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Mémofiches
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Pierre Karn1na
Jean Pierre Richer
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Mémofiches Anatomie Netter – Tête et cou, 5e édition, de J.T. Hansen, 2020, 192 pages.
Mémofiches Anatomie Netter – Tronc, 5e édition, de J.T. Hansen, 2020, 224 pages.
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Mémofiches
Anatomie
Netter
Membres
John T. Hansen
University of Rochester, USA
School of Medicine and Dentistry
Traduction
Pierre Kamina et Jean-Pierre Richer
5e édition
Elsevier Masson
ELSEVIER
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Netter’s Anatomy Flash Cards
© Copyright Elsevier Inc, 2019, 2014, 2011, 2007, 2002.
ISBN : 978-0-323-53050-7
This translation of Netter’s Anatomy Flash Cards, 5th edition, by John T. Hansen, was undertaken by
Elsevier Masson SAS and is published by arrangement with Elsevier Inc.
Cette traduction de Netter’s Anatomy Flash Cards, 5th edition, de John T. Hansen, a été réalisée par
Elsevier Masson SAS et est publiée avec l’accord d’Elsevier Inc.
Mémofiches Anatomie Netter – Membres, 5e édition, de John T. Hansen.
© 2020 Elsevier Masson SAS
ISBN : 978-2-294-75870-6
e-ISBN : 978-2-294-75933-8
Tous droits réservés.
La traduction a été réalisée par Elsevier Masson SAS sous sa seule responsabilité.
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Table des matières
Membre supérieur
Os et articulations
1. Humérus et scapula : vue antérieure
2. Humérus et scapula: vue postérieure
3. Articulation de l'épaule (scapulo-humérale) : vue antérieure
4. Articulation de l'épaule (scapulo-humérale) : vue latérale
5. Os du coude : en extension
6. Os du coude : fl exion à 90°
7. Ligaments du coude
8. Os de l'avant-bras
9. Os du poignet et de la main
1O. Ligaments du poignet : vue palmaire
11. Ligaments du poignet : vue postérieure
12. Ligaments métacarpo-phalangiens et interphalangiens: vue médiale
13. Ligaments métacarpo-phalangiens et interphalangiens: vue antérieure
Muscles de l'épaule
14. Trapèze
15. Muscle grand dorsal
16. Muscle élévateur de la scapula
17. Muscle deltoïde
18. Muscles supra-épineux et infra-épineux
19. Muscles petit et grand ronds
20. Muscle subscapulaire
21. Muscle grand pectoral
Muscles du bras
22. Muscle biceps brachial
23. Muscle coraco-brachial
24. Muscle brachial
25. Muscles triceps brachial et anconé
26. Bras : série de coupes transversales
Muscles de l'avant-bras
27. Muscles pronateurs
28. Muscle fléchisseur radial du carpe
29. Muscle long palmaire
30. Muscle fléchisseur ulnaire du carpe
31. Muscle fléchisseur superficiel des doigts
32. Muscle fléchisseur profond des doigts
33. Muscle long fléchisseur du pouce
34. Muscle supinateur
35. Muscle brachio-radial
36. Muscle long extenseur radial du carpe
37. Muscle court extenseur radial du carpe
38. Muscle extenseur des doigts
39. Muscle extenseur du petit doigt
40. Muscle extenseur ulnaire du carpe
41. Muscle long abducteur du pouce
42. Muscle court extenseur du pouce
43. Muscle long extenseur du pouce
44. Muscle extenseur de l'index
45. Coupes transversales de l'avant-bras
Muscles de la main
46. Muscle court abducteur du pouce
47. Muscle court fl échisseur du pouce
48. Muscle opposant du pouce
49. Muscle adducteur du pouce
50. Muscle abducteur du petit doigt
51. Muscle court fléchisseur du petit doigt
52. Muscle opposant du petit doigt
53. Muscles lombricaux
54. Muscles interosseux dorsaux
55. Muscles interosseux palmaires
56. Coupe transversale de la paume de la main
Nerfs
57. Plexus brachial : schéma
58. Nerf radial dans le bras et nerfs de la région postérieure de l'épaule
59. Nerfs du membre supérieur
60. Nerfs de la main
Nerfs et vaisseaux
61. Nerfs cutanés et veines superficielles de l'épaule et du bras
62. Nerfs cutanés et veines superficielles de l'avant-bras
Vaisseaux
63. Artères entourant la scapula
64. Artère brachiale et anastomoses autour du coude
65. Artères de la main : vue palmaire
66. Artères du membre supérieur : résumé
Membre inférieur
Os et articulations
67. Os de la hanche (coxal) : vue latérale
68. Os de la hanche (coxal) : vue médiale
69. Articulation de la hanche : vue latérale
70. Articulation de la hanche : vues antérieure et postérieure
71 . Fémur
72. Tibia et fibula
73. Genou : ligaments croisés et collatéraux
74. Intérieur du genou : vue supérieure
75. Intérieur du genou : vue inférieure
76. Os du pied
77. Ligaments et tendons de la cheville : vue latérale
78. Ligaments et tendons de la cheville : vue médiale
79. Ligaments et tendons du pied
Muscles de la hanche et de la cuisse
80. Muscle grand psoas
81. Muscle iliaque
82. Muscle tenseur du fascia lata
83. Muscle sartorius
84. Muscle droit fémoral
85. Muscle vaste latéral
86. Muscle vaste intermédiaire
87. Muscle vaste médial
88. Muscle pectiné
89. Muscle long adducteur
90. Muscle court adducteur
91 . Muscle obturateur externe
92. Muscle grand adducteur
93. Muscle gracile
94. Muscle grand glutéal
95. Muscle moyen glutéal
96. Muscle petit glutéal
97. Muscle piriforme
98. Muscles jumeaux supérieur et inférieur
99. Muscle obturateur interne
100. Muscle carré fémoral
101. Muscle semi-tendineux
102. Muscle semi-membraneux
103. Muscle biceps fémoral
104. Coupes transversales de la cuisse
Muscles de la jambe
105. Muscle long fibulaire
106. Muscle court fibulaire
107. Muscle tibial antérieur
108. Muscle long extenseur du hallux
109. Muscle long extenseur des orteils
11o. Muscle gastrocnémien
111. Muscle soléaire
112. Muscle plantaire
113. Muscle poplité
114. Muscle long fléchisseur de l'hallux
115. Muscle long fléchisseur des orteils
116. Muscle tibial postérieur
117. Jambe: coupe transversale
Muscles de la plante du pied
118. Muscle abducteur de l'hallux
119. Muscle court fléchisseur des orteils
120. Muscle abducteur du petit orteil
121. Muscle court fléchisseur de l'hallux
122. Muscle carré plantaire
123. Muscle court fléchisseur du petit orteil
124. Muscles lombricaux
125. Muscle adducteur de l'hallux
126. Muscles interosseux dorsaux
127. Muscles interosseux plantaires
Nerfs
128. Plexus lombal
129. Nerfs de la région glutéale et de la cuisse
130. Nerf fibulaire commun
131. Nerf tibial
Nerfs et vaisseaux
132. Nerfs et veines superfi ciels du membre inférieur: vue antérieure
133. Nerfs et veines superfi ciels du membre inférieur: vue postérieure
Vaisseaux
134. Les veines profondes du membre inférieur
135. Artères de la cuisse et du genou
136. Artères de la jambe : vue antérieure
137. Artères de la jambe : vue postérieure
138. Artères de la plante du pied
139. Artères du membre inférieur : résumé
Avant-propos
Il est commun de dire que « ce qui est simple est faux ». Ce livre infirme ce vieux dicton.
En effet, les Mémofiches Anatomie Netter sont des brefs résumés d’anatomie
descriptive, fonctionnelle et clinique de grande qualité scientifique. Les planches
sélectionnées de la dernière édition du célèbre Atlas d’anatomie humaine de
Franck Netter sont accompagnées de commentaires cliniques pertinents de John T.
Hansen. Cette 5e édition est enrichie de nouvelles fiches et de légendes plus claires,
plus didactiques. Les applications médico-chirurgicales soulignent les éléments
anatomiques importants.
L’Anatomie est la mère de toutes les disciplines médicales et chirurgicales. Dans notre
monde moderne où les connaissances sont exponentielles et en perpétuelle évolution,
comment interpréter les données cliniques ou comprendre les actes techniques sans
assistant de navigation anatomique personnel ? Les Mémofiches apportent une réponse
rapide aux questions anatomiques des étudiants en situation clinique. Elles résument
l’essentiel des connaissances anatomiques de base, trop souvent oubliées.
Les trois carnets de Mémofiches Anatomie Netter (« Tête et cou », « Tronc » et
« Membres ») constituent un instrument de travail moderne, original et très pratique.
Leur maniabilité a été étudiée pour qu’ils tiennent dans la poche de l’étudiant. Ce
compagnon de travail est discret, efficace et esthétique. Ce mémento d’anatomie
est aussi l’instrument adapté pour réviser et réussir les épreuves d’anatomie des
examens des futurs médecins, dentistes, sages-femmes, kinésithérapeutes, ainsi
que des étudiants des écoles paramédicales.
P. Kamina
Professeur émérite d’anatomie
Université de Poitiers
J.-P. Richer
Professeur d’anatomie, chirurgien des hôpitaux Université de Poitiers.
Membre de l’Académie Nationale de Chirurgie.
Membre
supérieur
Os et articulations
Humérus et scapula : vue antérieure
1
Membre supérieur
1. Acromion
2. Tubercule majeur
3. Tubercule mineur
4. Sillon intertuberculaire
5. Épicondyles (médial, latéral)
6. Capitulum
7. Fossette coronoïdienne
8. Cavité glénoïdale de la scapula
9. Angle inférieur
10. Fosse subscapulaire
Commentaire – La clavicule et la scapula forment la ceinture scapulaire, ou l’épaule,
qui unit le membre supérieur au tronc. La clavicule sert de traverse : elle maintient le
membre supérieur à distance du tronc et le laisse libre de ses mouvements. Elle est
sujette aux fractures.
La scapula, ou lame de l’épaule, s’articule à la fois avec la clavicule et la tête de
l’humérus (articulation gléno-humérale). Dix-sept muscles s’insèrent sur la scapula.
Les fractures de la scapula sont relativement rares.
L’humérus est un os long. Son extrémité proximale fait partie de l’articulation de
l’épaule et son extrémité distale est une partie de l’articulation du coude. Le col
chirurgical de l’humérus (région immédiatement au-dessous du petit tubercule) est
une région fréquente de fractures. Les fractures à cet endroit peuvent blesser le nerf
axillaire du plexus brachial.
Clinique – Les fractures de la clavicule sont fréquentes, spécialement chez
l’enfant. La fracture résulte habituellement d’une chute sur une main tendue ou
d’un traumatisme direct, et siège fréquemment au niveau du tiers moyen de la
clavicule.
!))
Atlas Netter 7e édition : planche 409, voir aussi planche 192

