Diagnostic Imaging: Spine 4th Edition

Jeffrey S. Ross Md And Kevin R. Moore

Md Author
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 FOURTH EDITION

s oR
e ro M

i
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 FOURTH EDITION

Jeffrey S. Ross, MD
Consultant
Neuroradiology Division
Department of Radiology
Mayo Clinic in Arizona
Professor of Radiology
Mayo Clinic College of Medicine
Phoenix, Arizona

Kevin R. Moore, MD
Pediatric Radiologist and Neuroradiologist
Primary Children’s Hospital
Salt Lake City, Utah

iii
 Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

DIAGNOSTIC IMAGING: SPINE, FOURTH EDITION ISBN: 978-0-323-79399-5

Copyright © 2021 by Elsevier. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as
may be noted herein).

Notices

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds or experiments described herein.
Because of rapid advances in the medical sciences, in particular, independent verification of
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assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or
property as a matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.

Previous edition copyrighted 2015.

Library of Congress Control Number: 2020941756

Printed in Canada by Friesens, Altona, Manitoba, Canada

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

iv
 Dedication
Blessed is the one who finds wisdom,
And the one who gets understanding.
– Proverbs 3:13
JSR

Once again, I have the great fortune to work with Dr. Jeffrey Ross and the
excellent editorial and production staff at Elsevier, who spend countless hours in
the background attending to the many tiny details that distinguish an excellent
book. Although they frequently work in anonymity, the importance of these
team members is difficult to overstate. We are deeply indebted to them. I would
also like to acknowledge (and thank!) my wife and colleagues, who directly
or indirectly have supported the devotion of many hours’ time committed to
completing this project.
KRM

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Contributing Authors

Nicholas A. Koontz, MD
Sara M. O’Hara, MD, FAAP
Usha D. Nagaraj, MD

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viii
 Preface
Welcome to the 4th edition of Diagnostic Imaging: Spine. Five years have passed since
the 3rd edition, and 16 years have flown by since the 1st edition was published in 2004.
This edition is a complete refresh with many new images, new categories of disease
(such as CSF leaks), new diagnoses, new art, and updated text and references. The same
wonderful formatting is present, with individual diagnoses capable of standing alone, but
with a logical integration within the larger sections. The Key Facts box retains its visual
prominence at the beginning of each diagnosis, allowing for a quick scan of the most
important bullet points when time is critical and attention spans are short. The text format
remains in the hallmark Diagnostic Imaging bulleted form that allows a large amount of
important information to be displayed in an easy-to-use and inviting layout. Prose text
chapters are included for the introduction to major sections, which are color coded, and
the use of tables allows quick scanning for important data and measurements.

Our coauthors and the staff at Elsevier are amazing to work with, and we have been
extremely fortunate to interact and learn from such a fantastic team. We hope you find
this edition useful, not only as a reference, but as an essential component in your daily
practice and in your care of patients.

Jeffrey S. Ross, MD
Consultant
Neuroradiology Division
Department of Radiology
Mayo Clinic in Arizona
Professor of Radiology
Mayo Clinic College of Medicine
Phoenix, Arizona

Kevin R. Moore, MD
Pediatric Radiologist and Neuroradiologist
Primary Children’s Hospital
Salt Lake City, Utah

ix
x
Acknowledgments
LEAD EDITOR
Nina I. Bennett, BA

LEAD ILLUSTRATOR
Richard Coombs, MS

TEXT EDITORS
Arthur G. Gelsinger, MA
Rebecca L. Bluth, BA
Terry W. Ferrell, MS
Megg Morin, BA
Kathryn Watkins, BA

IMAGE EDITORS
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS

ILLUSTRATIONS
Lane R. Bennion, MS
Laura C. Wissler, MA

ART DIRECTION AND DESIGN

Tom M. Olson, BA

PRODUCTION EDITORS
Emily C. Fassett, BA
John Pecorelli, BS

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 Sections

SECTION 1:
Congenital and Genetic Disorders

SECTION 2:
Trauma

SECTION 3:
Degenerative Diseases and Arthritides

SECTION 4:
Infection and Inflammatory Disorders

SECTION 5:
Neoplasms, Cysts, and Other Masses

SECTION 6:
Peripheral Nerve and Plexus

SECTION 7:
Spine Postprocedural Imaging

xiii
 TABLE OF CONTENTS

80 Lipomyelomeningocele
SECTION 1: CONGENITAL AND GENETIC Kevin R. Moore, MD and Usha D. Nagaraj, MD
DISORDERS 84 Lipoma
CONGENITAL Kevin R. Moore, MD and Jeffrey S. Ross, MD
88 Dorsal Dermal Sinus
NORMAL ANATOMICAL VARIATIONS Kevin R. Moore, MD
92 Simple Coccygeal Dimple
4 Normal Anatomy Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 94 Dermoid Cyst
10 Measurement Techniques Kevin R. Moore, MD
Jeffrey S. Ross, MD 98 Epidermoid Cyst
16 MR Artifacts Kevin R. Moore, MD
Kevin R. Moore, MD
22 Normal Variant ANOMALIES OF CAUDAL CELL MESS
Kevin R. Moore, MD 102 Tethered Spinal Cord
26 Craniovertebral Junction Variants Kevin R. Moore, MD
Kevin R. Moore, MD 106 Segmental Spinal Dysgenesis
30 Ponticulus Posticus Kevin R. Moore, MD and Jeffrey S. Ross, MD
Kevin R. Moore, MD 110 Caudal Regression Syndrome
32 Ossiculum Terminale Kevin R. Moore, MD
Kevin R. Moore, MD 114 Terminal Myelocystocele
34 Conjoined Nerve Roots Kevin R. Moore, MD and Jeffrey S. Ross, MD
Kevin R. Moore, MD 118 Anterior Sacral Meningocele
38 Limbus Vertebra Kevin R. Moore, MD
Kevin R. Moore, MD 122 Sacral Extradural Arachnoid Cyst
42 Filum Terminale Fibrolipoma Kevin R. Moore, MD
Kevin R. Moore, MD 126 Sacrococcygeal Teratoma
44 Bone Island Kevin R. Moore, MD and Sara M. O'Hara, MD, FAAP
Kevin R. Moore, MD
46 Ventriculus Terminalis ANOMALIES OF NOTOCHORD AND
Kevin R. Moore, MD VERTEBRAL FORMATION
CHIARI DISORDERS 130 Craniovertebral Junction Embryology
Kevin R. Moore, MD
50 Approach to Chiari 136 Paracondylar Process
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
56 Chiari 1 138 Split Atlas
Kevin R. Moore, MD and Usha D. Nagaraj, MD Kevin R. Moore, MD
60 Complex Chiari 140 Klippel-Feil Spectrum
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD
62 Chiari 2 144 Failure of Vertebral Formation
Kevin R. Moore, MD and Usha D. Nagaraj, MD Kevin R. Moore, MD
66 Chiari 3 148 Vertebral Segmentation Failure
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD
ABNORMALITIES OF NEURULATION 152 Split Cord Malformation
Kevin R. Moore, MD
68 Approach to Spine and Spinal Cord Development 156 Partial Vertebral Duplication
Kevin R. Moore, MD Kevin R. Moore, MD
76 Myelomeningocele 158 Incomplete Fusion, Posterior Element
Kevin R. Moore, MD and Usha D. Nagaraj, MD Kevin R. Moore, MD

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 TABLE OF CONTENTS
160 Neurenteric Cyst 258 Burst C2 Fracture
Kevin R. Moore, MD and Usha D. Nagaraj, MD Jeffrey S. Ross, MD
262 Hangman's C2 Fracture
DEVELOPMENTAL ABNORMALITIES Jeffrey S. Ross, MD
164 Os Odontoideum 266 Apophyseal Ring Fracture
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
168 Lateral Meningocele 270 Cervical Hyperflexion Injury
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
172 Dorsal Spinal Meningocele 276 Cervical Hyperextension Injury
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
176 Dural Dysplasia 280 Cervical Burst Fracture
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
284 Cervical Hyperflexion-Rotation Injury
GENETIC DISORDERS Kevin R. Moore, MD
180 Neurofibromatosis Type 1 286 Cervical Lateral Flexion Injury
Kevin R. Moore, MD Jeffrey S. Ross, MD
184 Neurofibromatosis Type 2 288 Cervical Posterior Column Injury
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
188 Schwannomatosis 290 Traumatic Disc Herniation
Kevin R. Moore, MD and Nicholas A. Koontz, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
190 Achondroplasia 292 Thoracic and Lumbar Burst Fracture
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
194 Mucopolysaccharidoses 296 Facet-Lamina Thoracolumbar Fracture
Kevin R. Moore, MD Kevin R. Moore, MD
198 Sickle Cell Disease 298 Fracture Dislocation
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
202 Osteogenesis Imperfecta 300 Chance Fracture
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
206 Tuberous Sclerosis 306 Thoracic and Lumbar Hyperextension Injury
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
210 Osteopetrosis 308 Compression Fracture
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
212 Gaucher Disease 312 Lumbar Facet-Posterior Fracture
Kevin R. Moore, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
214 Ochronosis 314 Sacral Traumatic Fracture
Kevin R. Moore, MD Kevin R. Moore, MD
216 Connective Tissue Disorders 318 Pedicle Stress Fracture
Kevin R. Moore, MD Jeffrey S. Ross, MD
220 Spondyloepiphyseal Dysplasia 322 Sacral Insufficiency Fracture
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD

