior
circumflex Splenius capitis
humeral a and and splenius
branches cervicis mm
and axillary n
and branches Rhomboid
major m
Triceps brachii m, Teres Subscapularis m Infraspinatus m Serratus Trapezius m
long head minor m anterior m
Figure 1.1.11 Coracobrachialis m

Pectoralis major m,
clavicular head Costochondral
Biceps brachii t, Biceps brachii t, Pectoralis cartilage,
long head short head Axillary a Axillary v minor m first rib
Sternum
Left
brachiocephalic v
Humerus
Brachiocephalic a
Right
brachiocephalic v
Deltoid m Trachea
Thoracic
vertebral body
Subscapularis m
Quadrangular
space Rib
Rhomboid
Axillary n and major m
posterior
circumflex
humeral a Trapezius m
Triceps brachii m, Teres Teres Infraspinatus m Scapular body Serratus

long head major m minor m anterior m
Figure 1.1.12 Biceps brachii t,

long head
Biceps brachii m,
short head Coracobrachialis m Axillary a
Pectoralis major m,
sternoclavicular head
Sternum
Ascending aorta
Superior vena
cava
Deltoid m Pectoralis minor m
Trachea
Superior Right lung

portion of t of
latissimus Subscapularis m
dorsi m
Serratus anterior m
Triceps m,
lateral head Rhomboid
major m
Latissimus
dorsi m
Triceps
brachii m, Trapezius m
long head
Teres major m
Circumflex Teres Subscapular a Infraspinatus m
scapular a minor m
Figure 1.1.13 Biceps brachii m,

Axillary
neurovascular
Pectoralis
major m, Pectoralis
short head Coracobrachialis m bundle sternocostal head minor m
Pectoralis
major t
Sternum
Biceps
brachii m,
long head Ascending aorta
Superior
Deltoid m vena cava
Latissimus Right mainstem

dorsi and bronchus
teres major tt Subscapularis m
Triceps Vertebral body

brachii m,
lateral head Rib
Axillary n, Serratus
posterior branch anterior m
Rhomboid
Triceps major m
brachii m,
long head Trapezius m
Infraspinatus m
Teres Latissimus Teres Inferior

major m dorsi m minor m scapula

short head Coracobrachialis m
Pectoralis
minor m
Pectoralis major m,
costosternal head
Cephalic v Sternum
Internal thoracic
Pectoralis a and v
major t
Ascending
Biceps aorta
brachii m,
long head Superior
vena cava
Deltoid m
Right lung
Humeral
diaphysis
Subscapularis m
Latissimus
dorsi t Teres major m
and teres
major m Semispinalis
Triceps thoracis m
brachii m, Erector spinae m
lateral head
Axillary n, Trapezius m
posterior branch
Triceps
brachii m,
long head Axillary Latissimus Scapula Infraspinatus m Serratus Rhomboid
neurovascular dorsi m anterior m major m
bundle

Pectoralis
minor m
Pectoralis major m,
costosternal head
Sternum
Biceps Internal thoracic

brachii m, a and v
long head
Ascending
aorta
Cephalic v
Pectoralis Superior
major t vena cava
Deltoid m
Right main
pulmonary a
Triceps
brachii m,
lateral head Thoracic
vertebral body
Brachial
neurovascular Rib
bundle
Latissimus Semispinalis
dorsi m thoracis m
Erector
Triceps
spinae m
brachii m,
long head
Subscapularis m Teres Inferior Serratus Rhomboid Trapezius m

major m scapular body anterior m major m
Figure 1.1.16 Coracobrachialis m

Pectoralis
minor m
Pectoralis major m,
costosternal head
Sternum
Biceps Internal
brachii m, thoracic
long head a and v
Cephalic v Ascending
aorta
Biceps
Superior
brachii m,
vena cava
short head
Deltoid m
Humeral
diaphysis
Triceps
brachii m, Erector
lateral head spinae m
Triceps
brachii m, Semispinalis
long head thoracis m
Radial n and
deep brachial a Trapezius m
Latissimus Teres Inferior Serratus Rhomboid

dorsi m major m scapula anterior m major m

Pectoralis
minor m
Pectoralis major m,
costosternal head
Internal thoracic
a and v
Sternum
Biceps
brachii m,
long head
Cephalic v
Deltoid m
Humeral
diaphysis
Triceps
brachii m, Erector
medial head spinae m
Radial n
Triceps
brachii m, Semispinalis
lateral head thoracis m
Triceps Trapezius m
brachii m,
long head
Neurovascular Latissimus Teres Serratus Inferior medial Rhomboid

bundle dorsi m major m anterior m scapula major m

Pectoralis
minor m
Pectoralis
major m
Sternum
Internal
thoracic
a and v
Cephalic v
Biceps
brachii m,
long head
Deltoid m
Triceps Right lung
brachii m,
medial head
Radial n
Triceps
brachii m, Intercostal m
lateral head
Triceps Erector
brachii m, spinae m
long head
Trapezius m
Brachial Latissimus Long thoracic Serratus Inferior medial

neurovascular dorsi m n and a anterior m scapula
bundle

short head
Pectoralis
minor m
Pectoralis major m,
costosternal head
Internal thoracic
a and v
Sternum
Biceps
brachii m,
long head
Cephalic v
Coracobrachialis m
Deltoid m
Radial n and Vertebral

deep brachial a body
Triceps Costovertebral
brachii m, joint
lateral head
Triceps Erector
brachii m, spinae m
long head
Trapezius m
Triceps brachii m, Brachial Latissimus Serratus Latissimus Rib

medial head neurovascular dorsi m anterior m dorsi m
bundle
SAGITTAL
Figure 1.2.1
Deltoid m
Deltoid m
artery = a
arteries = aa
vein = v
veins = vv
muscle = m
muscles = mm
tendon = t
Cephalic v tendons = tt
nerve = n
Triceps brachii m,
nerves = nn
long head
ligament = lig
ligaments = ligs
nerve &
Triceps brachii m, vessels
lateral head bone
Figure 1.2.2 Infraspinatus t Deltoid m
Greater
tuberosity
of humerus
Humeral head
Deltoid m
Cephalic v
Triceps brachii m,
lateral head
Deltoid Triceps brachii m,

tuberosity long head
Figure 1.2.3 Infraspinatus t
Lateral edge
of acromion
Supraspinatus t
Teres minor m and t
Deltoid m
Humeral head
Biceps brachii t, Posterior circumflex

long head humeral a and axillary n
Teres major m
Deltoid m
Cephalic v Triceps brachii m,
lateral head
Deltoid tuberosity
Humeral diaphysis
Triceps brachii m,
medial head
Triceps brachii m,
long head
Biceps brachii m,
long head
Figure 1.2.4 Acromion
Supraspinatus t
Infraspinatus t
Humeral head
Subscapularis t Deltoid m
Lesser tuberosity
Teres minor m
of humerus
Deltoid m
Posterior circumflex a
Anterior circumflex and axillary n
humeral a
Teres major m
Cephalic v
Radial n and
Pectoralis major t deep brachial a
Biceps brachii m,
short head Triceps brachii m,
medial head
Biceps brachii m,
long head Triceps brachii m
Humeral diaphysis
Figure 1.2.5 Supraspinatus m and t
Acromion
Infraspinatus m and t
Coracoacromial lig
Deltoid m
Humeral head
Deltoid m
Teres minor m
Pectoralis major m
Posterior circumflex a Teres major m

and axillary n
Latissimus dorsi t
Latissimus dorsi m
Radial n and deep

Biceps brachii m, brachial a
short head, and
coracobrachialis m Brachial neurovascular
bundle
Biceps brachii m
Figure 1.2.6 Distal clavicle Distal scapular spine
Supraspinatus m
Coracoacromial lig
Deltoid m Infraspinatus m
Deltoid m
Medial
humeral head
Teres minor m
Glenoid
Subscapularis m
Cephalic v
Teres major m
Pectoralis major m Latissimus dorsi m
Biceps brachii m,
short head
Brachial neurovascular bundle

Figure 1.2.7 Distal clavicle
Trapezius m
Scapular spine
Deltoid m
Supraspinatus m
Coracoacromial lig
Coracohumeral lig Infraspinatus m

Coracoid process Suprascapular
neurovascular
bundle
Subscapularis m Scapula
Biceps brachii m,
Teres minor m
short head, and
coracobrachialis m
Pectoralis major m,
clavicular head
Teres major m
Pectoralis major m,
sternocostal head
Latissimus dorsi m
Axillary a and neurovascular bundle
Figure 1.2.8 Clavicle Trapezius m
Supraspinatus m Scapular spine
Deltoid m
Infraspinatus m
Coracoid process
Subscapularis m
Scapula
Coracobrachialis m
Teres minor m
Axillary a
Pectoralis major m,
clavicular head Teres major m
Pectoralis major m,
sternocostal head
Latissimus dorsi m
Figure 1.2.9 Trapezius m
Clavicle Scapular spine

Supraspinatus m
Deltoid m
Infraspinatus m
Cephalic v
Pectoralis minor m
Subscapularis m
Axillary a
Pectoralis major m,
clavicular head Teres major m
Scapula
Pectoralis major m, Latissimus dorsi m

sternocostal head
Serratus anterior m
Latissimus dorsi m
Supraspinatus m
Clavicle
Subclavius m
Cephalic v
Infraspinatus m
Subscapularis m
Pectoralis minor m
Axillary a
Axillary v
Teres major m
Scapula
Pectoralis major m
Latissimus dorsi m
Ribs
Latissimus dorsi m
Serratus anterior m
Supraspinatus m
Clavicle
Scapular spine
Subclavius m
Cephalic v
Subscapularis m
Pectoralis minor m
Axillary a Infraspinatus m
Axillary v
Teres major m
Pectoralis major m Scapula
Latissimus dorsi m
Right lung Ribs
Latissimus dorsi m
Serratus anterior m
Figure 1.2.12 Inferior omohyoid m and t
Supraspinatus m
Subclavius m
Trapezius m
Clavicle
Medial scapular spine
Cephalic v
Subscapularis m
Cords of brachial plexus
Axillary a
Axillary v Serratus
anterior m
Pectoralis minor m
Infraspinatus m
Pectoralis major m
Scapula,
inferior angle
Right lung
Serratus anterior m
Latissimus dorsi m
Figure 1.2.13 Inferior omohyoid m and t
Serratus anterior m
External jugular v Trapezius m
Supraspinatus m
Subclavius m
Clavicle
Cords of brachial plexus Serratus anterior m