Os et articulations
Humérus et scapula : vue postérieure
2
Membre supérieur
1. Clavicule (coupée)
2. Incisure supra-scapulaire
3. Angle supérieur
4. Fosse supra-épineuse
5. Épine de la scapula
6. Fosse infra-épineuse
7. Épicondyle médial
8. Trochlée
9. Fosse olécrânienne
10. Tubérosité deltoïdienne
11. Tête de l’humérus
Commentaire – En arrière, la scapula présente une épine proéminente qui sépare les
fosses supra- et infra-épineuse.
La clavicule est le premier os à s’ossifier mais le dernier à fusionner, et elle est
formée par une ossification intramembraneuse. C’est l’un des os le plus fréquemment
fracturé.
Sur le milieu de l’humérus se situe la tubérosité deltoïdienne, point d’insertion du
muscle deltoïde.
Sur l’extrémité distale, la dépression au-dessus de la trochlée s’appelle fosse
olécrânienne : elle contient l’olécrâne de l’ulna quand le coude est en extension totale.
Clinique – Les fractures de la scapula sont relativement peu fréquentes. Les
fractures du col chirurgical de l’humérus sont fréquentes et peuvent blesser le
nerf axillaire issu du plexus brachial. Une fracture de la diaphyse de l’humérus
peut léser le nerf radial.
Atlas Netter 7e édition : planche 410, voir aussi planche 192