SECTION 2: TRAUMA CORD, DURA, AND VESSELS

326 SCIWORA
VERTEBRAL COLUMN, DISCS, AND Kevin R. Moore, MD
PARASPINAL MUSCLE 330 Posttraumatic Syrinx
226 Fracture Classification Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 334 Presyrinx Edema
232 Atlantooccipital Dislocation Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 338 Spinal Cord Contusion-Hematoma
236 Ligamentous Injury Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 344 Central Spinal Cord Syndrome
240 Occipital Condyle Fracture Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 348 Traumatic Dural Tear
244 Jefferson C1 Fracture Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 352 Traumatic Epidural Hematoma
248 Atlantoaxial Rotatory Fixation Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 356 Traumatic Subdural Hematoma
254 Odontoid C2 Fracture Jeffrey S. Ross, MD
Jeffrey S. Ross, MD

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 TABLE OF CONTENTS
358 Vascular Injury, Cervical
Jeffrey S. Ross, MD
SPONDYLOLISTHESIS AND SPONDYLOLYSIS
364 Traumatic Arteriovenous Fistula 478 Spondylolisthesis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
366 Wallerian Degeneration 482 Spondylolysis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
486 Instability
SECTION 3: DEGENERATIVE DISEASES Kevin R. Moore, MD and Jeffrey S. Ross, MD
AND ARTHRITIDES
INFLAMMATORY, CRYSTALLINE, AND
DEGENERATIVE DISEASES MISCELLANEOUS ARTHRITIDES
370 Nomenclature of Degenerative Disc Disease 490 Adult Rheumatoid Arthritis
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
374 Degenerative Disc Disease 496 Juvenile Idiopathic Arthritis
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
380 Degenerative Endplate Changes 502 Spondyloarthropathy
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
384 Degenerative Arthritis of Craniovertebral Junction 508 Neurogenic (Charcot) Arthropathy
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
388 Disc Bulge 512 Hemodialysis Spondyloarthropathy
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
392 Anular Fissure, Intervertebral Disc 514 Ankylosing Spondylitis
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
396 Cervical Intervertebral Disc Herniation 520 CPPD
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
402 Thoracic Intervertebral Disc Herniation 526 Gout
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
406 Lumbar Intervertebral Disc Herniation 528 Longus Colli Calcific Tendinitis
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
412 Intervertebral Disc Extrusion, Foraminal
Jeffrey S. Ross, MD SCOLIOSIS AND KYPHOSIS
416 Cervical Facet Arthropathy 532 Introduction to Scoliosis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
420 Lumbar Facet Arthropathy 536 Scoliosis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
424 Facet Joint Synovial Cyst 540 Kyphosis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
430 Baastrup Disease 542 Degenerative Scoliosis
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
434 Bertolotti Syndrome 546 Flat Back Syndrome
Jeffrey S. Ross, MD Kevin R. Moore, MD
436 Schmorl Node 548 Scoliosis Instrumentation
Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
440 Scheuermann Disease
Jeffrey S. Ross, MD and Kevin R. Moore, MD SECTION 4: INFECTION AND
444 Acquired Lumbar Central Stenosis INFLAMMATORY DISORDERS
Jeffrey S. Ross, MD
448 Congenital Spinal Stenosis, Idiopathic INFECTIONS
Kevin R. Moore, MD 554 Pathways of Spread
454 Cervical Spondylosis Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 558 Spinal Meningitis
460 DISH Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 562 Pyogenic Osteomyelitis
464 OPLL Kevin R. Moore, MD
Jeffrey S. Ross, MD 568 Tuberculous Osteomyelitis
470 Ossification Ligamentum Flavum Kevin R. Moore, MD
Jeffrey S. Ross, MD 574 Fungal and Miscellaneous Osteomyelitis
474 Retroodontoid Pseudotumor Jeffrey S. Ross, MD
Jeffrey S. Ross, MD

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 TABLE OF CONTENTS
578 Osteomyelitis, C1-C2
Jeffrey S. Ross, MD
SECTION 5: NEOPLASMS, CYSTS, AND
582 Brucellar Spondylitis
OTHER MASSES
Jeffrey S. Ross, MD and Kevin R. Moore, MD NEOPLASMS
584 Septic Facet Joint Arthritis
Jeffrey S. Ross, MD INTRODUCTION AND OVERVIEW
590 Paraspinal Abscess
Jeffrey S. Ross, MD 678 Spread of Neoplasms
594 Epidural Abscess Jeffrey S. Ross, MD
Jeffrey S. Ross, MD EXTRADURAL
600 Subdural Abscess
Jeffrey S. Ross, MD and Kevin R. Moore, MD 682 Imaging of Metastatic Disease
604 Abscess, Spinal Cord Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 688 Blastic Osseous Metastases
608 Viral Myelitis Jeffrey S. Ross, MD
Jeffrey S. Ross, MD and Kevin R. Moore, MD 692 Lytic Osseous Metastases
612 HIV Myelitis Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 696 Hemangioma
616 Syphilitic Myelitis Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 700 Osteoid Osteoma
618 Opportunistic Infections Kevin R. Moore, MD
Jeffrey S. Ross, MD and Kevin R. Moore, MD 704 Osteoblastoma
622 Echinococcosis Jeffrey S. Ross, MD and Kevin R. Moore, MD
Jeffrey S. Ross, MD 708 Aneurysmal Bone Cyst
626 Schistosomiasis Jeffrey S. Ross, MD and Kevin R. Moore, MD
Jeffrey S. Ross, MD 712 Giant Cell Tumor
630 Cysticercosis Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 716 Osteochondroma
Jeffrey S. Ross, MD and Kevin R. Moore, MD
INFLAMMATORY AND AUTOIMMUNE 720 Chondrosarcoma
DISORDERS Jeffrey S. Ross, MD
724 Osteosarcoma
634 Acute Transverse Myelopathy
Jeffrey S. Ross, MD and Kevin R. Moore, MD
Jeffrey S. Ross, MD
728 Chordoma
638 Idiopathic Acute Transverse Myelitis
Jeffrey S. Ross, MD and Kevin R. Moore, MD
Jeffrey S. Ross, MD and Kevin R. Moore, MD
734 Ewing Sarcoma
642 Multiple Sclerosis
Jeffrey S. Ross, MD and Kevin R. Moore, MD
Jeffrey S. Ross, MD
738 Lymphoma
646 Neuromyelitis Optica Spectrum Disorder
Jeffrey S. Ross, MD
Jeffrey S. Ross, MD
744 Leukemia
650 Myelin Oligodendrocyte Glycoprotein Autoantibody
Jeffrey S. Ross, MD and Kevin R. Moore, MD
Myelitis
748 Plasmacytoma
Jeffrey S. Ross, MD
Jeffrey S. Ross, MD
652 ADEM
752 Multiple Myeloma
Kevin R. Moore, MD
Jeffrey S. Ross, MD
656 Guillain-Barré Syndrome
756 Neuroblastic Tumor
Jeffrey S. Ross, MD and Kevin R. Moore, MD
Kevin R. Moore, MD
660 CIDP
760 Langerhans Cell Histiocytosis
Jeffrey S. Ross, MD
Kevin R. Moore, MD
664 Chronic Recurrent Multifocal Osteomyelitis
764 Angiolipoma
Jeffrey S. Ross, MD
Jeffrey S. Ross, MD and Kevin R. Moore, MD
666 Grisel Syndrome
Jeffrey S. Ross, MD INTRADURAL EXTRAMEDULLARY
668 Paraneoplastic Myelopathy
768 Schwannoma
Jeffrey S. Ross, MD
672 IgG4-Related Disease/Hypertrophic Pachymeningitis Jeffrey S. Ross, MD
774 Melanotic Schwannoma
Jeffrey S. Ross, MD
Jeffrey S. Ross, MD
776 Meningioma
Jeffrey S. Ross, MD