Axillary a
Axillary v
Pectoralis major m,
Infraspinatus m
clavicular head
Pectoralis minor m
Scapular body
Ribs
Pectoralis major m Scapula,

inferior angle
Serratus anterior m
Right lung
Latissimus dorsi m
Figure 1.2.14 External jugular v
Trapezius m
Cords of brachial plexus
Inferior omohyoid m
Serratus anterior m
Subclavius m Supraspinatus m
Scapula, medial margin
Clavicle Serratus anterior m
Axillary a
Trapezius m
Axillary v
Pectoralis major m,
clavicular head
Pectoralis minor m Scapula, medial

inferior margin
Pectoralis major m,
sternocostal head Rhomboid major m
Posterior rib
Intercostal m
Right lung
Latissimus dorsi m
Figure 1.2.15 Cords of brachial plexus
Serratus anterior m
Trapezius m
Subclavian v
External jugular v
Levator scapulae m
Subclavius m Subclavian a
Serratus posterior
Clavicle superior m
Pectoralis major m, Rhomboid minor m

clavicular head
Rhomboid major m
Posterior ribs
Pectoralis major m, Posterior intercostal

sternocostal head neurovascular bundle
Serratus posterior
inferior m
Internal intercostal m
Latissimus dorsi m
Figure 1.2.16 Middle scalene m
Subclavian a Posterior scalene m

Anterior scalene m
Trapezius m
Subclavian v
Levator scapulae m
Sternocleidomastoid m, Serratus posterior

clavicular head superior m
External jugular v Rhomboid minor m
Clavicle
Pectoralis major m,
clavicular head
Rhomboid major m
Right lung
Pectoralis major m, Posterior rib

sternocostal head
Serratus posterior
inferior m
Latissimus dorsi m
Costal cartilage
Subclavian a
Posterior scalene m
Anterior scalene m
Trapezius m
External jugular merging
with subclavian v
Levator scapulae m
Sternocleidomastoid m, Rhomboid minor m
clavicular head
Serratus posterior
Anterior jugular v
superior m
Clavicle Rhomboid major m
Pectoralis major m,
clavicular head
Sternoclavicular joint, Posterior rib

lateral aspect
Serratus posterior
Pectoralis major m, inferior m
sternocostal head
Intercostal m
Costal cartilage
Latissimus dorsi m
Trapezius m
Anterior scalene m
Splenius cervicis and

splenius capitis mm
Subclavian a Rhomboid minor m
Serratus posterior
Sternocleidomastoid m, superior m
clavicular head
Anterior jugular v Trapezius m
Clavicle
Pectoralis major m, Rhomboid major m

clavicular head
Pectoralis major m,
sternocostal head
Posterior rib
Intercostal m
Costal cartilage
Latissimus dorsi m
Serratus posterior
inferior m
Sternohyoid m
Subclavian v
Figure 1.2.19
Sternocleidomastoid m Internal jugular v
Splenius cervicis and

splenius capitis mm
Semispinalis
capitis m
Sternohyoid m
Sternocleidomastoid m, Trapezius m
clavicular head
Anterior jugular v Posterior ribs medially
Brachiocephalic v Rhomboid major m
Medial clavicle
Sternoclavicular joint
Manubrium
Pectoralis major m,
costosternal head Trapezius m
Intercostal
neurovascular bundle
Costal cartilage, third rib
Erector spinae m
Medial posterior rib

CORONAL
Figure 1.3.1
artery = a
arteries = aa
vein = v
veins = vv
muscle = m
muscles = mm
tendon = t
Pectoralis major m, tendons = tt
clavicular head nerve = n
nerves = nn
ligament = lig
ligaments = ligs
nerve &
vessels
bone
Costal cartilage
Pectoralis major m,
sternocostal head
Sternum
Internal thoracic a and v

(internal mammary vessels)
Figure 1.3.2 Clavicle
Trachea
Anterior deltoid m
Pectoralis major m, Articular disc in

clavicular head sternoclavicular joint
Manubrium
Cephalic v
Pectoralis major m,
sternocostal head
Internal thoracic a and v

(internal mammary vessels)
Costal cartilage
Figure 1.3.3 Clavicle

sternal head
Infrahyoid m
Deltoid m
Pectoralis major m, Sternoclavicular

clavicular head joint
Costoclavicular lig
Manubrium
Cephalic v
Internal thoracic
a and v
Pectoralis major m,
sternocostal head
Figure 1.3.4 Coracoid

process Cephalic v
Shaft of
clavicle Subclavius m
Proximal end
of clavicle
Thyroid cartilage
Deltoid m
Sternocleidomastoid m
Conjoined t of
coracobrachialis m and
biceps brachii m,
short head
Biceps brachii m, Anterior jugular v
long head
Subclavian v
Lesser tuberosity of
humerus
Deltoid m Interclavicular lig
Pectoralis
major m, clavicular head
Cephalic v
Right lung
Pectoralis major m,
sternocostal head
Figure 1.3.5 Acromioclavicular joint

Coracoid
process Mid-clavicle Subclavius m Sternocleidomastoid m
Acromion
Deltoid m Common carotid a
Humeral head Trachea

Greater tuberosity Internal jugular v
of humerus
Biceps brachii t,
long head Left brachiocephalic v
Deltoid m
Cephalic v
Right lung
Lesser tuberosity
of humerus
Conjoined t of Pectoralis major m Pectoralis minor m

coracobrachialis m
and biceps brachii m, short head
Figure 1.3.6 Trapezoid lig,

coracoclavicular portion
Coracoid
process Clavicle Subclavius m
External
jugular v
Acromioclavicular Sternocleidomastoid m
joint
Acromion
Internal jugular v
Supraspinatus t
Trachea
Greater tuberosity of Right common carotid a

humerus
Humeral head
Brachiocephalic trunk
Subscapularis m
Deltoid m
Superior vena cava
Deltoid m Ascending aorta

Cephalic v
Deltoid m
Pectoralis Omohyoid m, Subclavian v Right

minor m inferior belly brachiocephalic v
Figure 1.3.7 Trapezoid lig, Coracoid

Cords of
brachial Omohyoid m,
coracoclavicular portion process plexus Axillary a inferior belly
Distal clavicle
Anterior scalene m
Acromioclavicular joint
Acromion Middle scalene m
External jugular v
Supraspinatus t
Humeral head Subclavian a and v
Subscapularis m
Thyrocervical trunk
Greater tuberosity
of humerus Trachea
Right
Deltoid m brachiocephalic v
Superior vena cava

Biceps brachii t,
long head
Cephalic v
Right lung
Biceps brachii m
Biceps brachii m, Serratus Ribs Axillary v

short head anterior m
Coracobrachialis m
Figure 1.3.8 Glenoid

Supraspinatus m
Distal end of
Trapezius m
Inferior
labrum clavicle Subscapularis m omohyoid m and t
Posterior
sternocleidomastoid m
Middle scalene m
Acromion
Brachial plexus
Deltoid m Subclavian a
Greater tuberosity Brachial plexus
of humerus
Axillary a
Humeral head
Axillary v
Latissimus dorsi t
Biceps brachii m,
short head
Coracobrachialis m
Biceps brachii m,
long head
Cephalic v
Serratus Ribs
anterior m
Figure 1.3.9 Scapular notch with

suprascapular a and n Trapezius m
Inferior Serratus
omohyoid t anterior m
Levator
scapulae m
Multifidus m
Posterior scalene m
Acromion Middle scalene m
Supraspinatus m Brachial plexus
Superior glenoid
Greater tuberosity of Thoracic vertebrae
humerus
Humeral head
Subscapularis m
Deltoid m
Teres major m and t
Latissimus dorsi m
Biceps brachii m,
short head
Biceps brachii m,
long head
Coracobrachialis m Axillary Serratus Ribs

a and v anterior m
Figure 1.3.10 Transverse

Dorsal
scapular
Subscapularis m Supraspinatus m Trapezius m cervical a and v a and v
Posterior scalene m
Acromion Semispinalis capitis m
Scapular notch with Levator scapulae m

suprascapular
a and n Posterior scalene m
Humeral head Serratus anterior m
Glenoid
Thoracic vertebrae
Deltoid m
Quadrangular space
Teres major m
Subscapular a
Latissimus dorsi m
Right lung
Humeral diaphysis
Coracobrachialis m
Biceps brachii m
Brachial Circumflex Serratus Ribs

a and v scapular a anterior m
Figure 1.3.11 Spinoglenoid notch

with inferior
Trapezius m
suprascapular
Serratus Transverse
a and n Supraspinatus m anterior m cervical a and v
Dorsal
scapular a and v
Semispinalis
capitis m
Acromion
Splenius
Infraspinatus m capitis m
Levator
Posterior glenoid scapulae m
Teres minor m Quadrangular
space
Deltoid m
Axillary n and Triceps brachii t,
posterior circumflex long head
humeral a
Teres major m
Latissimus dorsi m
Radial n and
deep brachial a
Humeral diaphysis
Coracobrachialis m
Biceps brachii m
Circumflex Serratus Subscapularis m

scapular a in anterior m
triangular space
Figure 1.3.12 Transverse

cervical a and v
Dorsal
Scapular scapular Levator
spine Supraspinatus m Trapezius m a and v scapulae m
Trapezius m
Semispinalis
cervicis
and semispinalis
capitis mm
Acromion
Splenius capitis m
Infraspinatus m
Serratus
Teres minor m anterior m
Deltoid m
Axillary n, Thoracic
posterior branch vertebral body
Latissimus dorsi m
Triceps brachii m,
lateral head Right lung
Radial n and
deep brachial a
Humeral diaphysis
Brachial Teres Circumflex Serratus Subscapularis m

neurovascular major m scapular a anterior m
bundle
Figure 1.3.13 Subscapularis m Supraspinatus m
Serratus Levator Semispinalis