Os et articulations
Articulation de l’épaule (scapulo-humérale) : vue antérieure
Vue antérieure
3
Membre supérieur
1.
Capsule de l’articulation acromio-claviculaire (comprenant le
ligament acromio-claviculaire)
2. Ligament coraco-acromial
3. Tendon supra-épineux (coupé)
4. Tendon subscapulaire (coupé)
5. Tendon du biceps brachial (chef long)
6. Ligaments capsulaires
7.
Ligament scapulaire transverse supérieur et incisure
supra-scapulaire
8.
Ligament coraco-claviculaire (ligament trapézoïde, ligament
conoïde)
Commentaire – L’épaule est une articulation synoviale (sphéroïde) multi-axiale.
Ses mouvements comprennent l’abduction et l’adduction, la flexion et l’extension, la
rotation et la circumduction. La cavité glénoïdale peu profonde de la scapula permet
des mouvements amples de l’épaule, mais rend aussi cette articulation vulnérable
à la dislocation. Les quatre tendons des muscles de la coiffe des rotateurs aident à
stabiliser l’articulation.
On voit également ici l’articulation acromio-claviculaire, une articulation synoviale
plane unissant l’acromion et la clavicule. Cette articulation permet un mouvement de
glissement pendant l’élévation du bras et la rotation de l’épaule.
Clinique – En raison de la grande étendue des mouvements de l’épaule et de la faible
profondeur de sa cavité glénoïdale, cette articulation est l’une des plus exposée
aux luxations du corps humain. L’articulation scapulo-humérale (gléno-humérale)
est habituellement luxée en direction antérieure ou antéro-inférieure (luxation
subcoracoïdienne) et peut mettre en danger les nerfs axillaire et musculo-cutané
du plexus brachial.
Atlas Netter 7e édition : planche 412