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 TABLE OF CONTENTS
782 Solitary Fibrous Tumor/Hemangiopericytoma 858 Intracranial Hypotension
Jeffrey S. Ross, MD Jeffrey S. Ross, MD and Kevin R. Moore, MD
786 Neurofibroma 862 Fast CSF Leak/Meningeal Diverticulum
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
790 Malignant Nerve Sheath Tumors 866 Fast CSF Leak/Ventral Dural Tear
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
794 Metastases, CSF Disseminated 870 Slow CSF Leak/CSF Venous Fistula
Jeffrey S. Ross, MD and Kevin R. Moore, MD Jeffrey S. Ross, MD
798 Paraganglioma 874 Idiopathic Spinal Cord Herniation
Jeffrey S. Ross, MD Jeffrey S. Ross, MD
INTRAMEDULLARY VASCULAR
802 Astrocytoma
Jeffrey S. Ross, MD and Kevin R. Moore, MD VASCULAR ANATOMY AND CONGENITAL
806 Ependymoma LESIONS
Jeffrey S. Ross, MD and Kevin R. Moore, MD 878 Vascular Anatomy
810 Myxopapillary Ependymoma Jeffrey S. Ross, MD
Jeffrey S. Ross, MD and Kevin R. Moore, MD 884 Persistent First Intersegmental Artery
814 Hemangioblastoma Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 886 Persistent Hypoglossal Artery
820 Spinal Cord Metastases Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 888 Persistent Proatlantal Artery
824 Primary Melanocytic Neoplasms/Melanocytoma Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD
826 Ganglioglioma VASCULAR MALFORMATIONS
Jeffrey S. Ross, MD 890 Spinal Dural Arteriovenous Fistula (Type 1)
Jeffrey S. Ross, MD
NONNEOPLASTIC CYSTS AND TUMOR 896 Spinal Cord Arteriovenous Malformation (Type 2)
MIMICS Jeffrey S. Ross, MD
900 Complex Spinal Cord Arteriovenous Malformation
CYSTS (Type 3)
828 CSF Flow Artifact Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 904 Spinal Perimedullary Fistula (Type 4)
830 Meningeal Cyst Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 908 Conus Arteriovenous Malformation
836 Perineural Root Sleeve Cyst Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 912 Posterior Fossa Dural Fistula With Intraspinal
840 Syringomyelia Drainage
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
916 Spinal Epidural Arteriovenous Fistula
NONNEOPLASTIC MASSES AND TUMOR Jeffrey S. Ross, MD
MIMICS 920 Cavernous Malformation
844 Epidural Lipomatosis Jeffrey S. Ross, MD
Kevin R. Moore, MD
846 Normal Fatty Marrow Variants VASCULAR MISCELLANEOUS
Kevin R. Moore, MD 924 Spinal Artery Aneurysm
848 Fibrous Dysplasia Jeffrey S. Ross, MD
Kevin R. Moore, MD 926 Spinal Cord Infarction
850 Calcifying Pseudoneoplasm of Neuraxis Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 930 Subarachnoid Hemorrhage
852 Kümmell Disease Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 934 Spontaneous Epidural Hematoma
854 Hirayama Disease Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 940 Subdural Hematoma
Kevin R. Moore, MD and Jeffrey S. Ross, MD
CSF LEAK DISORDERS 944 Superficial Siderosis
856 Introduction and Overview of CSF Leak Kevin R. Moore, MD and Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 948 Hematomyelia/Nontraumatic Cord Hemorrhage
Kevin R. Moore, MD and Jeffrey S. Ross, MD

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952 Bow Hunter Syndrome 1040 Peripheral Neurolymphomatosis
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD
954 Vertebral Artery Dissection 1042 Hypertrophic Neuropathy
Kevin R. Moore, MD and Jeffrey S. Ross, MD Kevin R. Moore, MD and Jeffrey S. Ross, MD

SYSTEMIC DISORDERS SECTION 7: SPINE POSTPROCEDURAL

IMAGING
SPINAL MANIFESTATIONS OF SYSTEMIC
DISEASES POSTOPERATIVE IMAGING AND
COMPLICATIONS
960 Osteoporosis
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1048 Surgical Approaches
964 Paget Disease Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1052 Normal Postoperative Change
968 Hyperparathyroidism Jeffrey S. Ross, MD
Kevin R. Moore, MD 1058 Postoperative Spinal Complications
970 Renal Osteodystrophy Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1064 Myelography Complications
972 Hyperplastic Vertebral Marrow Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1068 Vertebroplasty Complications
976 Myelofibrosis Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1072 Failed Back Surgery Syndrome
978 Bone Infarction Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1076 Recurrent Disc Herniation
980 Extramedullary Hematopoiesis Jeffrey S. Ross, MD
Kevin R. Moore, MD 1080 Peridural Fibrosis
984 Tumoral Calcinosis Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1084 Arachnoiditis/Adhesions
988 Sarcoidosis Jeffrey S. Ross, MD
Kevin R. Moore, MD and Jeffrey S. Ross, MD 1090 Arachnoiditis Ossificans
994 Hemophilic Pseudotumor Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 1092 Accelerated Degeneration
996 EBV-Associated Smooth Muscle Tumor Jeffrey S. Ross, MD
Jeffrey S. Ross, MD 1096 Postoperative Infection
998 Subacute Combined Degeneration Jeffrey S. Ross, MD
Kevin R. Moore, MD 1100 Pseudomeningocele
Jeffrey S. Ross, MD
SECTION 6: PERIPHERAL NERVE AND 1106 Postsurgical Deformity
PLEXUS Jeffrey S. Ross, MD

PLEXUS AND PERIPHERAL NERVE LESIONS HARDWARE

1004 Normal Plexus and Nerve Anatomy 1110 Metal Artifact
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1010 Superior Sulcus Tumor 1114 Occipitocervical Fixation
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1014 Thoracic Outlet Syndrome 1116 Plates and Screws
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1018 Muscle Denervation 1120 Cages
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1020 Brachial Plexus Traction Injury 1122 Interbody Fusion Devices
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1024 Idiopathic Brachial Plexus Neuritis 1126 Interspinous Spacing Devices
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1028 Traumatic Neuroma 1130 Cervical Artificial Disc
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1032 Radiation Plexopathy 1134 Lumbar Artificial Disc
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD
1036 Peripheral Nerve Sheath Tumor 1138 Hardware Failure
Kevin R. Moore, MD and Jeffrey S. Ross, MD Jeffrey S. Ross, MD and Kevin R. Moore, MD

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 TABLE OF CONTENTS
1144 Bone Graft Complications
Jeffrey S. Ross, MD
1148 rhBMP-2 Complications
Jeffrey S. Ross, MD
1152 Heterotopic Bone Formation
Jeffrey S. Ross, MD

POST RADIATION AND CHEMOTHERAPY

COMPLICATIONS
1156 Radiation Myelopathy
Kevin R. Moore, MD and Jeffrey S. Ross, MD
1160 Postirradiation Vertebral Marrow
Kevin R. Moore, MD
1164 Anterior Lumbar Radiculopathy
Kevin R. Moore, MD

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FOURTH EDITION

Ross
Moore

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 SECTION 1

Congenital and Genetic Disorders

Congenital

Normal Anatomical Variations

Normal Anatomy 4
Measurement Techniques 10
MR Artifacts 16
Normal Variant 22
Craniovertebral Junction Variants 26
Ponticulus Posticus 30
Ossiculum Terminale 32
Conjoined Nerve Roots 34
Limbus Vertebra 38
Filum Terminale Fibrolipoma 42
Bone Island 44
Ventriculus Terminalis 46

Chiari Disorders
Approach to Chiari 50
Chiari 1 56
Complex Chiari 60
Chiari 2 62
Chiari 3 66

Abnormalities of Neurulation
Approach to Spine and Spinal Cord Development 68
Myelomeningocele 76
Lipomyelomeningocele 80
Lipoma 84
Dorsal Dermal Sinus 88
Simple Coccygeal Dimple 92
Dermoid Cyst 94
Epidermoid Cyst 98

Anomalies of Caudal Cell Mess

Tethered Spinal Cord 102
Segmental Spinal Dysgenesis 106
Caudal Regression Syndrome 110
Terminal Myelocystocele 114
Anterior Sacral Meningocele 118
Sacral Extradural Arachnoid Cyst 122
Sacrococcygeal Teratoma 126
Anomalies of Notochord and Vertebral Formation
Craniovertebral Junction Embryology 130
Paracondylar Process 136
Split Atlas 138
Klippel-Feil Spectrum 140
Failure of Vertebral Formation 144
Vertebral Segmentation Failure 148
Split Cord Malformation 152
Partial Vertebral Duplication 156
Incomplete Fusion, Posterior Element 158
Neurenteric Cyst 160

Developmental Abnormalities
Os Odontoideum 164
Lateral Meningocele 168
Dorsal Spinal Meningocele 172
Dural Dysplasia 176

