is given of them in the Edinburgh Medical and Surgical Journal, vol. xl. In the same journal for 1892 a case is recorded where the excision of the rib was deemed necessary in order to relieve pain in the neck and arm and formication of the skin and numbness in the hand.

Dr. J. Collins Warren, records a similar case in the Boston Medical Journal which required the complete disarticulation of a supernumerary rib attached to the seventh cervical vertebræ in order to relieve the patient. The pressure of the rib was the cause of pain about the middle of the shoulder and passing down the arm.

An interesting example of the occurrence of cervical ribs is given by Dr. Herbert Alderson in the British Medical Journal, 1897. A lady, twenty-one years of age, consulted him about a slight swelling in the right side of her neck. There was a little pain, but her alarm was caused by the fear lest the protuberance should increase. A radiograph was taken of the chest and demonstrated the presence of two cervical ribs, one on either side. That on the left side was rudimentary, having only head, neck and tubercule, articulating with the transverse process of the seventh cervical vertebra, but it possessed no shaft. Articulating with the right transverse process of the same vertebra was a full-grown rib. The shaft passed under the clavicle or collar bone to the first intercostal space and probably joined the second rib by a cartilaginous union. At an earlier period the lady had met with an accident in which a collar bone was broken, but the surgeon who attended her was not aware that a cervical rib (of whose existence he could not be expected to suspect) had been broken also.

We now come to consider supernumerary sternal ribs. Man has normally seven ribs attached to the sternum and the orang has the same number. Other anthropoid apes have from eight to ten sternal ribs. It may be assumed that the ribs that are now attached to one another in the maminalia were at one time connected directly with the sternum. Cases are not infrequent in man where only six ribs reach the sternum, while perhaps more frequently eight ribs are found to be so attached.

It has been stated that the literature on the subject of

cervical ribs is not extensive; and it may be added here, that the references to supernumerary sternal ribs are even less so, Dr. Humphry in his classical work on the human skeleton (p. 323) makes the following brief reference to the subject: "In a specimen in the Cambridge Museum which measures seven inches, there are eight cartilages of ribs separately united to the sternum." This has been quoted by medical authorities as the only reference in English literature to such a phenomenon, but it is not so. At the close of the last century a work was published at intervals in Edinburgh entitled, "Medical Essays and Observations, Revised and Published by a Society in Edinburgh." In the fifth volume, that published in 1742, there is a paper by Dr. John Gemmil, surgeon in Irvine, on a case of supernumerary ribs that had come under his observation. It is that of a woman of about thirty years of age, of a strong robust constitution, who was hanged for childmurder on January 16th, 1735. On dissecting her body it was found to have a pair of extra ribs. Dr. Gemmil says: "On the skeleton of this woman, which I preserve, there are thirteen vertebræ of the back, and as many ribs on each side, to wit, eight true, and five false; the cartilages of the two lowest true ribs unite in the middle for about an inch, then divide again, and are inserted separately into the sternum; the two lower false ribs are about five and a half inches long."

At a meeting of the Anatomical Society during the session of the Medical Congress held at Washington in 1888, Dr. Lamb of the U. S. Army Medical Museum, gave some interesting particulars regarding ten cases that had come under his observation. Nine of these were in negroes and one in an Indian. In the anatomy class of Trinity College, Dublin, Cunningham and Robinson made some investigations on the subject. In the course of two months in 1888, thirty subjects were examined, and it was found that the eighth costal cartilage was united to the sternum in no less than five of these. In four subjects, two of each sex, the eighth cartilage of the right side alone was attached to the sternum. In the other case, a male, the eighth cartilage on each side reached the breast bone and articulated with its fellow in front of the upper part of the ziphi-sternum. This form of supernumer

ary rib has thus been observed in about seventeen per cent. of the subjects examined.