Os et articulations
Articulation de l’épaule (scapulo-humérale) : vue latérale
Articulation ouverte : vue latérale
4
Membre supérieur
1. Bourse subdeltoïdienne
2. Cavité glénoïdale
3. Ligament gléno-huméral inférieur
4. Ligament gléno-huméral moyen
5. Tendon du subscapulaire (fixé à la capsule)
6. Tendon du biceps brachial (chef long)
7. Ligament coraco-huméral
8. Processus coracoïde
9. Ligament coraco-acromial
10. Acromion
Commentaire – La cavité glénoïdale est rendue un peu plus profonde par la
présence du bourrelet (labrum) glénoïdal. L’articulation est stabilisée par une capsule,
des ligaments, et les quatre tendons des muscles de la coiffe des rotateurs. Il est
à noter que les quatre tendons des muscles de la coiffe des rotateurs renforcent
l’articulation en arrière, en haut et dans sa moitié antérieure (tendon subscapulaire).
Ainsi, la plupart des luxations de l’épaule sont antérieures ou antéro-inférieures, là où
il y a moins de « résistance ».
L’épaule est irriguée par des branches des artères supra-scapulaire, circonflexe
humérale et circonflexe de la scapula.
Clinique – La bourse est un coussin fermé à revêtement synovial, rempli d’un
liquide qui protège les tendons et les ligaments des lésions dues aux mouvements
de friction contre les saillies osseuses adjacentes ou d’autres surfaces rugueuses.
Elle peut être infectée, mise en tension par du liquide et devenir alors douloureuse.

Os et articulations
Os du coude : en extension
Coude droit
Humérus
Coude en extension :
vue antérieure
Coude en extension :
vue postérieure
5
Membre supérieur
1. Fosse radiale
2. Capitulum
3. Tête
4. Tubérosité (du radius)
5. Fosse coronoïde
6. Épicondyle médial
7. Trochlée de l’humérus
8. Tubérosité (de l’ulna)
9. Fosse olécrânienne
10. Sillon du nerf ulnaire
11. Épicondyle latéral
12. Olécrâne
13. Tête
14. Col
Commentaire – Les os du coude comprennent l’humérus et les deux os de
l’avant-bras, le radius et l’ulna. L’ulna est médial dans l’avant-bras et il est le plus
long des deux os. La pointe du coude qui peut être aisément localisée est l’olécrâne,
situé en arrière et à l’extrémité proximale de l’ulna.
Clinique – La luxation de l’articulation du coude, troisième en fréquence après
les dislocations de l’épaule et des doigts, résulte habituellement d’une chute
sur une main en extension. Les luxations postérieures sont les formes les plus
communes.
!))

Os et articulations
Os du coude : flexion à 90°
.
Flexion , le
a, 900 : vue latera
w-r-
.
Flexron a, 90 0: vue m e, diale
6
Membre supérieur
1. Épicondyle latéral
2. Capitulum
3. Col du radius
4. Radius
Ulna (incisure radiale, processus coronoïde, incisure trochléaire,
5.
olécrâne)
6. Humérus
7. Tête du radius
8. Tubérosité
9. Incisure trochléaire
10. Sillon du nerf ulnaire
11. Épicondyle médial de l’humérus
Commentaire – Les os du coude comprennent l’humérus et les deux os de
l’avant-bras, le radius et l’ulna. L’ulna est médial dans l’avant-bras et il est le plus
long des deux os. La pointe du coude qui peut être aisément localisée est l’olécrâne,
situé en arrière et à l’extrémité proximale de l’ulna.
Clinique – Les luxations du coude peuvent s’accompagner de fractures de
l’épicondyle huméral, de l’olécrâne (ulna), de la tête radiale ou du processus
coronoïde de l’ulna. Les nerfs médian et/ou ulnaire du plexus brachial peuvent
être lésés au cours des luxations ou des fractures du coude.
Les fractures de l’extrémité proximale du radius intéressent habituellement la tête
ou le col du radius. Les fractures de l’ulna proviennent souvent d’un coup direct ou
d’une pronation forcée de l’avant-bras, et intéressent la diaphyse ulnaire.
!))

Os et articulations
Ligaments du coude
Flexion à 90°: Flexion à 90°:

vue latérale vue médiale
Radius Radius
Articulation ouverte: Articulation ouverte:

vue antérieure vue postérieure
7
Membre supérieur
1. Capsule articulaire
2. Ligament collatéral radial
3. Membrane synoviale
4. Cartilage articulaire
5. Tendon du biceps brachial
6. Ligament annulaire du radius
7. Ligament collatéral ulnaire
8. Tendon du triceps brachial
Commentaire – L’articulation du coude forme une articulation synoviale uni-axiale
en charnière (ginglyme), qui comprend l’articulation huméro-radiale (entre le
capitulum de l’humérus et la tête du radius) et l’articulation huméro-ulnaire (entre la
trochlée de l’humérus et l’incisure trochléaire de l’ulna). L’articulation comprend aussi
une articulation radio-ulnaire uni-axiale (trochoïde), qui effectue la supination et la
pronation (rotation). Les mouvements du coude comprennent la flexion et l’extension.
L’articulation est stabilisée par le ligament collatéral radial, situé latéralement, et
le ligament collatéral ulnaire triangulaire, situé médialement. Le ligament annulaire
maintient en place la tête du radius.
Le coude est vascularisé par des branches de l’artère brachiale et les branches
collatérales récurrentes des artères radiale et ulnaire.
Clinique – Une poussée violente sur l’avant-bras, surtout chez l’enfant, peut
repousser la tête radiale hors du ligament annulaire, entraînant une luxation de
l’articulation radio-ulnaire proximale. Les luxations du coude sont les troisièmes
luxations par ordre de fréquence après les luxations de l’épaule et des doigts.
li)