Genetic Disorders
Neurofibromatosis Type 1 180
Neurofibromatosis Type 2 184
Schwannomatosis 188
Achondroplasia 190
Mucopolysaccharidoses 194
Sickle Cell Disease 198
Osteogenesis Imperfecta 202
Tuberous Sclerosis 206
Osteopetrosis 210
Gaucher Disease 212
Ochronosis 214
Connective Tissue Disorders 216
Spondyloepiphyseal Dysplasia 220
 Normal Anatomy
Congenital and Genetic Disorders
Imaging Anatomy
There are 33 spinal vertebrae, which comprise 2 components:
A cylindrical ventral bone mass, which is the vertebral
body, and the dorsal arch.
7 cervical, 12 thoracic, 5 lumbar bodies
• 5 fused elements form sacrum
• 4-5 irregular ossicles form coccyx
Arch
• 2 pedicles, 2 laminae, 7 processes (1 spinous, 4 articular,
2 transverse)
• Pedicles attach to dorsolateral aspect of body
• Pedicles unite with pair of arched flat laminae
• Lamina capped by dorsal projection, called spinous
process
• Transverse processes arise from sides of arches
The 2 articular processes (zygapophyses) are diarthrodial
joints.
• Superior process bearing facet with surface directed
dorsally
• Inferior process bearing facet with surface directed
ventrally
Pars interarticularis is the part of the arch that lies between
the superior and inferior articular facets of all subatlantal
movable elements. The pars are positioned to receive
biomechanical stresses of translational forces displacing
superior facets ventrally, whereas inferior facets remain
attached to dorsal arch (spondylolysis). C2 exhibits a unique
anterior relation between the superior facet and the
posteriorly placed inferior facet. This relationship leads to an
elongated C2 pars interarticularis, which is the site of the
hangman's fracture.
Cervical
The cervical bodies are small and thin relative to the size of the
arch and foramen with the transverse diameter greater than
the AP diameter. The lateral edges of the superior surface of
the body are turned upward into the uncinate processes. The
transverse foramen perforates the transverse processes. The
vertebra artery resides within the transverse foramen, most
commonly starting at the C6 level.
C1 has no body and forms a circular bony mass. The superior
facets of C1 are large ovals that face upward, and the inferior
facets are circular in shape. Large transverse processes are
present on C1 with fused anterior and posterior tubercles.
The C2 complex consists of the axis body with dens/odontoid
process. The odontoid embryologically arises from the
centrum of the 1st cervical vertebrae.
The C7 vertebral body shows a transitional morphology with a
prominent spinous process.
Thoracic
• Thoracic bodies are heart-shaped and increase in size
from superior to inferior
• Facets are present for rib articulation, and laminae are
broad and thick
• Spinous processes are long, directed obliquely caudally
• Superior facets are thin, directed posteriorly
• T1 vertebral body shows complete facet for capitulum of
1st rib and inferior demifacet for capitulum of 2nd rib
• T12 body has transitional anatomy and resembles upper
lumbar bodies with inferior facet directed more laterally
4
Lumbar
The lumbar vertebral bodies are large, wide, and thick and lack
a transverse foramen or costal articular facets. The pedicles
are strong and directed posteriorly. The superior articular
processes are directed dorsomedially and almost face each
other. The inferior articular processes are directed anteriorly
and laterally.
Joints
Synarthrosis is an immovable joint of cartilage and occurs
during development and in the 1st decade of life. The
neurocentral joint occurs at the union point of 2 centers of
ossification for 2 halves of the vertebral arch and centrum.
Diarthrosis is a true synovial joint that occurs in the articular
processes, costovertebral joints, and atlantoaxial and sacroiliac
articulations. The pivot-type joint occurs at the median
atlantoaxial articulation. All others are gliding joints.
Amphiarthroses are nonsynovial, movable connective tissue
joints. Symphysis is a fibrocartilage fusion between 2 bones,
as in the intervertebral disc. Syndesmosis is a ligamentous
connection common in the spine, such as the paired ligamenta
flava, intertransverse ligaments, and interspinous ligaments.
An unpaired syndesmosis is present in the supraspinous
ligament.
Atlantooccipital (AO) articulation is composed of a
diarthrosis between the lateral mass of atlas and occipital
condyles and the syndesmoses of the AO membranes.
Anterior AO membrane is the extension of the anterior
longitudinal ligament (ALL). The posterior AO membrane is
homologous to the ligamenta flava.
Atlantoaxial articulation is a pivot joint. The transverse
ligament maintains the relationship of the odontoid to the
anterior arch of atlas. Synovial cavities are present between
the transverse ligament/odontoid and the atlas/odontoid
junctions.
Disc
The intervertebral disc is composed of 3 parts: The
cartilaginous endplate, the anulus fibrosis, and the nucleus
pulposus. The height of the lumbar disc space generally
increases as one progresses caudally. The anulus consists of
concentrically oriented collagenous fibers, which serve to
contain the central nucleus pulposus. These fibers insert into
the vertebral cortex via Sharpey fibers and also attach to the
anterior and posterior longitudinal ligaments (PLLs). Type I
collagen predominates at the periphery of the anulus, while
type II collagen predominates in the inner anulus. The normal
contour of the posterior aspect of the anulus is dependent
upon the contour of its adjacent endplate. Typically, this is
slightly concave in the axial plane, although commonly at L4-
L5 and L5-S1, these posterior margins will be flat or even
convex. A convex shape on the axial images alone should not
be interpreted as degenerative bulging.
The nucleus pulposus is a remnant of the embryonal
notochord and consists of a well-hydrated, noncompressible
proteoglycan matrix with scattered chondrocytes.
Proteoglycans form a major macromolecular component,
including chondroitin 6-sulfate, keratan sulfate, and hyaluronic
acid. Proteoglycans consist of protein core with multiple
attached glycosaminoglycan chains. The nucleus occupies an
eccentric position within the confines of anulus and is more
dorsal with respect to the center of the vertebral body. At
 Normal Anatomy
birth, ~ 85-90% of the nucleus is water. This water content
gradually decreases with advancing age. Within the nucleus
pulposus on T2-weighted sagittal images, there is often a
linear hypointensity coursing in an anteroposterior direction,
the intranuclear cleft. This region of more prominent fibrous
tissue should not be interpreted as intradiscal air or
calcification.
Anterior Longitudinal Ligament
The ALL runs along the ventral surface of the spine from the
skull to the sacrum. The ALL is narrowest in the cervical spine
and is firmly attached at the ends of each vertebral body. It is
loosely attached at the midsection of the disc.
Posterior Longitudinal Ligament
The PLL runs on the dorsal surface of bodies from the skull to
the sacrum. The PLL has a segmental denticulate
configuration and is wider at the disc space but narrows and
becomes thicker at the vertebral body level.
Craniocervical Ligaments
The craniocervical ligaments are located anteriorly to the
spinal cord and occur in 3 layers: Anterior, middle, and
posterior. Anterior ligaments consist of the odontoid
ligaments (apical and alar). The apical ligament is a small,
fibrous band extending from dens tip to basion. Alar
ligaments are thick, horizontally directed ligaments extending
from the lateral surface of dens tip to anteromedial occipital
condyles. The middle layer consists of the cruciate ligament.
The transverse ligament is a strong horizontal component of
the cruciate ligament extending from behind the dens to the
medial aspect of C1 lateral masses. The craniocaudal
component consists of a fibrous band running from the
transverse ligament superiorly to the foramen magnum and
inferiorly to C2. Posteriorly, the tectorial membrane is the
continuation of PLL and attaches to the anterior rim of the
foramen magnum.
Vertebral Artery
The vertebral artery arises as the 1st branch of the subclavian
artery on both sides. The vertebral artery travels cephalad
within the foramen transversarium (transverse foramen)
within the transverse processes. The 1st segment of the
vertebral artery extends from its origin to the entrance into
the foramen of the transverse process of the cervical
vertebrae, usually the 6th. The most common variation is the
origin of the left vertebral artery from the arch, between the
left common carotid and the left subclavian arteries (2-6%).
The vertebral artery in these variant cases almost always
enters the foramen of the transverse process of C5. The 2nd
segment runs within the transverse foramen to the C2 level.
Nerve roots pass posterior to the vertebral artery. The 3rd
segment starts at the C2 level where the artery loops and
turns lateral to ascend in the C1 transverse foramen. It then
turns medial, crossing on top of C1 in a groove. The 4th
segment starts where the artery perforates the dura and
arachnoid at the lateral edge of the posterior occipitoatlantal
membrane, coursing ventrally on the medulla to join with the
other vertebral artery to make the basilar artery.
Vertebral Column Blood Supply
Paired segmental arteries (intercostals, lumbar arteries) arise
from the aorta and extend dorsolaterally around the middle
of the vertebral body. Near the transverse process, the
segmental artery divides into lateral and dorsal branches. The
Congenital and Genetic Disorders
lateral branch supplies dorsal musculature, and the dorsal
branch passes lateral to the foramen, giving off branch(es) and
providing major vascular supply to bone and vertebral canal
contents. The posterior central branch supplies disc and
vertebral body, while the prelaminal branch supplies the inner
surface of the arch, ligamenta flava, and regional epidural
tissue. The neural branch entering the neural foramen
supplies pia, arachnoid, and cord. The postlaminar branch
supplies musculature overlying lamina and branches to bone.
Nerves
• Spinal nerves are arranged in 31 pairs and grouped
regionally: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and
1 coccygeal
• Ascensus spinalis is apparent developmental rising of
cord related to differential spinal growth
• Course of nerve roots becomes longer and more oblique
at lower segments
• C1 nerve from C1 segment and exits above C1
• C8 nerve from C7 segment and exits at C7-T1
• T6 nerve from T5 segment and exits at T6-T7
• T12 nerve from T8 segment and exits at T12-L1
• L2 nerve from T10 segment and exits at L2-L3
• S3 nerve from T12 segment and exits at S3 foramen
Meninges are divided into dura, arachnoid, and pia.
Dura is a dense, tough covering corresponding to the
meningeal layer of the cranial dura. The epidural space is filled
with fat, loose connective tissue, and veins. The dura
continues with spinal nerves through the foramen to fuse
with the epineurium. Cephalic attachment of the dura is at the
foramen magnum and the caudal attachment at the back of
the coccyx.
Arachnoid is the middle covering, which is thin, delicate, and
continuous with cranial arachnoid. The arachnoid is separated
from the dura by the potential subdural space.
Pia is the inner covering of delicate connective tissue closely
applied to the cord. Longitudinal fibers are laterally
concentrated as denticulate ligaments lying between
posterior and anterior roots and attach at 21 points to dura.
Longitudinal fibers are concentrated dorsally as the septum
posticum, attaching the dorsal cord to the dorsal midline dura.
Selected References
1. Gailloud P: Spinal vascular anatomy. Neuroimaging Clin N Am. 29(4):615-33,
2019
2. Shanechi AM et al: Spine anatomy imaging: an update. Neuroimaging Clin N
Am. 29(4):461-80, 2019
3. Griessenauer CJ et al: Venous drainage of the spine and spinal cord: a
comprehensive review of its history, embryology, anatomy, physiology, and
pathology. Clin Anat. 28(1):75-87, 2015
4. Fardon DF et al: Lumbar disc nomenclature: version 2.0: recommendations
of the combined task forces of the north american spine society, the
american society of spine radiology, and the american society of
neuroradiology. Spine (Phila Pa 1976). 39(24):E1448-65, 2014
5. Santillan A et al: Vascular anatomy of the spinal cord. J Neurointerv Surg.
4(1):67-74, 2012
6. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61,
2007
7. Battie MC et al: Lumbar disc degeneration: epidemiology and genetics. J
Bone Joint Surg Am. 88 Suppl 2:3-9, 2006
8. Grunhagen T et al: Nutrient supply and intervertebral disc metabolism. J
Bone Joint Surg Am. 88 Suppl 2:30-5, 2006
9. Haughton V: Imaging intervertebral disc degeneration. J Bone Joint Surg
Am. 88 Suppl 2:15-20, 2006
5
 Normal Anatomy
Congenital and Genetic Disorders