Supraspinatus m Trapezius m anterior m scapulae m capitis m
Infraspinatus m
Subscapularis m
Teres minor m Multifidus m
Rotatores thoracis m
Triceps brachii m,
long head
Rib
Deltoid m
Teres major m
Triceps brachii m,
lateral head
Thoracic vertebral
Radial n body
Triceps brachii m, Posterior intercostal
medial head a and v
Humeral diaphysis
Intervertebral disc
Latissimus Circumflex Serratus

dorsi m scapular a anterior m
Figure 1.3.14 Scapula,

superior margin
Scapular Serratus Levator
spine Supraspinatus m Trapezius m anterior m scapulae m
Splenius capitis m
Infraspinatus m
Scapular body
Semispinalis capitis m
Deltoid m
Rotatores thoracis mm
Teres minor m
Triceps brachii m,
long head
Teres major m
Latissimus dorsi m Right lung
Triceps brachii m,
lateral head
Radial n
Posterior
Triceps brachii m, intercostal a and v
medial head
Humeral diaphysis
Circumflex Latissimus Serratus Subscapularis m

scapular a dorsi m anterior m
Figure 1.3.15 Infraspinatus m

Scapular
body
Scapular
spine Trapezius m
Levator Splenius
scapulae m capitis m
Teres minor m
Spinalis thoracis m
Semispinalis capitis m
Deltoid m Serratus posterior

superior m
Subscapularis m
Teres major m
Triceps brachii m,
lateral head
Triceps brachii m, Costotransverse joints
long head
Triceps brachii m,
medial head Posterior
intercostal a and v
Radial n
Humeral diaphysis
Latissimus Serratus Ribs

dorsi m anterior m
Long thoracic
neurovascular bundle
Figure 1.3.16 Subscapularis m

Scapular spine
Serratus
Scapular posterior
body Infraspinatus m Trapezius m superior m
Rhomboid minor m
Semispinalis thoracis m
Deltoid m Semispinalis capitis m
Teres minor m Costotransverse joint
Teres major m
Spinal cord
Triceps brachii m,
long head
Triceps brachii m, Intercostal

lateral head vessels and nn
Latissimus Ribs
dorsi m
Serratus
anterior m
Figure 1.3.17 Teres

Medial
inferior Serratus Rhomboid
minor m scapula Infraspinatus m anterior m Trapezius m minor m
Splenius capitis and

splenius cervicis mm
Deltoid m Semispinalis thoracis m
Teres major m
Costovertebral joint
Triceps brachii m,
long head
Levator costae m
Latissimus Serratus
dorsi m anterior m
Figure 1.3.18 Infraspinatus m

Scapular
body Subscapularis m
Serratus
anterior m Trapezius m
Rhomboid minor m
Teres minor m
Rhomboid major m
Deltoid m
Erector spinae m
Teres major m
Posterior rib
Intercostal m
Triceps brachii m, Levator costae m

long head
Costotransverse joint
Latissimus Serratus Intercostal

dorsi m anterior m vessels
and nn
Figure 1.3.19 Deltoid m Infraspinatus m Trapezius m
Teres major m
Rib
Inferior scapula
Triceps brachii m, Intercostal m

long head
Semispinalis
thoracis m
Erector spinae m
Latissimus Serratus
dorsi m anterior m
Figure 1.3.20 Teres

major m Infraspinatus m
Trapezius m
Rhomboid major m
Inferior scapula
Spinous process,
Triceps brachii m, thoracic spine
long head
Semispinalis
thoracis m
Latissimus Serratus Latissimus Erector

dorsi m anterior m dorsi m spinae m
2
Chapter
MRI of the Shoulder

UPPER EXTREMITY: MRI OF THE SHOULDER 35
Table 2-1. Muscles of the Shoulder

MUSCLE ORIGIN INSERTION NERVE SUPPLY
Pectoralis Medial half of the anterior surface of the Crest of the greater tubercle of the Lateral and medial
major clavicle, side and front of the sternum as humerus, lateral lip of the intertu- pectoral (C5 and C6
far as the 6th costal cartilage, front and bercular groove, deltoid tubercle, for the clavicular part,
surfaces of the cartilage of the 2nd and fibrous periosteum of the in- and C7, C8, and T1
through 6th ribs, osseous ends of the 6th tertubercular sulcus for the sternocostal
and 7th ribs, and aponeurosis of external part)
abdominal oblique
Pectoralis Aponeurotic slips from the 2nd through Anterior half of the medial border Medial and lateral
minor 5th ribs, near costal cartilages and upper surface of the coracoid pectoral (C6, C7, C8)
process of the scapula
Subclavius First rib and its cartilage Inferior surface of the clavicle Nerve to subclavian
between the costal and coracoid (C5 or C5 and C6)
tuberosities
Deltoid Lateral border and upper surface of the Deltoid tuberosity of the humerus Axillary (C5, C6)
lateral third of the clavicle, the
acromion, and the scapular spine
Supraspinatus Supraspinous fossa and investing Shoulder capsule and superior Suprascapular
fascia facet of the greater tubercle of the (C4, C5, C6)
humerus
Infraspinatus Infraspinous fossa, scapular spine, Shoulder capsule and middle facet Suprascapular
investing (deep) fascia, and adjacent of the greater tubercle of the hu- (C4, C5, C6)
aponeurotic septa merus
Teres minor Upper two thirds of the axillary Shoulder capsule and inferior facet Axillary (C4, C5, C6)
border of the scapula of the greater tubercle of the
humerus
Subscapularis Subscapularis fossa Shoulder capsule and lesser tubercle Two or three subscap-
of humerus and its shaft immedi- ular branches from
ately below the tubercle posterior cord and
upper and lower
subscapular (C5,
C6, C7)
Teres major Inferior angle of the scapula Medial lip of the intertubercular Lower subscapular
groove of the humerus (C6, C7)
Latissimus Spine and interspinous ligaments of the Muscle tendon inserts onto the Thoracodorsal (C6,
dorsi lower five or six thoracic vertebrae, upper ventral side of the lesser tubercle of C7, C8)
lumbar vertebrae, thoracodorsal fascia, the humerus and onto the floor of
posterior third of the crest of the ilium, the intertubercular groove ventral
and the lateral surface and upper edge of to the tendon of the teres major.
the lower three or four ribs The tendon may extend to the
greater tubercle of the humerus.
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Symptoms. These are very indefinite, depending very much on the
complications. Some loss or perversion of appetite, a licking of the
soil or walls, eating litter, filth and even manure, a clammy mouth, a
redness along the margin of the tongue, eructations or attempts to
eructate, or actual vomiting, colicy pains which are usually dull until
the bowels are implicated, more or less rumbling in the bowels,
sometimes icterus, in other cases tympany, and nearly always tardy
passage of hard and scanty mucus-covered fæces. The colics may be
intermittent, appearing only just after food is taken, or they may be
continuous, the animal pawing incessantly hour after hour. A slight
hyperthermia and a distinct tenderness of the epigastrium and left
hypochondrium to pressure are valuable symptoms. Percussion
causes even keener suffering.
If the gastric contents are abundant and fermentation active, death
may ensue from gastric tympany. In other cases, the persistence of
colics at the time of feeding, of impaired appetite, constipation and
loss of condition are the main symptoms. In the last named cases the
patient may die of marasmus.
Lesions. In cases terminating in fermentation and fatal tympany
the stomach is full; in other types it is empty of all but water, mucus,
and perhaps some irritant contents, or decomposed food. The
alveolar mucosa of the right sac and above all of the pylorus is red,
congested, petechiated, macculated, thickened to double its normal
thickness or more, thrown into rugæ, and covered with tenacious
mucus. This mucus is highly charged with detached epithelial cells,
and at different points the mucosa is abraded by their desquamation.
The epithelium generally shows swollen, opaque cells. The red
congested spots show active engorgement of the capillaries, and this
is especially marked around the glandular follicles, with more or less
formation of embryonic cells. The duodenum is often implicated with
similar lesions of the mucosa and its epithelial layers, which may
block the orifices of the pancreatic and especially of the biliary duct.
In this case there is a yellowish discoloration of the liver, excess of
pigment in the hepatic cells, and hemorrhagic spots in the liver and
even in the kidneys. The urine may be yellow or reddish brown from
the presence of bile or blood pigment. In ruptured stomach,
spiroptera, bots, and other irritants, we find their characteristic
lesions, and in petechial fever there is excessive and partly
hemorrhagic infiltration of the mucosa and submucosa. In
protracted cases ulcers may be present on both stomach and
intestine. When it is a localization of some specific fever the
characteristic lesions of that affection will be found.
Treatment. If appetite continues, diet should be restricted to a
very moderate allowance of green food, pulped roots, bran mash,
boiled flaxseed, boiled middlings, with pure water or whey. If there
are irritants in the stomach they may be got rid of by a laxative (aloes
4 drachms, or sulphate of soda ½ pound). Sodium bicarbonate (½
drachm 2 or 3 times daily) is desirable to stimulate peptic secretion
and check acid fermentations. Pepsin (2 drachms) should be given at
equal intervals. Fermentations should be checked by the use of salol
(1 to 2 drachms), naphthalin (1 to 2 drachms), benzo-naphthol (1 to 3
drachms), or calcium salicylate (2 drachms).
In this connection bitters are of value to improve the tone of the
gastric mucosa, nux vomica, gentian, quinia and quassia in
combination with ipecacuan giving good results.
PHLEGMONOUS (PURULENT) GASTRITIS
IN THE HORSE.
Definition: deep inflammation tending to abscess. Causes: invasion by pus
microbes, infectious diseases, parasitism, traumas. Symptoms: hyperthermia,
colic, tenderness, icterus, coincident disease, hæmatemesis. Lesions: submucous or
subperitoneal abscess, parasites, peritonitis, exudation, thickening, neoplasm of
mucosa, catarrhal complications. Treatment: careful diet, antiseptics, bitters,
laxatives.
Definition. This is a gastric inflammation affecting the
membranous layers, and tending to submucous or subperitoneal
abscess. It is much less frequent than the catarrhal form.
Causes. It may be attributed to invasion of the gastric walls by pus
microbes, and appears as secondary abscess in pyæmia and above all
in strangles. The microbes are introduced more directly through the
wounds inflicted by the larvæ of œstrus, or by the burrowing of these
(Argus, Schlieppe, Schortmann), or of spiroptera (Argus). Wounds
by sharp pointed bodies taken in with the food, furnish other
infection—atria, and in their turn ulcers connected with catarrhal or
toxic inflammation may furnish a means of entrance.
Symptoms. These resemble those of catarrhal inflammation, but
are usually attended by greater hyperthermia, and the colicy
symptoms are more marked. There is also greater tenderness in the
epigastrium and left hypochondrium, and icterus is more marked.
When it occurs as an extension of strangles or pyæmia the symptoms
of these affections elsewhere are pathognomonic. When the abscess
bursts into the stomach there may be vomiting of bloody mucus
(hæmatemesis) which is not necessarily followed by a fatal result.
Lesions. As these are seen only in fatal cases, the presence of an
abscess is the characteristic feature. This is usually submucous, or
less frequently subperitoneal, and may vary in size from a hazelnut
upward. The tendency appears to be to open into the stomach,
though it may burst into the peritoneum and cause general infection
of that membrane. In case of parasites, the spiroptera or œstrus larva
may be found in the abcess cavity having a narrow opening into the
stomach. In certain cases the abscess on the pyloric sac has been
found opening into the duodenum. Congestion, thickening,
puckering into rugæ and laceration of the adjacent mucosæ may be a
marked feature, a circumscribed catarrhal gastritis complicating the
local phlegmon.
Treatment. This is less hopeful than in catarrhal gastritis, but
should be conducted along the same lines. The same careful diet,
with daily antiseptics and bitters may prove valuable in limiting the
inevitable suppuration, and, if the pus should escape into the
stomach, in healing the lesion. Sulphites of soda, sulphide of
calcium, chamomile, and quinia, are to be commended and pepsin
may be added to secure at once proteid digestion and antisepsis.
Laxatives may be required to counteract constipation or expel
irritants, and these may be combined with the antiseptics already
named or with salol, eucalyptol, sodium salicylate or other non-
poisonous agent of this class.
TOXIC GASTRITIS IN SOLIPEDS.
Causes: caustics or irritants acting on mucosa, accidently, or maliciously.