Os et articulations
Os de l’avant-bras
Radius et ulna droits Radius et ulna droits

en supination : vue antérieure en pronation : vue antérieure
8
Membre supérieur
1. Tête radiale
2. Col radial
3. Tubérosité radiale
4. Membrane interosseuse
5. Processus styloïde de l’ulna
6. Corde oblique
7. Tubérosité ulnaire
8. Incisure trochléaire
9. Olécrâne
10. Processus styloïde radial
11. Tubercule dorsal (de Lister)
12. Bord postérieur du radius
Commentaire – Les os de l’avant-bras comprennent l’ulna, médial et long, et le
radius, latéral.
Sur toute la longueur de l’avant-bras, le radius et l’ulna sont joints par la membrane
interosseuse, qui contribue à former une partie de l’articulation radio-ulnaire, de type
fibreux (syndesmose). La membrane interosseuse divise l’avant-bras en deux parties
musculaires, antérieure et postérieure. Les extrémités distales du radius et de l’ulna
présentent des processus styloïdes.
Clinique – La fracture de Colles est une fracture de l’extrémité distale du
radius, induite habituellement par une chute sur une main tendue. Dans de
telles fractures, le fragment distal du radius est repoussé en haut et en arrière,
entraînant une déformation en « dos de fourchette ».
Il)

Os et articulations
Os du poignet et de la main
Main droite:
vue antérieure
(palmaire)
Main droite :
vue postérieure
(dorsale)
9
Membre supérieur
1. Scaphoïde et son tubercule

2. Trapèze et son tubercule
3. Trapézoïde
4. Os métacarpiens
5. Phalanges proximales
6. Phalanges moyennes
7. Phalanges distales
8. Capitatum
9. Lunatum
10. Hamatum et hamulus
11. Os pisiforme
12. Os triquétrum
Commentaire – Les os du poignet et de la main comprennent les huit os carpiens,
les cinq métacarpiens (un pour chaque doigt) et, pour les doigts II à V, les phalanges
proximale, moyenne et distale. Le 1er doigt, ou pouce, possède seulement une
phalange proximale et une phalange distale.
Le scaphoïde, le lunatum et le triquétrum s’articulent avec la partie distale du radius
pour former l’articulation radio-carpienne du poignet.
Clinique – Le scaphoïde est l’os du carpe le plus fréquemment fracturé. Il est
situé juste en dessous de la « tabatière anatomique » (région postérieure à la
base du pouce) ; aussi sa douleur et son enflure sont habituelles dans cette aire.
Le métacarpien V est le métacarpien le plus fréquemment fracturé, et le doigt III
est le doigt de la main le plus fréquemment fracturé (sur sa phalange distale).
!l)

Os et articulations
Ligaments du poignet : vue palmaire
Rétinaculum
des fléchisseurs
enlevé: vue
palmaire
10
Membre supérieur
1. Long ligament radio-lunaire

2. Ligament radio-scapho-capital
3. Court ligament radio-lunaire
4. Lunatum
5. Ligament scapho-capital
6. Trapèze
7. Ligament ulno-lunaire
8. Ligament ulno-capital
9. Ligament ulno-triquétral
10. Pisiforme
11. Ligament triquétro-capital
12. Capitatum
Commentaire – Le poignet, ou articulation radio-carpienne, est une articulation
synoviale bi-axiale ellipsoïde formée par l’extrémité distale du radius (un disque
articulaire) et les os carpiens scaphoïde, lunatum et triquétrum ; cette articulation
est renforcée par les ligaments collatéraux radial et ulnaire et par les ligaments
radio-carpiens dorsal et palmaire. L’articulation permet la flexion, l’extension,
l’abduction, l’adduction et la circumduction.
Les anatomistes, souvent pour simplifier, englobent ces ligaments dans un
ligament radio-carpien palmaire (ligaments long et court radio-lunaires et
radio-scapho-capital : légendes 1 à 3), un ligament ulno-carpien palmaire (ligaments
ulno-lunaire, ulno-capital et ulno-triquétral : légendes 7 à 9) et divers ligaments
intercarpiens et métacarpiens.
L’articulation carpo-métacarpienne du pouce est une articulation bi-axiale « en selle »
(avec le trapèze). Elle permet la flexion et l’extension, l’abduction et l’adduction, et
la circumduction. Les quatre autres articulations carpo-métacarpiennes sont des
articulations synoviales planes qui permettent des mouvements de glissement.
Clinique – Les manuels des chirurgiens donnent une classification plus précise de
ces ligaments fondée sur leurs insertions, mais les anatomistes les associent en
ensembles (voir le deuxième paragraphe de la section Commentaire ci-dessus).
Il)