Atlas

7 cervical vertebral bodies

Axis

12 thoracic vertebral bodies

Transverse process
5 lumbar vertebral bodies

Iliac wing

5 fused sacral vertebral bodies

Sacral ala
4 coccygeal bodies

Brachial plexus

C8 root exiting at C7-T1 level

Thoracic intervertebral discs

Intercostal nerves

T12 root exiting at T12-L1 level

Lumbar intervertebral discs

L4 root exiting at L4-L5 level

Lumbosacral plexus
Sacral nerve roots

Sciatic nerve

(Top) Coronal graphic of the spinal column shows the relationship of 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 coccygeal
bodies. Note the cervical bodies are smaller with the neural foramina oriented at 45° and capped by the unique C1 and C2 morphology.
Thoracic bodies are heart-shaped, with thinner intervertebral discs, and are stabilized by the rib cage. Lumbar bodies are more massive
with prominent transverse processes and thick intervertebral discs. (Bottom) Coronal graphic demonstrates exiting spinal nerve roots.
C1 exits between the occiput and C1, while the C8 root exits at the C7-T1 level. Thoracic and lumbar roots exit below their respective
pedicles.

6
Another random document with
no related content on Scribd:
themselves are often protected with earth during winter.
In the south of Persia, and also in the north, the very slightest
cultivation is employed, yet in good years the harvests of every kind
are very heavy. In all cases it is the abundance, or the reverse, of the
supply of water that regulates the amount of harvest. Given plenty of
water, the harvest must be large.
The melon has been spoken of in another place. The water-
melons and the white-fleshed melons of Gourgab, near Ispahan, are
the finest in the world. I have seen melons weighing twenty-eight
pounds of the former variety; these were, however, phenomenal.
In the orchards of Ispahan clover is sown under the trees to break
the fall of the fruit, which is only plucked when a choice dish of it is
required as a present. The usual way is simply to pick up the
droppings. The Persian never thins the fruit. I have often
recommended their doing so, but on two occasions when I tried the
experiment and marked the trees, it did not succeed: the trees where
the fruit had been thinned merely giving fewer fruit, of the same size
as the unthinned trees under the same conditions and of the same
variety.
Nothing can be more delightful than these cool and silent gardens
in the summer in Ispahan. The thick foliage keeps out the sun, and
the deep green of the short clover refreshes the eye. Tea in a
garden, with pipes and fruit, is a pleasant way of spending a warm
afternoon. Unfortunately the Persian or Armenian usually looks on a
fruit garden merely as a good place to get drunk in, and the frequent
sounds of music and singing show the passer-by that this idea is
being carried out.
Garden parties are, however, often given by Persians who never
touch liquor, and they are as enjoyable a form of entertainment as
may be. An invitation to one is generally given without any
preparation, as during the paying of a call; it is accepted, and
forthwith an immediate start is made. A few carpets and pillows are
rolled up and placed on a mule, with the samovar or Russian urn in
its leather case, and the tea equipage in its travelling box. The cook,
on his pony, takes his whole batterie de cuisine, and hurries to the
garden indicated by his master, probably buying a lamb and a couple
of fowls, as he passes through the bazaar. The entertainer, his wife
and children too, if we are very intimate, the former on his horse, the
latter astride on white donkeys, proceed at a leisurely pace in the
direction of the garden; while the servants, all smiles, for they enjoy
the outing as much as the family, accompany them on foot or
horseback, carrying water-pipes, umbrellas, and odds and ends. On
reaching the garden, fruit is eaten; then the whole party roam
unrestricted among the shady paths while tea is prepared. This is
partaken of, and then a musician, or a singer, or perhaps a story-
teller, makes his appearance and diverts us all. Or some servant,
who has a good voice, sings or plays on the flute to us.
Often a grave and reverend merchant will produce a “tarr,” a
species of lute, or a “santoor” (the dulcimer), a kind of harmonica,
and astonish us by really good Eastern music. Few will consent to
sing; it is infra dig. The nightingales sing merrily, and dull care is
effectually banished. In these thoroughly family parties, wine or
spirits are never introduced. Chess or backgammon (Takht-i-Nadir,
the camp of Nadir Shah) are constantly played for a nominal stake of
a lamb or fat pullet.
The party is collected on a raised daïs in the open air, and sit on
carpets or lean on huge pillows. Candles are lighted in the lallahs or
Russian candle-lamps; these are convenient, as they are not
extinguished by wind. At about nine dinner is brought, after
innumerable kalians or water-pipes have been smoked: this is eaten
in comparative silence; host, guest, wives, and children, all sitting
round the leathern sheet which represents a table, and dipping their
hand in the platters. At about ten all retire, the bedding of each is
spread in a separate nook, on one’s own carpet—all of course being
in the open air—and at dawn one smokes a pipe, drinks a little cup
of black coffee, and takes one’s leave.
Our host and his guests go about their several businesses, while
the women and children and servants generally breakfast in the
garden and return home together in the cool of the evening, bringing
back fruit and huge bouquets of the moss-rose with them.
 These impromptu entertainments are most enjoyable: there is no
sense of restraint, and their absolute suddenness, absence of
formality, and true hospitality, form a remarkable contrast to the more
formal pleasures of European life and the regularity of
entertainments which hang over one, till their very thought becomes
insupportable. Of course, such entertainments are only possible in a
country where the gardens are freely thrown open to everybody.
 CHAPTER XXIX.
PERSIAN CHARACTER, COSTUMES, AND
MANNERS.