Symptoms: colics, pinched face, small rapid pulse, hurried breathing,
hyperthermia, sometimes salivation, color of buccal mucosa, odor, congestion of
tongue, thirst, urination, icterus, albuminuria, analysis of urine or vomited matter.
Lesions: congestion, corrosion, necrosis or ulceration of gastric mucosa,
discoloration. Treatment: antidote, stomach pump, demulcents, coagulants.
Causes. Toxic gastritis in solipeds is peculiar in this that it must be

due to one or other of the more caustic or irritant agents, which act
chemically on the tissues, while those agents that require to be
absorbed to establish a physiological irritation are comparatively
harmless. This depends on the fact that few or none of the poisonous
agents are absorbed by the gastric mucosa of the soliped, and if
ingested they must pass on into the duodenum before they can be
absorbed into the tissues and blood-vessels. Hence the horse is
injured mainly by actual caustics like mercuric chloride, zinc
chloride, ferric or cupric sulphate, the caustic alkalies or earths, or
alkaline carbonates, and the mineral acids. These may be taken
accidently or administered maliciously, or as medicines.
Symptoms. Morbid symptoms vary according to the agent
swallowed. There are colics, anxious countenance, small accelerated
pulse, rapid breathing, hyperthermia, and salivation, especially
marked with mercuric chloride. The buccal mucosa may give
valuable indications, becoming white with muriatic acid, or zinc, or
antimony, or mercuric chloride, yellow with nitric acid, and white
changing to black with sulphuric acid or silver nitrate. Ferric or
cupric sulphate may give their respective colors to the saliva, and the
former will darken the fæces.
The mouth is usually dry, hot, and clammy, and the edges of the
tongue red. Temperature is usually elevated, yet with tartar emetic it
may be distinctly reduced. Thirst is usually marked, and urination
frequent. Icterus and albuminuria attend on phosphorus poisoning.
When vomiting takes place the appearance or analysis of the matters
rejected, or otherwise of the urine, will often indicate the nature of
the poison.
Lesions. The gastric mucosa is congested and discolored, but the
corrosion and even the ulceration are especially characteristic.
Patches of necrotic mucous membrane may be more or less detached
exposing a deep red submucosa. The coloration otherwise varies;—
white or black with sulphuric acid or silver nitrate; white with
muriatic acid, the caustic alkalies, or zinc chloride; yellow with nitric
acid; or green with salts of copper.
Similar lesions are found on the buccal, œsophagean and intestinal
mucosæ, and even at times on the respiratory.
Treatment. In the treatment of this form of gastritis the first
consideration is to expel, or use an antidote to, the poison. In the
soliped, emetics are useless. The stomach pump or tube may,
however, be applied with good effect in nearly all cases, alternately
throwing in water and drawing it off. Demulcents and coagulants are
also universally applicable. Milk, eggs beaten up in milk, blood
albumen, flaxseed tea, well boiled gruels, or slippery elm bark, may
be used as may be most convenient. Next come the other chemical
antidotes the use of which however demands a previous knowledge
of the poison present. For the mineral acids one can make use of
calcined magnesia, lime water, chalk, or carbonate of soda in weak
solution. For alkalies the appropriate antidote is vinegar. For carbolic
acid, vinegar, alcohol, or failing these a weak solution of soda or oil.
For tartar emetic, gallic or tannic acid. For bichromate of potash or
chromic acid, calcined magnesia, magnesia carbonate, or lime
carbonate. For phosphorus, old oil of turpentine and demulcents—no
oil. For ammonia, vinegar followed by almond, olive or sweet oil. In
case of œdema glottidis, tracheotomy. For copper salts yellow
prussiate of potash, which precipitates the copper in an insoluble
form, and demulcents. For mercuric chloride, demulcent drinks can
be resorted to, there is no other reliable antidote. In all cases after
the evacuation of the stomach and the use of the antidote,
mucilaginous agents must be given freely with morphia or other
anodynes.
CATARRHAL INFLAMMATION OF THE
FOURTH STOMACH.
Usually a complication. Causes, predisposing, exciting, changes of food or water,

spoiled, frosted or fermented food, green potatoes, caterpillars, nitrogenous food,
irritants. Symptoms: Separation from herd, grinding teeth, eructation, depraved
appetite, fever, tender epigastrium, coated dung, red eyes, fixed or retracted,
dilated, blind eyes, drooping ears, nervous symptoms, reckless unconscious
movements, bellowing, tender skin, tremors. Lesions: Congestion and exudate in
gastric mucosa, hemorrhagic discoloration, desquamation, excess of mucus,
resemblance to rinderpest, Texas fever and malignant catarrh. Treatment: Empty
stomach by bland laxatives, stimulants of peristalsis, calmatives, cold to head,
counter-irritants, enemata, bitters.
This affection is by no means rare in cattle, though it is usually