Os et articulations
Ligaments du poignet : vue postérieure
Vue postérieure
(dorsale)
11
Membre supérieur
1. Ulna
2. Ligament radio-ulnaire dorsal
3. Triquétrum
4. Hamatum
5. Capitatum
6. Trapézoïde
7. Ligament trapézo-trapézoïde
8. Trapèze
9. Scaphoïde
10. Ligament scapho-lunaire
11. Ligament radio-carpien dorsal
12. Radius
Commentaire – L’articulation radio-ulnaire distale est une articulation uni-axiale
synoviale à pivot (trochoïde) située entre l’ulna et l’incisure ulnaire du radius, à la
partie proximale du poignet. Elle permet la pronation et la supination (rotation).
Le poignet, ou articulation radio-carpienne, est une articulation synoviale bi-axiale
ellipsoïdale formée par l’extrémité distale du radius (un disque articulaire) et les os
carpiens scaphoïde, lunatum et triquétrum. Les mouvements du poignet comprennent
la flexion, l’extension, l’abduction, l’adduction et la circumduction.
Les anatomistes, souvent pour simplifier, réduisent ces ligaments en des ligaments
radio-carpien dorsal, carpo-métacarpien dorsal et intercarpiens.
Entre les rangées proximale et distale des os carpiens se trouvent les articulations
médio-carpiennes (intercarpiennes), articulations synoviales planes. Ces articulations
permettent quelques mouvements de glissement et de translation.
Clinique – Les chirurgiens de la main classent ces ligaments avec plus de
précision, en fonction de leurs insertions.
!l)

Os et articulations
Ligaments métacarpo-phalangiens et interphalangiens :
vue médiale
En extension :
vue médiale
En flexion:
vue médiale
12
Membre supérieur
1. Os métacarpien
3. Articulation métacarpo-phalangienne (MP)
4. Articulation interphalangienne proximale (IPP)
5. Articulation interphalangienne distale (IPD)
6. Phalanges (proximales, moyennes, distales)
7. Ligament palmaire (lame)
8. Ligament collatéral
Commentaire – Les articulations métacarpo-phalangiennes sont des articulations
synoviales condylaires bi-axiales qui participent à la flexion et à l’extension, à
l’abduction et à l’adduction, et à la circumduction. La capsule est maintenue par
les ligaments collatéral et palmaire. Les ligaments collatéraux sont tendus lors de la
flexion et lâches lors de l’extension.
Les articulations interphalangiennes distales et proximales sont des articulations
synoviales uni-axiales charnières qui participent à la flexion et à l’extension. Des
ligaments, semblables aux ligaments métacarpo-phalangiens, renforcent ces
articulations. Les ligaments palmaires empêchent l’hyperextension.
Clinique – La luxation dorsale de l’articulation interphalangienne proximale est
assez fréquente. Les luxations palmaires et en rotation sont moins fréquentes
mais possibles. Les luxations distales ou les fractures de l’articulation
interphalangienne distale peuvent se produire à la suite d’un coup direct sur
l’extrémité du doigt (doigt en maillet), comme cela peut se produire au baseball
ou au volley-ball, souvent avec une lésion des tendons extenseurs.
Il)

Os et articulations
Ligaments métacarpo-phalangiens et interphalangiens :
vue antérieure
Vue antérieure
(palmaire)
13
Membre supérieur
2. Tendon fléchisseur superficiel des doigts (coupés)
3. Tendons fléchisseurs profonds des doigts
4. Ligaments palmaires (lames)
5. Ligaments métacarpiens transverses profonds
6. Ligaments métacarpiens palmaires
7. Ligaments carpo-métacarpiens palmaires
Commentaire – Les articulations métacarpo-phalangiennes sont des articulations
synoviales condylaires bi-axiales qui participent à la flexion et à l’extension, à
l’abduction et à l’adduction, et à la circumduction. Ces articulations sont renforcées
par les ligaments palmaires et les deux ligaments collatéraux de chaque côté.
Les articulations interphalangiennes des doigts II à V comprennent l’articulation
interphalangienne proximale et une articulation interphalangienne distale.
Ces articulations sont des articulations synoviales uni-axiales charnières qui
sont renforcées par les ligaments palmaires et les deux ligaments collatéraux.
Elles permettent la flexion et l’extension. Les ligaments palmaires empêchent
l’hyperextension.
Clinique – Les fractures des métacarpiens peuvent survenir à la suite de coups
directs (fractures du boxeur) et peuvent rompre non seulement les os et les
ligaments, mais aussi affecter la traction des tendons musculaires qui se fixent
sur les métacarpiens. Ces fractures nécessitent d’être soigneusement réduites
pour que le doigt récupère une fonction optimale après la blessure et le traitement
médical avec rééducation.
!l)