Character of the Persians—Exaggeration—Mercifulness—Anecdote—Costumes of

men—Hair—Beards—Arms—Costumes of women—Jewellery—Glass bangles—
Nose-rings—Painting of the face—Tattooing—Hair—Outdoor costume—Dress of
children—Their manners—Strange custom—Love of mothers—The uncle—
Cousins—Slaves—Servants—Slavery.

The character of the Persian, as it appears to me, is that of an easy-

going man with a wish to make things pleasant generally. He is
hospitable and obliging, as honest as the general run of mankind, and
is specially well disposed to the foreigner. He is very kind and indulgent
to his children, and as a son his respect for both parents is excessive,
developed in a greater degree to his father, in whose presence he will
rarely sit, and whom he is in the habit of addressing and speaking of as
“master;” the full stream of his love and reverence is reserved for his
mother; and an undutiful son or daughter is hardly known in the country.
Home virtues among the Persians are many.
No act of serious import is ever undertaken without the advice of the
mother; no man would think, for instance, of marrying contrary to his
mother’s advice; and by the very poorest the support of their parents
would never be looked on as a burden. Respect for the aged is
universal; “this grey beard” is a common term of respect; and an aged
man or woman will frequently give an opinion unsolicited, and such
advice is often requested, and always listened to as valuable.
The peculiar honesty of the Persian servant towards his master in
respect to his goods and chattels has been previously remarked; and in
commercial morality, I fancy that a Persian merchant will compare not
unfavourably with that of the European generally, if he does not always
attain the high standard theoretically adopted by the Englishman.
 To the poor, Persians are unostentatiously generous; most of the rich
have regular pensioners, old servants, or poor relations who live on
their bounty, and though there are no workhouses, there are in ordinary
times no deaths from starvation; and charity, though not organised, is
general.
The Persian is, I regret to say, a liar, but Oriental exaggeration and a
tendency “to run into poetry,” as Mr. Wegg said, perhaps accounts for
much of this. After a time one learns to mentally discount the
statements made by the natives, and habit generally enables one to do
this correctly. All ranks of society exaggerate and draw the long bow; a
curious instance of this occurred in Shiraz. I was conversing on the
subject of hunting with the king’s son, and a large circle of courtiers and
priests filled the room.
The prince narrated his exploits in hunting the antelope the previous
day, and gravely stated that while pursuing a pair of “ahū,” when riding
a very restive horse that he had, his head-stall broke.
“What should you have done, doctor?”
“I should have tried to stick on as long as the ground was good, and,
expecting an accident, have awaited it.”
“Ah, that was because you were not a prince,” he said. “I leant
forward, and unclasping my belt, placed it in the horse’s mouth as a
bridle, and thus directing him, pursued my game and killed both
antelope.”
All the circle applauded (as of course they were bound to do). I was
silent.
“You don’t mean to say you don’t believe that?” said the prince.
I smiled.
“Speak out if you don’t; I shan’t be offended in the least.”
“Well, your Highness, I don’t believe it.”
“Quite right, darogh bood” (it was a lie), unblushingly replied his
Royal Highness, and burst into a fit of laughter quite unabashed; the
circle of courtiers, of course, were convulsed.
 The giving of the lie is no insult in Persia; among the natives a
common expression is, “You are lying,” and the general reply is merely
to asseverate the statement by an oath, no indignation whatever being
shown at the charge.
Procrastination is the attribute of all Persians, “please God, to-
morrow,” being ever the answer to any proposition, and the to-morrow
means indefinite delay. A great dislike is shown generally to a written
contract binding the parties to a fixed date; and, as a rule, on breaking it
the Persian always appeals for and expects delay and indefinite days of
grace.
Only the upper classes and the natives of towns, among the military
and servant class, are in the habit of indulging in intoxicants, and
unchastity is confined to the females of these classes; this vice among
young women prior to marriage is very unusual; and the Persian
woman compares favourably with her European sister in this respect.
Persians are clean in their persons, washing themselves and their
garments frequently, differing in this habit from the Armenians, who
never wash more frequently than once a month, and consider it
unhealthy to do so; these people have great fear of taking cold, and
dread water like cats.
I will not trust myself to give my opinion on the character of the
Armenian. Of course I have known brilliant exceptions; but when I say
that I endorse all that Morier, Malcom, Lady Shiel, and the standard
writers on Persia have said of these people, I need not add that my
impression is unfavourable in the extreme. They possess one good
quality, however,—thrift.
The Persian always makes the best of his appearance; he is very
neat in his dress, and is particular as to the sit of his hat and the cut of
his coat They are all fond of animals, and do not treat them badly when
their own property. Of course hired horses and mules are often over-
ridden, and a good deal of cruelty from ignorance, in the way of riding
animals with sore backs, is seen; but as travellers must proceed, and
are frequently unable to give their horses or mules a rest, because they
must keep with their caravan, this is not to be wondered at. The
Persian, however, generally saves his animal as much as possible, and
frequently dismounts and walks, leading his mule or horse. Much of the
frequency of sore backs must be put down to the badly-made saddles
and pack-saddles, the latter of which are merely stuffed with “kah” (cut
straw).
MIDDLE CLASS PERSIANS.
 PERSIAN BOY.