The eleventh and twelfth ribs are decidedly rudimentary in character. Dr. Wiedersheim points out that the twelfth rib, as might be expected, has a much wider range of variation (2 to 27 c.m.) than the eleventh (15 to 28 c.m.). They never reach the sternum. The reduction of the lumbar ribs has been recent, for rudimentary ribs are found in connection with the lumbar vertebræ of the embryo. The occurrence of supernumerary ribs in the sternal or lumbar regions may not occasion surprise, but at first sight the presence of cervical ribs does not seem so easily accounted for. The number of vertebræ in the neck of all mammals is remarkably constant, being the same number whether in the short necks of the whale or elephant, or in the longer ones of the camel or the giraffe. There are very few exceptions to this almost universal rule. The three-toed sloth (Bradypus tridactylus), and B. infuscatus, have normally nine cervical vertebræ, while B. cuculliger has either eight or nine. In certain of the twotoed sloths, (B. cholæpus.) there are only six cervical vertebræ. The two lower cervical ribs of B. tridactylus usually support movable ribs though they do not reach the sternum. The manatee, or sea-cow, believed to be the origin of the stories of the fabulous mermaid, has only six vertebræ in the neck. In the Platypus (Ornithorynchus), reduced cervical ribs, according to Dr. Wiedersheim, remain for life distinct on six of the seven cervical vertebræ, being absent from the atlas only. Such ribs may occasionally appear in mammals generally as well as in man. In the proceedings of the Zoological Society of London for 1882, there is an illustrated paper by Mivart on the occurrence of a rib on the last cervical vertebræ of a binturong, a quadruped nearly allied to the

racoons.

The crocodiles represent the highest living reptiles, and in them cervical ribs are normally present. The number of cervical vertebræ is usually nine; the dorsal, eleven or twelve; the lumbar, four or three; the sacral, two; and the caudal not less than thirty-five. All the vertebræ in the neck are provided with ribs which lie nearly parallel with the vertebral column and overlap one another. The eighth and ninth ribs

are longer than the others and take on more of the character of dorsal ribs, the ninth having a terminal cartilage (Huxley). The presence of rudimentary gills in the human embryo, of tonsils in the pharynx, and the occasional occurrence of auricles in the neck of man and other mammals has been often described, and need not be further referred to here. The presence of cervical and other supernumerary ribs in man must be placed in the same category as these, affording additional evidence of man's amphibian and reptilian relationship.

There can be little doubt that radiography may soon make known more examples of supernumerary ribs than would be brought to light under former conditions. The case of the lady we have already referred to, who suffered from a broken rib in the neck unsuspected by her first medical attendant, suggests the advisability of everyone being provided with a radiograph of his or her anatomy, so that, in the event of an accident, the surgeon, on being sent for, would first ask for the radiograph of his patient, and having examined it for the presence of any abnormalities, would then proceed to operate with confidence, being certain that he would not mistake a supernumerary rib for a collar bone.

That surgical science has been recently making rapid strides is well known. An anonymous Bard in the New York Public Health Journal for October, 1898, has indicatedperhaps it would be more correct to say, anticipated-some of these in the following lines:

"They sawed off his arms and his legs,
They took out his jugular vein;
They put fancy frills on his lungs,
And they deftly extracted his brain.

'Twas a triumph of surgical skill

Such as never was heard of till then;

'Twas the subject of lectures before
Conventions of medical men.

The news of this wonderful thing
Was heralded far and wide;

But as for the patient-there's nothing to say—
Excepting, of course-that he died.

LILIAN'S LESSON.

BY L. C. BLAIR.

ROBABLY one of the happiest periods in a person's life

is the time spent during convalescence, especially after a very severe and painful illness. Oh, how welcome is the peaceful release from agonising pain, the restful calm after the feverish and uncertain surging of disease! No murmur rises to the lips, which lately quivered in delirium or burned with fever's parching heat; few thoughts of past or future trouble the mind; it simply and quietly returns from the border of the grave to life again. But the dear ones who venture to the verge of the unseen world with us, what becomes of them during the days of convalescence?

The nerve-exhausting anxiety of watching ended, it is not always easy to resume the ordinary duties of life. When the loved one needs the watcher less, stealthily creeps into the heart a nameless discontent, a restlessness of which the very thankfulness for health restored makes the lips ashamed to speak. It was thus with Lilian Raby, as she stood at the window of her little home looking into the street below, yet seeing nothing, until a gentle voice from a couch close by aroused her, when hastily turning, she met the gaze of her much-loved sister Winnie.

"Lilian, dear, you are pale to-night; will you not go for a stroll? The air will refresh you.'

Lilian smiled as she answered, "Yes, I think it would. I will go; but promise you will not feel lonely whilst I am away, Winnie."

you will

go, dear."

"It will please me much if So bending her head and touching the invalid's brow with her brave young lips, Lilian passed silently out of the room. Slowly donning her outdoor apparel, she sighed softly as she crossed the threshold into the summer twilight.

Lilian Raby and her sister Winifred were orphans; they lived in a crowded city, far from the fresh, green fields and shady lanes, where the wild flowers grow, creating a neverending source of interest and pleasure, and where at intervals