Muscles de l’épaule
Trapèze
Vue postérieure
14
Membre supérieur
1. Muscle trapèze
2. Muscle deltoïde
Origine – Le muscle trapèze naît de la protubérance occipitale externe et du
tiers médial de la ligne nucale supérieure de l’os occipital, du ligament nucal, des
processus épineux de la 7e vertèbre cervicale et des 12 vertèbres thoraciques.
Terminaison – Les fibres supérieures du muscle trapèze s’insèrent sur le bord
postérieur du tiers latéral de la clavicule. Les fibres moyennes s’insèrent sur le
bord médial de l’acromion et le bord postérieur de l’épine de la scapula. Les fibres
inférieures convergent pour se terminer en une aponévrose qui s’insère sur l’épine
scapulaire.
Action – Les fibres supérieures et inférieures du muscle trapèze agissent d’abord
comme rotateur de la scapula pour assurer l’abduction totale de son extrémité
supérieure. Les fibres supérieures, agissant seules, élèvent l’épaule et soutiennent
la ceinture scapulaire lorsque l’épaule ou la main supportent un poids. Les fibres
centrales agissent horizontalement et rétractent l’épaule. Les fibres inférieures tirent
l’épaule vers le bas. Quand les deux muscles agissent ensemble, la scapula peut être
en adduction et la tête tirée directement en arrière.
Innervation – L’innervation motrice provient du nerf accessoire (XI). Des fibres
proprioceptives proviennent des 3e et 4e nerfs cervicaux.
Commentaire – Le trapèze, contrairement aux autres muscles de l’épaule, ne reçoit
pas de fibres nerveuses du plexus brachial.
Clinique – Le trapèze peut être testé chez le patient élevant ses épaules contre
une résistance (la partie supérieure du muscle en contraction peut être palpée).
Ceci permet d’évaluer l’intégrité du nerf accessoire (XI) qui innerve ce muscle.
Il)
Atlas Netter 7e édition : planche 413, voir aussi planches 36, 180, 194
Muscle grand dorsal
Vue postérieure
15
Membre supérieur

2. Muscle grand rond
3. Fascia thoraco-lombaire
Origine – Le muscle grand dorsal naît d’une large aponévrose de la lame postérieure
du fascia thoraco-lombaire, des processus épineux des six dernières vertèbres
thoraciques, et des digitations charnues des trois ou quatre côtes les plus caudales.
Le muscle peut aussi s’attacher à la crête iliaque.
Terminaison – Les fibres du muscle grand dorsal convergent en s’incurvant pour
contourner le bord inférieur du muscle grand rond et se tordre sur elles-mêmes. Elles
se terminent en tendon qui s’insère dans le sillon intertuberculaire de l’humérus.
Action – Extenseur, adducteur et rotateur médial de l’humérus (bras).
Innervation – Le nerf thoraco-dorsal (C6-C8).
Commentaire – Avec son extrémité supérieure fixée, le muscle grand dorsal élève
le tronc quand les bras sont tendus au-dessus de la tête, comme lever les bras dans
l’escalade.
L’origine du muscle sur les vertèbres thoraciques et sur les côtes inférieures peut
être variable.
Il est irrigué par l’artère thoraco-dorsale, branche de l’artère subscapulaire (qui naît
de l’artère axillaire).
Clinique – Le grand dorsal est testé cliniquement chez le patient élevant son bras
à l’horizontale avec le coude fléchi, comme s’il signalait un « stop ». Ensuite le
patient effectue une adduction du bras contre résistance pour tester la force du
muscle et l’intégrité du nerf thoraco-dorsal. Le muscle peut aussi être palpé à
l’arrière en superficie du dos du patient, quand on lui demande de tousser.
Il)

Muscle élévateur de la scapula
Vue postérieure
16
Membre supérieur
1. Muscle élévateur de la scapula