Cruelty is not a Persian vice; torture and punishments of an unusual

and painful nature being part of their judicial system. There are no
vindictive punishments, such as solitary confinement, penal servitude
for long terms of years, etc. Seldom, indeed, is a man imprisoned more
than twelve months, the rule being that there is a general jail delivery at
the New Year. Royal clemency is frequently shown, often, perhaps, with
want of judgment; still, it is very frequent. A cook I had, was years ago
one of the Baabi rebels, and was seized and conducted to Teheran.
(His guilt was undoubted; he himself acknowledged it; and these men
had made an attempt, nearly successful, on the Shah’s life, actually
wounding him.) This cook, “Mehdi,” was chained by the neck, with
eleven others, and led out in the Shah’s presence for execution. The
eleven men had their throats cut. “Enough,” said the king, “let that poor
rascal go!”
He was taken back to prison and his life spared; but though the Shah
had meant that he should be released, there being no formal order, he
remained in prison for several years, making a good living by selling
savoury messes to his fellow-prisoners.
The costume of the Persians may be shortly described as fitted to
their active habits. The men invariably wear an unstarched shirt of
cotton. This is sewn with white silk, cotton as a sewing material being
unknown; it is often, particularly in the south of Persia, elaborately
embroidered about the neck. It fastens in front by a flap, having two
small buttons or knots at the left shoulder. It seldom comes below the
hips. There is no collar, and the sleeves are quite loose, and are not
confined at the wrist. The lower orders often have it dyed blue,
particularly the villagers; but the servant and upper classes invariably
wear a white shirt. Silk shirts used to be worn, but are now seldom seen
on men. Among the very religious, during the mourning month
(“Mohurrim”), the shirt is at times dyed black.
The “zerejumah,” or trousers, are of cloth among the higher classes,
particularly those of the military order, who affect a garment of a
tightness approaching that worn by Europeans. But the ordinary
“zerejumah” is of cotton, white or dyed blue, or at times red, cut very
loose, and exactly similar to the “pyjamas” worn by Europeans in India.
They are held up by a thin cord of red or green silk or cotton round the
waist, and the labouring classes, when engaged in heavy or dirty work,
or when running, generally tuck the end of these garments in under the
cord, which leaves their leg bare and free to the middle of the thigh.
The amplitude of these loose garments enables the Persian to sit
without discomfort on his heels, his usual mode of sitting, for chairs are
only used by the rich, great, or Europeanised; and it is a common thing
for a visitor, if on familiar terms, to ask to be allowed to sit on his heels,
as the unaccustomed chair tires him.
 Over the shirt and “zerejumah” comes the “alkalūk,” generally of
quilted chintz or print. This is a closely-fitting garment, collarless, with
tight sleeves to the elbow, whence to the wrist are a number of little
metal buttons; these are fastened in winter, and left open in summer.
Above this is the coat, or “kemmercheen,” a tunic of coloured calico,
silk, satin, moiré, cloth, Cashmere, or Kerman shawl, gold embroidered
silk, satin, or velvet, according to the time of year and the purse or
position of the wearer. This, like the alkalūk, is open in front, and shows
the shirt. It has a small standing collar at times, and is double-breasted.
It has a pocket-hole on either side, giving access to the pockets, which
are always in the alkalūk, in which garment is the breast-pocket, where
watch, money, jewels, and seals are kept. The length of the
“kemmercheen” denotes the class of the wearer. The military and
official classes and the various “noker,” or servants, from the king’s
valet, who may be also prime minister, wear them short; that is to say,
to the knee, while fops and lutis (sharpers) wear them shorter even
than this. The priests, and merchants, and the villagers, especially
about Shiraz, and the townsmen and shopkeepers, with doctors and
lawyers, wear them very long, often nearly to their heels.
Over the kemmercheen is worn the kolajah, or coat. This is as a rule
cast off in summer, save on formal occasions, as when the wearer is
performing his functions or making a call, and is often borne by a
servant or carried over the shoulder by the owner himself. They are of
cloth, shawl, or camel-hair cloth, and are invariably lined throughout
with either silk or cloth, flannel, or even fur. They are like the Turkish
frock-coat, made with a very loose sleeve, and with many plaits behind.
They have lappels, as with us, and are trimmed with gold lace
(derbeeri), shawl, or fur, or at times worn quite plain; they have a roll
collar and false pockets.
Besides these garments there are others, as the long juba, or cloth
cloak. This ample and majestic garment is affected by mirzas
(secretaries), Government employés of high rank, as ministers, farmers
of taxes, courtiers, physicians, priests. The wearers carry a staff as a
rule. The jubas are made of the finest cloth, very amply cut. They have
a standing collar and long sleeves. These sleeves are from one to two
feet longer than the arm, and are often allowed to hang down empty
when the garment is worn out of doors; but when in the actual presence
of guests or a grandee, they are used to keep the hands hidden (a
token of respect to those present), and the many wrinkles formed by
the excessive length of these sleeves are supposed to be their beauty.
The abba, or camel-hair cloak of the Arab, is often worn by travellers,
priests, and horsemen. The priests particularly affect it; it is a very
picturesque garment, warm, and waterproof, also very light. Some of
these abbas are very expensive, though plain; while others, much
embroidered in gold, are given as dresses of honour to the middle
classes and priests, and are used at weddings, etc.
Among outer garments worn by travellers and the aged are the well-
known poosseen, or Afghan skin-cloak. These are full length, only used
by travellers and the sick or aged; and the “neemtan,” or common
sheepskin jacket, with short sleeves, used by shopkeepers and the
lower class of servants, grooms, etc., in winter. They are mostly seen at
Ispahan. The Afghan poosseen is a wonderful garment for travellers, as
it is so very warm, and forms bed and bedding, but it has to be kept dry.
The skins are dyed yellow; the fur is generally a natural brown. An
ample cloak is made with very long sleeves, which act as gloves, the
hands not being protruded. They are often elaborately embroidered
with yellow silk, and are worth in Teheran, where they are very
common, from four pounds (ten tomans) to sixteen pounds (forty
tomans).
Besides these “balapoosh,” or overcoats, is the “yapunjah,” or
woollen Kūrdish cloak. This is a kind of felt, having a shaggy side, of
immense thickness. It looks like a bear-skin, and is of great weight. It is
a half-circle in shape; a strap at the neck holds it on. The wearer,
generally a shepherd, uses it as great-coat, bed and bedding. It is quite
waterproof, and very warm. The thing is worn slung, closed side to the
wind, and is used as a shield against the wind or snow.
There is also the felt coat of the villager, before described, a very
warm and inexpensive garment, which wears well. It is from half an inch
to one inch thick, and enables the villager to defy the severest weather.
The cost is from five to fifteen kerans.
The kemmerbund, or belt, is also characteristic of the class. It is
made of muslin, shawl, or cotton cloth among the priests, merchants,
traders, and bazaar people; shawls and muslin are also affected by the
secretary class and the more aged or old-fashioned among the great
Government employés.
In it is carried by the literati and merchants the pencase and a roll of
paper, and its voluminous folds are used as pockets: and by the bazaar
people and villagers, porters, and merchants’ servants a small sheath
knife is stuck in it; while by “farrashes,” the carpet-spreader class, a
large canjar, or curved dagger, with a heavy ivory handle, is carried;
less for use than as a badge of office.
The headgear, too, is very distinctive. The turban is worn by the
priests. These use generally a white one, consisting of many yards of
muslin, unless they be “Syuds,” or descendants of the prophet, when a
green one is worn. This at times is a very deep colour, nearly black; at
others a grass-green.
These Syuds, too, usually wear a kemmerbund, or girdle of green
muslin, shawl, or cotton cloth. Merchants also affect the turban, usually
of muslin, embroidered in colours; or of a yellow pattern on straw-
coloured muslin, or of calico, or at times of shawl.
The waist of the Persian is generally small, and he is very proud of
his fine figure and broad shoulders.
The distinctive mark of the courtier, military, and upper servant class
is the belt, generally of varnished leather, black in colour, with a brass
clasp, usually of Russian manufacture. The princes and courtiers often
replace the brass clasp by a huge round ornament of cut stones, the
favourite one of his Royal Highness Zil-es-Sultan being of diamonds, of
large size, a huge emerald being in the centre.
The “kola,” or hat, is of cloth or sheepskin, on a frame of pasteboard.
The most expensive are made of the black skin of the fœtal lamb.
Strange to say, these skins usually go to Europe to be dyed—I believe
to Leipzig. The commoner people wear coloured lambskin hats, as
grey, or even sheepskin, with the wool long. The fashions in hats
change yearly; they are generally affected by the military and noker
(servant) class, by courtiers and beaux, and are usually worn with a
knowing cock. The Ispahani merchant, and the Armenian, at times wear
very tall ones.
The hair is generally shaved at the crown, or the entire head is
shaved, a karkool, or long thin lock, being at times left, often two feet
long from the middle of the crown. This is kept knotted up and hidden.
Its use is to enable the prophet Mahommed to draw up the believer into
paradise. The lower orders generally have the hair over the temporal
bone long, and this is brought in two long locks, turning backwards
behind the ear; they are termed “Zūlf;” the beaux and youths are
constantly twisting and combing them. The rest of the head is shaven.
Long hair, however, is going out of fashion in Persia, and the more
civilised affect the cropped hair worn by Europeans, and even have a
parting in it.
The chin is never shaved, save by “beauty men,” or “Kashangs,”
though often clipped, while the moustache is usually left long. At forty, a
man generally lets his beard grow its full length, and cherishes it much;
part of a Persian’s religious exercises is the combing of his beard.
Socks, knitted principally at Ispahan, are worn: they are only about
two inches long in the leg. The rich, however, affect a longer sock: white
cotton ones are worn in summer, and coloured worsted in winter. The
patterns of these worsted socks are often very pretty and effective. The
villagers only wear a sock on state occasions, as at a wedding, the New
Year, etc.
Shoes are of many patterns; the Orūssi or Russian shoe, similar to
our children’s shoe without the strap, is the most common. Next, the
Kafsh, or slippers of various kinds. The heel is folded down, and
remains so. The priests affect a peculiar heavy shoe, with an ivory or
wooden lining at the heel. Green shoes of shagreen are very common
at Ispahan. Blacking is unknown to Persians generally, but a
European’s servant may be always recognised by his polished shoes.
Boots are only used by horsemen, and are then worn much too large,
for ease. Those worn by couriers often come up the thigh, and are
similar to those used by our sewer-men.
With boots are worn shulwar, or baggy riding breeches. These are
very loose, and tied at the ankle by a string; a sort of kilt is worn by
couriers. Pocket-handkerchiefs are never used, save by the rich or the
Teheranis.
Most Persians affect a “shub kola,” or night hat, for wear in their
homes. This is a loose, baggy cap, of shawl or quilted material: it is
often embroidered by the ladies, and presents of “night hats” are as
frequent with them as our ones of embroidered slippers.
As to arms, these are usually carried only by the tribesmen, who
bristle with weapons. The natives of the south of Persia and servants—
these latter generally, particularly in Shiraz—carry a kammer, or dirk,
which is, however, seldom used as an offensive weapon, save in
drunken rows. The soldiery, on or off duty, always carry one of these
“kammers” or their side-arms, sometimes both. They hack, but never
thrust with them. Of course on the road the carrying of weapons is the
rule, and it is needed, as there is no police, save the ephemeral
phenomena introduced by Count Monteforte at Teheran. These men,
who are really efficient, are too good to last.
The costume of the women has undergone considerable change in
the last century; it is now, when carried to the extreme of the fashion,
highly indecent, and must be very uncomfortable.
The garment doing duty as a chemise is called a perhān; it is, with
the lower orders, of calico, white or blue, and comes down to the middle
of the thigh, leaving the leg nude. Among the upper classes it is
frequently of silk. At Shiraz it is often of fine cotton, and elaborately
ornamented with black embroidery: among the rich it is frequently of
gauze, and much embroidered with gold thread, pearls, etc. With them
it often reaches only to the navel.
The head is usually covered with a chargāt, or large square of silk or
cotton, embroidered. These chargāts are folded, as were shawls
amongst us some years ago, thus displaying the corners, two in front
and two behind; it is fastened under the chin by a brooch. It is often of
considerable value, being of Cashmere shawl, embroidered gauze, etc.
A jika, a jewelled, feather-like ornament, is often worn at the side of
the head, while the front hair, cut to a level with the mouth, is brought
up in love-locks on either cheek. Beneath the chargāt is generally a
small kerchief of dark material, worn to set off the complexion, and
preserve the chargāt; only the edge of this is visible. The ends of the
chargāt cover the shoulders, but the gauze perhān, quite transparent,
leaves nothing to the imagination. The breasts and chest are very
visible, and the abdomen is quite bare.
 On state occasions, or with women who aim at beauty, the face is
always painted more or less, and a profusion of jewellery worn. This is
of the most solid description, the gold some twenty-three carats fine,
and quite flexible: no hollow jewellery is worn, intrinsic value being what
is aimed at.
Silver is only worn by the very poor: coral only by negresses.
Necklaces and bracelets are much worn, and numerous chains with
scent-caskets attached to them; while the arms are covered with
clanking glass bangles, called “Alangū,” some twenty even of these
hoops being worn on an arm.
Jewelled “Bazūbund,” containing talismans, are often worn on the
upper arm, while among the lower orders and South Persian or Arab
women nose-rings are not uncommon, and at times bangles, or anklets
of beads, on the ankles.
The face on all important occasions—as at entertainments,
weddings, etc.—is usually much painted, save by young ladies in the
heyday of beauty. The colour is very freely applied, the cheeks being
reddled, as are a clown’s, and the neck smeared with white, while the
eyelashes are marked round with kohl (black antimony). This is
supposed to be beneficial to the eyes, and almost every woman uses it
—very needlessly, as the large languishing eye of the Persian belle
needs no adventitious aid. The eyebrows are widened and painted till
they appear to meet, while sham moles or stars are painted on the chin
and cheek—various in their way, as the patches of the eighteenth-
century belles: even spangles are stuck at times on the chin or
forehead. Tattooing is common among the poor and villagers, and is
seen among the upper classes.
The hair, though generally hidden by the chargāt, is at times exposed
and plaited into innumerable little tails of great length, while a
coquettish little skull-cap of embroidery or shawl or coloured silks is
worn. False hair is common. The Persian ladies’ hair is very luxuriant,
and never cut; it is nearly always dyed red with henna, or black with
indigo to a blue-black tinge; it is naturally a glossy black. Fair hair is not
esteemed, and I have been asked to condole with ladies in their grief in
being the possessors of fair locks. At Ispahan so universal is this
feeling that a young half-caste lady having beautiful golden hair, dyed it
on her marriage to a pre-Raphaelite auburn, to please her Baghdadi
husband.
Blue eyes are not uncommon, but brown ones, like those of the full-
blooded Jewess, are the rule: a full-moon face is much admired, and
the possession of a dark complexion termed “nummak” (salt) is the
highest native idea of beauty.
Most Persian women are small, with tiny feet and hands. The figure,
however, is always lost after maternity, and they wear no support of any
kind.
A very short jacket of gay colour, quite open in front, and not covering
the bosom, with tight sleeves with many metal buttons, is usually worn
in summer: a lined outer coat in cold weather.
In winter a pair of very short white cotton socks are used, and tiny
slippers with a high heel; in summer in the house ladies go often
barefoot.
The rest of the costume is composed of the “tūmbūn,” or “shulwar;”
these are simply short skirts of great width, held by a running string; the
outer one usually of silk, velvet, or Cashmere shawl, often trimmed with
gold lace, according to the purse of the wearer; or among the poor, of
loud-patterned chintz or print. Beneath these are innumerable other
garments of the same shape, and varying in texture from silk and satin
to print.
The whole is very short indeed; among the women of fashion merely
extending to the thigh, and as the number of these garments is
amazing, and they are much bouffée, the effect of a lady sitting down
astonishes the beholder, and would scandalise the Lord Chamberlain.
As the ladies are supposed, however, to be only seen by their lords in
these indoor dresses, there is perhaps no harm done.
Indecency, too, is very much an idea, for a Persian lady, who will thus
expose her extremities and the greater part of her trunk, will carefully
veil her face, showing nothing but the eyes. The ladies of rank,
however, have no shame of any kind, and display very redundant
charms. The indoor costume of the Persian lady is in fact exactly that of
the corps de ballet, but shorter: while in winter, an over-mantle like the
“kolajah” or coat of the man, and with short sleeves, lined and trimmed
with furs, is worn; this gives the costume a peculiarly graceful
appearance.