complicated with inflammation of the first three stomachs or of the
intestines. Nevertheless, when the disease appears to be
concentrated on the fourth stomach mainly, it may well take its name
accordingly.
Causes. A predisposition to the affection occurs in the weak and
debilitated, the overworked oxen, underfed cattle, in those that are
just recovering from a severe illness and in which the gastric
secretions and functions are still poor. The usual exciting cause is
some fault in the food, it may be a sudden change from one kind to
another, and especially from dry to green, or from one kind of green
food to another and more tempting one, as when the animal breaks
into a field of grain which is advancing to maturity. Even a sudden
change of water, as from soft to hard has seemed in our experience to
contribute to its development. Next come spoiled aliments, frosted or
frozen turnips, beets, carrots, potatoes, apples, turnip tops,
fermented grasses, musty hay, sun-exposed potatoes, putrid
vegetables, and caterpillars on cabbages, tree leaves and other
vegetables. Next come products that are highly nitrogenous, like
vetches, alfalfa, sainfoin, clover, and the cakes of linseed, rape and
cotton seed. Irritant plants such as colchicum, digitalis, yew, radish,
etc., have been charged as causative agents.
Symptoms. These are often difficult to distinguish from those of
indigestion or acute lead poisoning, and they vary in different cases
according to the severity of the attack. In the milder cases there may
be loss of appetite and rumination, some tympany, arching of the
back, uneasy movements of the hind limbs and tail, a disposition to
leave the herd, grinding of the teeth, and frequent gaseous
eructations. Some show a depraved appetite, picking up and chewing
various non-alimentary substances. Somewhat more characteristic
are the dry, hot muzzle, the hyperthermia of the body, the tenderness
to pressure of the epigastrium, and the baked appearance and
glistening surface of the fæces. In the more severe forms the
suffering is increased and the nervous system participates in the
disorder. The eyes are congested, fixed or rolled back, the pupils
dilated, the vision appears to be abolished, the ears are pendant, if
tied the subject attempts to get loose, if at liberty he moves steadily
in some one direction regardless of obstacles or dangers, he bellows,
pushes against walls or other obstructions and may seriously injure
himself or others. There is, however, no mischievous purpose, he is
simply impelled to blind motion, and no regard is had to anything
which may be in his way. In some instances the nervous disorder is
manifested by a sensitiveness of the skin, so that the animal shrinks
when handled or pinched along the chine or back. Tremors is
another marked symptom.
Lesions. These consist mainly in congestion and swelling of the
gastric mucosa, which is further covered by a thick layer of mucus.
The folds are especially thickened and discolored, and the seat of
hemorrhagic extravasations (petechiæ) and exudations in spots and
patches. Desquamation of the epithelium may be met with at points
and even distinct ulcers. Exudation in the submucous tissue, and
petechiæ in the peritoneum are common. The condition may bear a
close resemblance to what is seen in rinderpest or malignant catarrh.
Treatment. The first desideratum is the elimination of the irritant
ingesta from the stomach. But for this purpose emetics are useless
and we must fall back on laxatives. Again we are met by the
consideration that the inflamed stomach will neither readily absorb
nor respond to a stimulus. Yet as a rule the viscus is not equally
inflamed throughout, and even the affected parts do not necessarily
have the whole muscular coat involved and paralyzed. We can
therefore hope for a measure of response which once started will
deplete and improve the adjacent and more violently affected parts.
But irritant and drastic purgatives like croton, podophyllin or
gamboge are proscribed as very liable to aggravate the inflammation.
Pilocarpin 3 grs. hypodermically may be given or in default of this, 1
lb. each of Glauber and common salt in not less than six quarts of
water, free access being allowed to pure water until it shall have
operated. Bismuth may also be given as a calmative. Active rubbing
of the abdomen will assist in rousing the stomachs to action, and
hasten the action of the purgative. If there should be any sign of
cerebral disorder, cold water or ice may be applied to the head, and
oil of turpentine, followed by a pulp of the best ground mustard may
be applied to the epigastrium and right hypochondrium. This may be
accompanied and followed by copious enemata, and doses of quinia,
gentian or still better nux vomica three times a day.
CATARRHAL GASTRITIS IN SWINE.
Definition. Causes, irritants, fermented, putrid swill, spoiled vegetables, irritant
molluscs or larvæ, hot or cold food, alkalies, indigestible food, specific germs and
toxins, parasites. Symptoms: inappetence, restlessness, vomiting, colic,
constipation, diarrhœa, fever, stiffness, tender abdomen, arched back, chill,
plaintive grunting, drooping tail. Lesions. Treatment: change diet, mucilaginous,
milk, protection from saprophytes, change pen, emetic, laxative, calomel, bismuth,
cleanliness, washing.
Definition. Inflammation of the gastric mucosa with mucopurulent
discharge.
Causes. Irritants of various kinds, fermented or putrid swill,
spoiled vegetables, irritant molluscs or larvæ, too hot or too cold
aliment, excess of brine, excess of alkalies, in swill (dishwashings),
indigestible foods of all kinds. The stomach may also be the seat of
catarrhal inflammation in hog cholera, swine plague, rouget,
diphtheritic affections and in the case of gastric parasites, so that it is
very important to distinguish the affections due to simple irritants,
from those dependent on plagues and parasitism.
Symptoms. There is inappetence, vomiting, restlessness and
constant movement, colics, vomiting, constipation or diarrhœa,
hyperthermia, stiffness, tenderness of the abdomen to handling,
arched back, a disposition to hide under the straw, plaintive grunting
when roused, drooping of the tail. The tendency is to a rapid recovery
after the evacuation of the stomach by vomiting, though it may
persist under a continuance of the irritating ingesta.
In these last cases the lesions may closely resemble those of the
contagious affections of the abdomen, but the disease may be
distinguished by its indisposition to spread beyond the herd which is
subjected to the unhealthy dietary.
Treatment. Change the diet to one of pure and easily digestible
materials, soups, mush, fresh whey or buttermilk, boiled farinas or
flax seed, and even fresh grass. If there is violent diarrhœa boiled
milk is often of great value.
Whatever food is given should be furnished in a vessel into which
the animal can’t get his feet, as these are usually charged with septic
germs which are pathogenic to the diseased stomach, though they
may have started from ordinary saprophytes.
For the same reason it is usually desirable to change the pen, as
the animal grubbing in the ground charges the snout with the same
offensive microbes.
If vomiting is not already established, 30 grains of ipecacuan may
be given, or tepid water may be used to assist the process. If
constipation is present 10 to 30 grains of calomel (according to size)
may be given. In case of diarrhœa a combination of calomel 1 part
and chalk 12 parts, may be given in 3 grain doses, two or three times
a day. Or ½ to 1 drachm nitrate of bismuth may be substituted.
Cleanliness in food and surroundings is among the most important
measures, and if the skin has been filthy, repeated washing with soap
and warm water may be resorted to with great benefit.
CHRONIC GASTRIC CATARRH IN
SOLIPEDS.
Causes: Debility, age, anæmia, leucæmia, lymph gland, kidney, heart or lung
disease, parasitism, dental or salivary disease, coarse, fibrous food, spoiled food,
putrid water, gastric neoplasms. Symptoms: Impaired appetite, eating lime or
earth, weariness, costiveness, coated dung, tympanies, diarrhœas, fatigue,
sweating, unthrifty hide, pallid mucosæ, emaciation, colics. Lesions: Thickened
right gastric mucosa, discoloration, mucus, petechiæ, opaque granular epithelium,
gastric dilatation. Treatment: Remove causes, diet, watering, exercise, sunshine,
bismuth, pepsin, acids, bitters, electricity, antiseptics, stomachics.
Causes. These are in the main the causes which operate in
producing the acute affection. In most chronic cases they act
continuously on a system rendered susceptible by debility or
otherwise. Among predisposing causes may be named: The debility
of old age, anæmia, leucæmia, chronic diseases of the lymph glands,
of the liver, kidney, heart, or lung, parasitic diseases, diseases of the
jaws, teeth, or salivary glands which interfere with proper
mastication and insalivation. Among exciting causes may be named:
A coarse, fibrous, innutritious diet, a too bulky diet, spoiled fodders
of all kinds, putrid drinking water, and stomach parasites
(spiroptera, œstrus larva). Actual disease of the stomach—papilloma,
cancer, actinomycosis, tumors, and oat-hair or other concretions are
further causes.
Symptoms. Impaired or capricious appetite, a disposition to lick
the walls or earth, or to drink impure water, yawning, constipation
with glossy mucus-covered fæces, and slight tympany, alternating
with diarrhœa, small, accelerated pulse, susceptibility to perspiration
and fatigue on slight exertion, unthrifty skin and hair, hide-bound,
dry, hot mouth, coated tongue, pallor of the mucous membranes,
loss of condition, and increasing weakness. Slight colics may occur at
intervals, and the sluggishness may deepen into stupor or vertigo.
Lesions. The right sac is usually the seat of more or less
hypertrophy of the mucosa, which is thickened, rugose, with patches
of dark red, gray and slate color, and covered with a layer of
tenacious mucus. The surface may show warty-like elevations, or
papillary projections, with here and there patches of blood
extravasation. The epithelial cells are increased, opaque and contain
many fatty granules.
Dilatation of the stomach is not uncommon especially in old
horses, and then the mucosa may be attenuated and smooth.
Hyperthermia may be present, but is so slight that inflammation
cannot be predicated from it and it is difficult to establish a diagnosis
from chronic dyspepsia.
Treatment. It is important to first correct any curable predisposing
disorder, in teeth, jaws, salivary glands, blood, or internal organs, to
carefully regulate feeding, watering and work, to secure as far as
possible an outdoor life, and to employ bitter and other tonics. All
over-exertion or fatigue must be carefully avoided. The food may be
as advised for the more acute affection. Costiveness may be best met
by boiled flaxseed, or in case of necessity by bran mashes, or green
food. The irritation of the stomach may be benefited by nitrate of
bismuth (3 to 4 drs.) and pepsin, and dilute muriatic acid with each
meal are often of value. Nux Vomica (10 to 25 grs. twice daily) will
help to restore the lost tone, and a current of electricity may be sent
through the epigastrium daily. As alternatives, sulphate of quinia or
gentian may replace the nux, and salol or salicylate of bismuth may
take the place of the nitrate. Bicarbonate of soda in ½ dr. doses,
common salt in ½ oz. doses, and fennel in ½ oz. doses are
sometimes useful in re-establishing gastric functions.
CHRONIC GASTRITIS IN RUMINANTS.
Causes: As in acute form, parasites, gravid womb, insufficient ration, overwork,
exhaustive milking, chronic diseases. Symptoms: deranged appetite, rumination,
pica, eructations, regurgitations, tympanies, colics after feeding, coated dung,
diarrhœa, fever, hot clammy mouth, sunken eyes, small weak pulse, palpitations,
emaciation, weakness, tender hypochondrium. Lesions: hypertrophy of gastric
mucosa, granular epithelium. Treatment: tonic regimen, diet, green food, roots,
sunshine, bismuth, salol, strychnia, pepsin, muriatic acid, common salt, counter-
irritants.
Causes. These are in the main the causes of the acute affection.
There may, however, be special persistent factors like parasites
(strongylus contortus and filicollis, spiroptera) in the stomach, the
pressure of a gravid womb, an alimentation deficient in lime or
phosphorus, overwork, exhausting milking, or chronic disease of
important organs (heart, liver, lung, kidney).
Symptoms. These are indefinite and not easily distinguished from
those of disorders of the third stomach. There is impaired or
capricious appetite, a disposition to eat lime, earth, and all sorts of
non-alimentary objects, rumination is rare or altogether suspended,
efforts to regurgitate are ineffectual, or result in gaseous eructations
only, there are tympanies and abdominal pains especially after
feeding, and constipation with a firm glazed appearance of any fæces
passed, may alternate for a short time with diarrhœa. The mouth is
hot and clammy, the eyes sunken and semi-closed, the pulse small
and weak, though the heart may palpitate, and there is a constantly
progressive emaciation and prostration. Among the more
characteristic symptoms are tenderness of the right hypochondrium
to manipulation and percussion, and the presence of slight
hyperthermia.
Lesions. The changes consist mainly in hypertrophy of the gastric
mucosa, with changes in the epithelium and submucosa such as are
already described in the horse. The pyloric region suffers most, and
here ulcers are not at all uncommon.
Treatment. The main aim must be to remove the causes, and to
build up the general health, so that the patient may rise above the
debilitating conditions. More is to be expected from the change of
diet to green food, roots, mashes, etc., and an outdoor life than from
the action of medicines, which are liable to disappear by absorption
in the first three stomachs, so that they can only act on the fourth
through the system at large. Yet benefit may be expected from the
use of nitrate of bismuth, and salol, as calmatives and antiferments,
nux vomica as a tonic and even from pepsin and muriatic acid as
digestive agents. The two last are not dependent on the fourth
stomach for their activity but will digest the contents more or less in
the first three, and the finely disintegrated and partly peptonized
ingesta coming to the fourth stomach in a less irritating, and less
fermentescible condition, lessens the work demanded of that organ
and gives a better opportunity for recuperation. Small doses of
common salt and one or other of the carminative seeds may be
added. The application of mustard or oil of turpentine to the right
hypochondrium will sometimes assist in giving a better tone to the
organ.
CHRONIC GASTRITIS IN SWINE.
Causes. Symptoms: inappetence, dullness, arched back, colic, irregular bowels,

fever, emaciation. Treatment: diet, green food, milk, mashes, cleanliness, bismuth,
salol, sodium bicarbonate, strychnia, pepsin, muriatic acid, sunshine, washing.
Causes. These are like those producing the acute affection which
may easily merge into this by a continuation of such causes.
The symptoms too are alike. Inappetence, dullness, prostration,
arched back, vomiting, colic, constipation, with alternating diarrhœa.
There is hyperthermia with hot dry snout, thirst, increasing
emaciation, and anæmia.
Treatment. An entire change of diet, to green food, roots, fresh
milk, and soft mashes in limited quantity. Allow pure water freely.
Adopt all precautions against contamination of the food by the feet
or snout. The stomach may be quieted by oxide of bismuth (20 grs.)
or salol (10 grs.) two or three times daily, and the tone and secretions
of the stomach may be stimulated by bicarbonate of soda (1 dr.) and
nux vomica (1 to 2 grs.) thrice daily. In addition pepsin and muriatic
acid may be given with each meal in proportion adapted to its
amount. A life in the open air, and an occasional soapy wash will do
much to restore healthy gastric functions.
CHRONIC GASTRITIS IN THE DOG.
Causes: faults in diet, musty food, foreign bodies, poisons, lack of sunshine,
retained fæces, parasites, ill health, chronic diseases, icy bath, septic drink.
Symptoms: irregular appetite and bowels, fever, foul breath, red tongue, tartar on
teeth, dullness, prostration, vomiting of mucus or bile, tender epigastrium, arched
back, fœtid stools, emaciation. Treatment: regulate diet, sunshine, pure water,
scraped muscle, soups without fat, antiseptics, calomel, pepsin, muriatic acid,
strychnia.
Causes. The irregularity and variability of the food, overfeeding,
highly spiced foods, putrid or spoiled food, musty food, the
swallowing of pieces of bone, and of indigestible bodies, the
consumption of poisons, the absence of open air exercise, the
compulsory suspension of defecation in house dogs, and the
presence in the stomach of worms (spiroptera, strongylus), are
among the common causes of the affection. As in other animals, ill
health, debility, lack of general tone, and chronic diseases of
important organs (liver, kidney, heart, lungs) must be taken into
account. The plunging into cold water when heated and the licking of
septic water must also be named.
Symptoms. Appetite is poor or irregular, the nose dry and hot, the
mouth fœtid, the tongue reddened around the borders and furred on
its dorsum, the teeth coated with tartar, the animal dull and
prostrate, vomits frequently a glairy mucus mixed with alimentary
matters or yellow with bile, and there is constipation alternating with
diarrhœa. The epigastrium is tender to the touch, the back arched,
the fæces glazed with mucus or streaked with blood, and offensive in
odor. Emaciation advances rapidly and death may occur from
marasmus.
Treatment. Adopt the same general plan of treatment. Stop all
offensive and irritating food, give regular outdoor exercise, free
access to pure water, and every facility to attend to the calls of
nature. Give plain easily digestible food in small amount. In the
worst cases pulped or scraped raw meat, in the less severe mush, or
well-prepared soups with the fat skimmed off, and bread added.
Check the irritant fermentations in the stomach by salol, bismuth,
salicylate of bismuth, or naphthol. In case of constipation give 8 to 10
grs. calomel. Then assist digestion by pepsin (5 grs.) and
hydrochloric acid (10 drops) in water with each meal. If the
bitterness is not an objection 1 gr. nux vomica may also be added.
ULCERATION OF THE STOMACH.
Causes: peptic digestion, paresis, caustics, irritants, acids, alkalies, salts,

mechanical irritants, hot food, parasites, thrombosis, embolism, specific disease
poisons, aneurism, tumors, infective growths, nervous disorder, debility, toxins of
diphtheria, staphylococcus, etc. Symptoms: slight colics, tympany, emaciation,
vomiting blood, tender epigastrium, dark or bloody stools, irregular bowels; in
carnivora abdominal decubitus, arched back, bloody, mucous, acid vomit, colics
after meals. Lesions: in horse erosions, ulcers, parasites, neoplasms,
discolorations, extravasations; in cattle and dogs on folds, nature of ulcer.
Treatment: restricted, digestible diet, lavage, anodynes, bismuth, antacids,
antiseptics, salol, naphthol, chloral, pure water.
Causes. Gastric ulcers may arise from quite a variety of causes

which determine necrotic conditions of the mucosa and the gradual
invasion of the resulting lesion by destructive microbes. One of the
simplest factors is the peptic juice, the stomach, being struck with
paresis (in inflammation, fever, nervous disorder), while containing
a quantity of its secretion, undergoes an autodigestion which affects
particularly the lowest (pyloric) portion, toward which the liquid
gravitates, and the free edges of the folds which are the most exposed
to its action.
The swallowing of irritant and caustic agents (the mineral acids or
alkalies, mercuric chloride, tartar emetic, antimony chloride, Paris
green, arsenious acid, etc.) by corroding or causing destructive
inflammation of the exposed mucous membrane may similarly
operate. This is especially the case with monogastric animals, (horse,
pig, dog, cat), as in the ruminants such agents tend to be diluted in
the first three stomachs and rendered more harmless.
Mechanical irritants may cause the lesion and infection atrium in
any of the domestic animals, pins, needles, nails, pieces of wire and
other sharp pointed bodies being swallowed by horse and ox, and
small stones, pieces of bone, and all sorts of irritant objects picked up
by the puppy or rabid dog.
Cooked food swallowed hurriedly at too high a temperature is
especially liable to start necrotic changes in the single stomach of
horse, pig or dog, the ruminant being in a measure protected by the
food passing first into the rumen.
The wounds caused by gastric parasites may become the starting
points of molecular degeneration and ulceration. In the horse the
spiroptera megastoma, s. microstoma, and the larvæ of the various
œstri; in cattle and sheep the strongylus contortus, s. convulutus, s.
filicollis and s. vicarius; in swine the spiroptera strongylina,
Simondsia paradoxa, and gnathostoma hispida; in dogs spiroptera
sanguinolenta, and in cats the ollulanus tricuspis act in this way.
Gastric catarrh debilitates the affected mucosa and lays it open to
necrotic microbian infection especially in the pyloric sac and on the
summit of the folds.
Interruption of the local circulation in the deeper parts of the
mucosa as in inflammation and capillary thrombosis, arterial
embolism, venous thrombosis, may lead to local sloughing and
ulcerous infection. This may be seen in the petechial fever of the
horse, malignant catarrh, rinderpest, and anthrax in cattle and
sheep, and in canine distemper in dogs. Vogel found ulcers resulting
from a gastric aneurism in the dog.
Tumors and infective growths in the walls of the stomach may
prove an occasion of ulceration. Thus sarcoma, epithelioma,
actinomycosis and tubercle may be the primary morbid lesion in
different cases.
Gastric ulcers have also been attributed to morbid nervous
influences as in dogs they have been found associated with lesions of
the dorsal myelon, and the corpora quadrigemini, and faradisation of
the vagus has apparently led to their production.
General constitutional debility has been alleged as a factor, and
experimentally in dogs, the hypodermic or intravenous injection of
various microbes or their toxins (diphtheritic toxin, Enriquez and
Hallion, staphylococci, Panum, Lebert, Letulle, and a bacillus of
dysentery in man, Chantemesse and Widal), have produced gastric
ulcers.
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Title: Amos Judd
Author: John Ames Mitchell
Illustrator: Arthur Ignatius Keller
Release date: November 7, 2023 [eBook #72058]
Language: English
Original publication: New York: Charles Scribner's Sons, 1895
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AMOS JUDD
AMOS JUDD
BY
J. A. MITCHELL
ILLUSTRATED BY A. I. KELLER
NEW YORK
CHARLES SCRIBNER’S SONS
1901
Copyright, 1895, 1901, by Charles Scribner’s Sons