OUTDOOR DRESS OF PERSIAN WOMEN.

(From a Native Drawing.)

Leg-coverings are now being introduced, and the last princess of the
blood royal I saw added to her comfort, though she destroyed the
poetry of her appearance, by a tightly-fitting pair of black cloth “pants”
with a gold stripe! This garment will doubtless soon become general.
In ancient days the Persian ladies always wore them, as may be
seen by the pictures in the South Kensington Museum. In those times
the two embroidered legs, now so fashionable as Persian embroideries
(“naksh”), occupied a girl from childhood to marriage in their making;
they are all sewing in elaborate patterns of great beauty, worked on
muslin, in silk.
The outdoor costume of the Persian women is quite another thing;
enveloped in a huge blue sheet, with a yard of linen as a veil,
perforated for two inches square with minute holes, the feet thrust into
two huge bags of coloured stuff, a wife is perfectly unrecognisable,
even by her husband, when out of doors. The dress of all is the same;
save in quality or costliness, the effect is similar. And yet with such a
hideous disguise, a Persian coquette will manage to let the curious
know if she have a good face and eye, by lifting her veil in a sly and
half-timid way. The only thing I know exceeding in folly the chimney-pot
hat, is the outdoor dress of the Persian woman. Expensive, ugly,
uncomfortable, hot in summer, cold in winter, words fail to express its
numerous disadvantages; it has one positive quality—as a disguise it is
perfect, and its use favours the intrigues rife in the country.
As for the children, they are always when infants swaddled: when
they can walk they are dressed as little men and women, and with the
dress they often, nay generally, ape the manners; a Persian child of the
upper class being a master of etiquette, an adept at flattery, and a
mirror of politeness. It is a strange custom with the Persian ladies to
dress little girls as boys, and little boys as girls, till they reach seven or
eight years; this is often done for fun, or on account of some vow,
oftener to avert the evil eye.
Persian women are very fond of their children, and pet them greatly.
The love of the Persian for his mother is very great; he never leaves her
to starve, and her wishes are laws to him, even when he is an old man,
and she an aged crone. The mother is always the most important
member of the household, and the grandmother is treated with
veneration. Mothers-in-law are not laughed at or looked down on in
Persia; their presence is coveted by their sons-in-law, who look on them
as the guardians of the virtue of their wives. The uncle, too, is a much
nearer tie than with us, that is to say, the paternal uncle: while men look
on their first cousins on the father’s side as their most natural wives.
Possibly this is because their female cousins are the only women they
have any opportunity of knowing anything of personally. Black slaves
and men-nurses, or “lallahs,” are much respected and generally
retained in a household, while the “dyah,” or wet nurse, is looked on as
a second mother, and usually provided for for life.
Persians are very kind to their servants, and try to make their people
look on them as second fathers; a master will be often addressed by a
servant as his father, and the servant will protect his master’s property
as he would his own, or even more jealously.
A servant is invariably spoken to as “butcha” (child). The servants
expect that their master will always take their part, and never allow
them to be wronged; if he does not do so, he cannot obtain a good
class domestic, while if he sticks to the man, he never leaves him.
The slaves in Persia have what Americans call “a good time;” well
fed, well clothed, treated as spoiled children, given the lightest work,
and often given in marriage to a favourite son, or taken as a “segah,” or
concubine, by the master himself (and respectable Persians only take a
“segah” for ninety-nine years, which is equivalent to a permanent
marriage), slaves have the certainty of comfort and a well-cared-for old
age. They are always looked on as confidential servants, are entrusted
with large sums of money, and the conduct of the most important
affairs; and seldom abuse their trust.
The greatest punishment to an untrustworthy slave is to give him his
liberty and let him earn his living. They vary in colour and value: the
“Habashi” or Abyssinian is the most valued; the Souhāli or Somāli, next
in blackness, is next in price; the Bombassi, or coal-black negro of the
interior, being of much less price, and usually only used as a cook. The
prices of slaves in Shiraz are, a good Habashi girl of twelve to fourteen,
forty pounds; a good Somāli same age, half as much; while a Bombassi
is to be got for fourteen pounds, being chosen merely for physical
strength. They are never sold, save on importation, though at times
they are given away. Strange as it may appear, to the mind of any one
who has lived in Persia, slavery in that country to the African is an
unmixed good. Of course the getting to Persia, and the being caught, is
another thing. But I have never seen a Persian unkind to his own horse