ILLUSTRATIONS
FROM DRAWINGS IN COLOR BY A. I. KELLER
Vignette Title-Page
Facing page
“How much do they represent, the whole lot”
18
“I beg your pardon, I—I was startled” 48
It seemed a long five minutes 136
Gently rocking with both feet on the ground 168
“I thank you, Bull, for chasing me into Molly
182
Cabot’s heart”
“He is the image of you” 206
“The end has come, my Moll” 250
AMOS JUDD
I
AT the station of Bingham Cross Roads four passengers got off the
train. One, a woman with bundles, who was evidently familiar with
her surroundings, walked rapidly away through the hot September
sunshine toward the little village in the distance.
The other three stood on the platform and looked about, as if taking
their bearings. They were foreigners of an unfamiliar species. Their
fellow-passengers in the car had discussed them with an interest not
entirely free from suspicion, and their finally getting out at such an
unimportant station as Bingham Cross Roads caused a surprise
which, although reasonably under control, was still too strong for
concealment. From the windows of the car at least a dozen pairs of
eyes were watching them. The two men and the little boy who
composed this group were of dark complexion, with clean-cut,
regular features. The oldest, a man of sixty years or more, had a
military bearing, and was, if one could judge from appearances, a
person of authority in his own country, wherever that might be.
Although the younger man seemed to resemble him, it was in such a
general way that he might be either his son or no relation whatever.
But the little boy had excited a yet greater interest than his
companions. Although but six or seven years old, he comported
himself with as much dignity and reserve as the gentleman with the
silver hair. This gave the impression, and without apparent intention
on his part, that he also was an important personage. His dark eyes
were strikingly beautiful and, like those of his seniors, were distinctly
foreign in design.
When the train moved away the three travellers approached the man
with one suspender, who filled the position of station agent,
baggage-master, switchman, telegraph operator and freight clerk,
and inquired if there was a conveyance to the village of Daleford. He
pointed to a wagon at the farther end of the platform; that was the
Daleford stage. In answer to further questions they learned that the
next train back again, toward New York, left at six-thirty; that
Daleford was seven miles away; that they could spend an hour in
that village and catch the train without hurrying.
The only baggage on the platform consisted of two peculiar-looking
trunks, or rather boxes, which the multifarious official knew to be
theirs, as no similar articles had ever been manufactured in America.
They were covered with designs laid on in metal, all elaborately
engraved, and it was not suspected along the route that these
profuse and tarnished ornaments were of solid silver. This luggage
was strapped behind the stage, two venerable horses were
awakened and the travellers started off. Joe, the driver, a youth with
large ears and a long neck, soon gave his passengers some
excellent opportunities to explain themselves, which they neglected.
Aside from a few simple questions about Daleford and Mr. Josiah
Judd, to whose house they were going, the conversation was in a
language of which he had no knowledge. The first two miles of their
route lay along the Connecticut valley, after which they climbed to
higher ground. The boy seemed interested in the size of the elms,
the smell of the tobacco fields, the wild grapes, and the various
things that any boy might notice who had never seen their like
before.
The day was warm, and the road dusty, and when they entered
Daleford the boy, with the old gentleman’s arm about him, had been
asleep for several miles. Coming into the village at one end, they
drove down the main street, beneath double rows of elms that met
above their heads in lofty arches, the wide common on their right.
The strangers expressed their admiration at the size and beauty of
these trees. Moreover the cool shade was restful and refreshing. No
signs of human life were visible either in the street or about the white
houses that faced the common, and this with the unbroken silence
gave an impression that the inhabitants, if they existed, were either
absent or asleep.
The driver stopped for a moment at the post-office which occupied a
corner in the only store, and gave the mail-bag to the post-mistress,
a pale young woman with eye-glasses and a wealth of artificial hair;
then, after rumbling through the village for half a mile, they found
themselves again in the country.
The last house on the right, with its massive portico of Doric
columns, seemingly of white marble, had the appearance of a
Grecian temple. But these appearances were deceptive, the building
being a private residence and the material of native pine.
As they approached this mendacious exterior the little boy said
something in the foreign language to his companions, whereupon
they told the driver to stop at the door, as Mr. Judd was inside.
“That ain’t Mr. Judd’s house,” he answered. “His is nearly a mile
farther on, around that hill,” and he gave the horses a gentle blow to
emphasize the information. But the boy repeated his statement,
whatever it was, and the younger man said, with some decision:
“Mr. Judd is inside. Stop here.”
As the driver drew up before the house he remarked, with a sarcastic
smile:
“If Mr. Judd lives here, he’s moved in since mornin’.”
But the remark made no visible impression. They all got out, and
while the two men approached the front door by an old-fashioned
brick walk, the boy strolled leisurely through the grassy yard beside
the house. The driver was speculating within himself as to what kind
of a pig-headed notion made them persist in stopping at Deacon
Barlow’s, when, to his surprise, Mr. Judd emerged from a doorway at
the side and advanced with long strides toward the diminutive figure
in his path.
Mr. Judd was a man about sixty years of age, tall, thin and high-
shouldered. His long, bony face bore no suggestions of beauty, but
there was honesty in every line. The black clothes which hung
loosely upon his figure made him seem even taller and thinner than
he really was. The boy looked him pleasantly in the face and, when
he had approached sufficiently near, said, in a clear, childish voice,
slowly and with laborious precision:
“Josiah Judd, the General Subahdàr Divodas Gadi and the Prince
Rájanya Kásim Mir Dewân Musnud desire to speak with you.”
Mr. Judd stopped short, the bushy eyebrows rising high in
astonishment. His mouth opened, but no sound came forth. The
foreign appearance of the speaker, his familiar manner of addressing
one so much older than himself, together with a demeanor that
showed no signs of disrespect, and above all, his allusion to the
presence of titled strangers caused the American to suspect, for a
few seconds, that he was the victim of some mental irregularity. He
pushed the straw hat from his forehead, and looked more carefully.
The youthful stranger observed this bewilderment, and he was
evidently surprised that such a simple statement should be received
in so peculiar a manner. But Mr. Judd recovered his composure,
lowered the bushy eyebrows, and drawing his hand across his
mouth as if to get it into shape again, asked:
“Who did you say wanted to see me, sonny?”
A small hand was ceremoniously waved toward the two strangers
who were now approaching along the Doric portico. Coming up to
Mr. Judd they saluted him with a stately deference that was seldom
witnessed in Daleford, and the General handed him a letter, asking if
he were not Mr. Josiah Judd.
“Yes, sir, that’s my name,” and as he took the letter, returned their
salutations politely, but in a lesser degree. He was not yet sure that
the scene was a real one. The letter, however, was not only real, but
he recognized at once the handwriting of his brother Morton, who
had been in India the last dozen years. Morton Judd was a
successful merchant and had enjoyed for some years considerable
financial and political importance in a certain portion of that country.
DEAR Josiah: This letter will be handed you by two
trustworthy gentlemen whose names it is safer not to
write. They will explain all you wish to know regarding the
boy they leave in your charge. Please take care of this boy
at least for a time and treat him as your own son. I am
writing this at short notice and in great haste. You have
probably read of the revolution here that has upset
everything. This boy’s life, together with the lives of many
others, depends upon the secrecy with which we keep the
knowledge of his whereabouts from those now in power.
Will write you more fully of all this in a few days. Give my
love to Sarah, and I hope you are all well. Hannah and I
are in excellent health. Your affectionate brother,
Morton Judd.
P. S. You might give out that the boy is an adopted child of
mine and call him Amos Judd, after father.
These words threw a needed light on the situation. He shook hands
with the two visitors and greeted them cordially, then, approaching
the boy who was absorbed in the movements of some turkeys that
were strolling about the yard, he bent over and held out his hand,
saying, with a pleasant smile:
“And you, sir, are very welcome. I think we can take good care of
you.”
But the child looked inquiringly from the hand up to its owner’s face.
“Mr. Judd wishes to take your hand,” said the General, then adding,
by way of explanation, “He never shook hands before. But these
customs he will soon acquire.” The small hand was laid in the large
one and moved up and down after the manner of the country.
“Don’t they shake hands in India?” asked Mr. Judd, as if it were
something of a joke. “How do you let another man know you’re glad
to see him?”
“Oh, yes, we shake hands sometimes. The English taught us that.
But it is not usual with persons of his rank. It will be easily learned,
however.”
After a word or two more they took their seats in the wagon, the boy
at his own request getting in front with the driver. They soon came in
sight of the Judd residence, a large, white, square, New England
farmhouse of the best type, standing on rising ground several
hundred feet from the road, at the end of a long avenue of maples.
Clustered about it were some magnificent elms. As they entered the
avenue the driver, whose curiosity could be restrained no longer,
turned and said to the boy:
“Did you ever see Mr. Judd before?”
“No.”
“Then how did you know ’twas him?”
“By his face.”
He looked down with a sharp glance, but the boy’s expression was
serious, even melancholy.
“Ever been in this town before?”
“No.”
“Did Mr. Judd know you was comin’?”
“No.”
“Then what in thunder made you s’pose he was in Deacon
Barlow’s?”
“In thunder?”
“What made you think he was in that house?”
The boy looked off over the landscape and hesitated before
answering.
“I knew he was to be there.”
“Oh, then he expected you?”
“No.”
Joe laughed. “That’s sort of mixed, ain’t it? Mr. Judd was there to
meet you when he didn’t know you were comin’. Kinder met you by
appointment when there wasn’t any.” This was said in a sarcastic
manner, and he added:
“You was pretty sot on stoppin’ and I’d like to know how you come to
be so pop sure he was inside.”
The dark eyes looked up at him in gentle astonishment. This gave
way to a gleam of anger, as they detected a mocking expression,
and the lips parted as if to speak. But there seemed to be a change
of mind, for he said nothing, looking away toward the distant hills in
contemptuous silence. The driver, as a free and independent
American, was irritated by this attempted superiority in a foreigner,
and especially in such a young one, but there was no time to
retaliate.
Mrs. Judd, a large, sandy-haired, strong-featured woman, gave the
guests a cordial welcome. The outlandish trunks found their way
upstairs, instructions were given the driver to call in an hour, and
Mrs. Judd, with the servant, hastened preparations for a dinner, as
the travellers, she learned, had eaten nothing since early morning.
When these were going on Mr. Judd and the three guests went into
the parlor, which, like many others in New England, was a triumph of
severity. Although fanatically clean, it possessed the usual stuffy
smell that is inevitable where fresh air and sunlight are habitually
excluded. There were four windows, none of which were open. All
the blinds were closed. In this dim light, some hair ornaments, wax
flowers, a marriage certificate and a few family photographs of
assiduous and unrelenting aspect seemed waiting, in hostile
patience, until the next funeral or other congenial ceremony should
disturb their sepulchral peace. While the men seated themselves
about the table, the boy climbed upon a long horse-hair sofa,
whence he regarded them with a bored but dignified patience. The
General, before seating himself, had taken from his waist an old-
fashioned money-belt, which he laid upon the table. From this he
extracted a surprising number of gold and silver coins and arranged
them in little stacks. Mr. Judd’s curiosity was further increased when
he took from other portions of the belt a number of English bank-
notes, which he smoothed out and also laid before his host.
“There are twelve thousand pounds in these notes,” he said, “and
about two thousand in sovereigns, with a few hundred in American
money.”
“Fourteen thousand pounds,” said Mr. Judd, making a rough
calculation, “that’s about seventy thousand dollars.”
The General nodded toward the boy. “It belongs to him. Your brother,
Mr. Morton Judd, perhaps told you we left in great haste, and this is
all of the available property we had time to convert into money. The
rest will be sent you later. That is, whatever we can secure of it.”
Now Mr. Judd had never been fond of responsibility. It was in fact his
chief reason for remaining on the farm while his younger brother
went out into the world for larger game. Moreover, seventy thousand
dollars, to one brought up as he had been, seemed an absurdly
large amount of money to feed and clothe a single boy.
“But what am I to do with it? Save it up and give him the interest?”
“Yes, or whatever you and Mr. Morton Judd may decide upon.”
While Mr. Judd was drawing his hand across his forehead to smooth
out the wrinkles he felt were coming, the General brought forth from
an inner pocket a small silk bag. Untying the cord he carefully
emptied upon the table a handful of precious stones. Mr. Judd was
no expert in such things, but they were certainly very pretty to look at
and, moreover, they seemed very large.
“These,” continued the General, “are of considerable value, the
rubies particularly, which, as you will see, are of unusual size.”
He spoke with enthusiasm, and held up one or two of them to the
light. Mr. Judd sadly acknowledged that they were very handsome,
and threw a hostile glance at the gleaming, many-colored, fiery-eyed
mass before him. “How much do they represent, the whole lot?”
The General looked inquiringly at his companion. The Prince shook
his head. “It is impossible to say, but we can give a rough estimate.”
Then taking them one by one, rubies, diamonds, emeralds, pearls,
and sapphires, they made a list, putting the value of each in the
currency of their own country, and figured up the total amount in
English pounds.
“As near as it is possible to estimate,” said the Prince, “their value is
about one hundred and sixty thousand pounds.”
“How much do they represent, the whole lot”
“One hundred and sixty thousand pounds!” exclaimed Mr. Judd.
“Eight hundred thousand dollars!” and with a frown he pushed his
chair from the table. The General misunderstood the movement, and
said: “But, sir, there are few finer jewels in India, or even in the
world!”
“Oh, that’s all right,” said Mr. Judd. “I’m not doubting their worth. It’s
only kind of sudden,” and he drew his hands across his eyes, as if to
shut out the dazzling mass that flashed balefully up at him from the
table. For a New England farmer, Josiah Judd was a prosperous
man. In fact he was the richest man in Daleford. But if all his earthly
possessions were converted into cash they would never realize a
tenth part of the unwelcome treasure that now lay before him. He
was, therefore, somewhat startled at being deluged, as it were, out
of a clear sky, with the responsibility of nearly a million dollars. The
guests also mentioned some pearls of extraordinary value in one of
the trunks.
“Well,” he said, with an air of resignation, “I s’pose there’s no dodgin’
it, and I’ll have to do the best I can till I hear from Morton. After the
boy goes back to India of course I sha’n’t have the care of it.”
The General glanced toward the sofa to be sure he was not
overheard, then answered, in a low voice: “It will be better for him
and will save the shedding of blood if he never returns.”
But the boy heard nothing in that room. He was slumbering
peacefully, with his head against the high back of the sofa, and his
spirit, if one could judge from the smile upon his lips, was once more
in his own land, among his own people. Perhaps playing with
another little boy in an Oriental garden, a garden of fountains and
gorgeous flowers, of queer-shaped plants with heavy foliage, a quiet,
dreamy garden, where the white walls of the palace beside it were
supported by innumerable columns, with elephants’ heads for
capitals: where, below a marble terrace, the broad Ganges
shimmered beneath a golden sun.
Maybe the drowsy air of this ancestral garden with its perfume of
familiar flowers made his sleep more heavy, or was it the thrum of
gentle fingers upon a mandolin in a distant corner of the garden,
mingling with a woman’s voice?
Whatever the cause, it produced a shock, this being summoned
back to America, to exile, and to the hair-cloth sofa by the voice of
Mrs. Judd announcing dinner; for the step was long and the change
was sudden from the princely pleasure garden to the Puritan parlor,
and every nerve and fibre of his Oriental heart revolted at the
outrage. There was a war-like gleam in the melancholy eyes as he
joined the little procession that moved toward the dining-room. As
they sat at table, the three guests with Mrs. Judd, who poured the
tea, he frowned with hostile eyes upon the steak, the boiled
potatoes, the large wedge-shaped piece of yellow cheese, the
pickles, and the apple-pie. He was empty and very hungry, but he
did not eat. He ignored the example of the General and the Prince,
who drank the strong, green tea, and swallowed the saleratus
biscuits as if their hearts’ desires at last were gratified. He scowled
upon Mrs. Judd when she tried to learn what he disliked the least.
But her husband, swaying to and fro in a rocking-chair near the
window, had no perception of the gathering cloud, and persisted in
questioning his visitors in regard to India, the customs of the people,
and finally of their own home life. Mrs. Judd had noticed the black
eyebrows and restless lips were becoming more threatening as the
many questions were answered; that the two-pronged fork of horn
and steel was used solely as an offensive weapon to stab his
potatoes and his pie.
At last the tempest came. The glass of water he had raised with a
trembling hand to his lips was hurled upon the platter of steak, and
smashed into a dozen pieces. With a swift movement of his arms, as
if to clear the deck, he pushed the pickles among the potatoes and
swept his pie upon the floor. Then, after a futile effort to push his
chair from the table, he swung his legs about and let himself down
from the side. With a face flushed with passion, he spoke rapidly in a
language of which no word was familiar to his host or hostess, and
ended by pointing dramatically at Mr. Judd, the little brown finger
quivering with uncontrollable fury. It appeared to the astonished
occupant of the rocking-chair that the curse of Allah was being

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SECTIONAL ANATOMY BY MRI AND CT, FOURTH EDITION ISBN: 978-0-323-39419-2

Copyright © 2017 by Elsevier, Inc. All rights reserved.

Previous editions copyrighted 2007, 1995, and 1990.

Library of Congress Cataloging-in-Publication Data

Content Strategist: Robin Carter

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Chapter 8 MRI of the Hand, 196

SECTION IV THORAX Chapter 23 CT of the Female Pelvis, 537

MRI of the Pectoral Girdle

C5-6 disc level

Figure 1.1.2 Platysma m

Levator Splenius cervicis Multifidus m

Figure 1.1.3 Distal

Trapezius m Transverse cervical Levator Splenius m Rhomboid

Figure 1.1.4 Middle

Acromioclavicular Externa Serratus Anterior Sternocleido-

Figure 1.1.5 Supraspinatus m

Supraspinatus t Scapular Trapezius m Levator Trapezius m Rhomboid

Figure 1.1.6 Thoracoacromial a,

Scapular Supraspinatus m Trapezius m Rhomboid Splenius capitis Semispinalis

Figure 1.1.7 Conjoined t of

Suprascapular neurovascular Infraspinatus m Scapular Serratus Trapezius m

Figure 1.1.8 Humeral

Infraspinatus m Suprascapular Infraspinatus m Subscapularis m Trapezius m Serratus

Figure 1.1.9 Lesser

Greater Erector spinae m

Figure 1.1.10 Deltoid m,

Figure 1.1.11 Coracobrachialis m

Triceps brachii m, Teres Teres Infraspinatus m Scapular body Serratus

Figure 1.1.12 Biceps brachii t,

Superior Right lung

Figure 1.1.13 Biceps brachii m,

Latissimus Right mainstem

Triceps Vertebral body

Teres Latissimus Teres Inferior

Figure 1.1.14 Biceps brachii m,

Figure 1.1.15 Biceps brachii m,

Biceps Internal thoracic

Subscapularis m Teres Inferior Serratus Rhomboid Trapezius m

Figure 1.1.16 Coracobrachialis m

Latissimus Teres Inferior Serratus Rhomboid

Figure 1.1.17 Biceps brachii m,

Neurovascular Latissimus Teres Serratus Inferior medial Rhomboid

Figure 1.1.18 Biceps brachii m,

Brachial Latissimus Long thoracic Serratus Inferior medial

Figure 1.1.19 Biceps brachii m,

Radial n and Vertebral

Triceps brachii m, Brachial Latissimus Serratus Latissimus Rib

Figure 1.2.2 Infraspinatus t Deltoid m

Deltoid Triceps brachii m,

Figure 1.2.3 Infraspinatus t

Biceps brachii t, Posterior circumflex

Figure 1.2.4 Acromion

Figure 1.2.5 Supraspinatus m and t

Posterior circumflex a Teres major m

Radial n and deep

Figure 1.2.6 Distal clavicle Distal scapular spine

Pectoralis major m Latissimus dorsi m

Brachial neurovascular bundle

SECTIONAL ANATOMY BY MRI AND CT, FOURTH EDITION ISBN: 978-0-323-39419-2