2. Muscle splénius de la tête
Origine – Le muscle élévateur de la scapula naît des processus transverses des
quatre premières vertèbres cervicales.
Terminaison – Il s’insère dans la partie supérieure du bord médial (vertébral) de la
scapula.
Action – Il élève l’angle supérieur de la scapula et le tire médialement. Il assure aussi
la rotation de la scapula de sorte que la cavité glénoïdale soit inclinée en bas. Quand
la scapula est maintenue dans une position fixe, le muscle élévateur de la scapula
incline le cou latéralement et le tourne légèrement du même côté.
Innervation – Par les 3e et 4e nerfs cervicaux issus du plexus cervical et par un
rameau du nerf scapulaire dorsal (C5) pour les fibres inférieures du muscle.
Commentaire – La contraction du muscle élévateur de la scapula aide à hausser les
épaules. Sa vascularisation provient en grande partie de l’artère cervicale transverse,
branche du tronc thyro-cervical.
Clinique – On peut facilement tester le muscle élévateur de la scapula en
demandant au patient de hausser les épaules contre résistance. Une faiblesse
dans la réalisation de ce mouvement requiert un examen plus spécifique pour
déterminer dans quelle mesure le muscle trapèze est éventuellement concerné
ou intervient en compensation, puisque les deux muscles élèvent la scapula.
Il)
Atlas Netter 7e édition : planche 413, voir aussi planches 36, 180, 194
Muscle deltoïde
Vue postérieure
17
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three days; but I had twenty-seven animals and thirty people to feed,
and one can stop only where provisions are to be found. To these
must be added the governor’s party, which, men and beasts
together, exceeded two hundred head. To-morrow we enter the
province of Dukkálah. Towards night-fall there was a great squabble
outside the tent, and I was obliged to go to Cohen’s rescue. The káïd
of Azamór wished me to take a present, consisting of fowls, sugar,
and wax-candles, for my attendance on his son: this my káïd and
soldiers said would be deducted from their monnah. Upon this there
arose a good deal of contention. As the monnah was for myself
alone, I find I have done wrong in giving them any of it, for they now
claim the whole. I will be a match for them yet. There has been
already a great deal of chaffing about the sale of a sheep-skin this
morning, which fetched seven-pence, and the soldiers could not
agree about the division of the money. Through the fear of being
devoured by the dogs, that are more fierce and numerous here than
in any other place, I packed up again, hoping to start by day-break;
and though I do not like travelling on a Sunday, any thing is better
than remaining here.
Sunday, Jan. 9.—Therm. 47°. The weather cold. Tried hard to get
off before the Mazazan[42] party and the governor, but failed to do
so. I had got rid of the first, when a soldier of the governor came to
see why we were not en route. We found him on a hill that overlooks
Mazazan, with an escort of sixty horse, his camels and baggage
having gone before. We rode through his gardens, the soil of which
was very rich, and, after exchanging compliments, he took the lead.
The road there leaves the sea, and runs E.S.E. to Morocco. It was
lined with people desirous to shew respect to him; the women
screaming, their scarfs and kerchiefs tied to reeds by way of
banners; the school-boys, with their boards, and the saints seated
along the side of the road; a man riding by the side of the governor,
distributing money. We reached our place of encampment at two
P.M., having been met by the Sheïkh and some of his people from the
dawár, at which we are to stop. The encampment looked very
beautiful. The governor’s tent, with his red and green standard, and
twenty other tents; mine with four; and as fresh parties were
continually arriving till it was dark, the whole number could not have
been less than from two to three hundred. My own people are
anxious not to continue with the governor. I had a great row with
them, and threatened to send them off. They will, however, return to
their senses, as they like the monnah and their ease; but to-night I
have kept it all to myself, and they have become very good. Read
the evening service and 10th chapter of the Acts. Received lots of
patients, and a visit from two of the descendants of the famed Múléï
Bú Shú’eïb.
Monday, Jan. 10.—Therm. 50°. Signs of rain. Tried hard, but
failed to get off before the governor. Our caravan is now above three
hundred. The road was lined the same as yesterday. The soil was
one of great fertility. By a gradual ascent we entered Dukkálah,
celebrated for its breed of horses. Indeed both men and cattle are
finer here than in any other part of the empire. At 10 A.M. we saw
Jebel Khadr, rising from an almost boundless plain. At 11 we halted
for a few minutes at a lovely spot, where there were palm-trees and
a spring of water. We then, by a steep ascent, came upon a second
plateau, from which we had a magnificent view of Mount Atlas
covered with snow. We halted for the night at the mesallá of Bú’
Sanawerer, who was a great saint. The wind was so high that we
were in great fear lest the tent should be carried away. The monnah
was very late in coming, and I was obliged to turn story-teller to keep
the people in good humour, and afterwards threatened the Sheïkh of
the dawár. The weather cold.
Tuesday, Jan. 11.—Therm. 47°. At day-break I was surrounded by
patients, men, women, and children; compelled to use sticks to keep
them off. There was a large market in the open air. Could it be
believed that my party allowed the whole caravan to move off while I
was engaged with my patients. They lost their way in the immense
plain, which is within a few days’ journey of Morocco. I went on to
Gherando; from a village at the foot of which the governor came out
to meet the káïd of Azamór. Quantities of powder wasted, and no
little hallooing and screaming. We encamped outside the town; here
tea was sent with three different sets of china, fire, &c. &c.; thin
bread and butter; then hot victuals, and then the monnah. I was
never so sick of the sight of food. Received many patients; amongst
them the governor, who came early.
Wednesday, Jan. 12.—Therm. 50°. Up as soon as the moon rose,
with the view of getting to Suwaïníyah this evening. Dispatched two
soldiers to Morocco, to inform the Sulṭán of my arrival, and to learn
where I was to lodge. From four to seven tried in vain to get off. It is
plain that my káïd wants to make another day of it. To prevent this, I
started, and took my baggage mules, to spite them; found I knocked
myself up by walking very fast for four hours. I have, however,
frightened them, and we halted at Suwaïníyah, where I looked at a
fine aqueduct cut through a limestone rock, for which the poor
fellows got nothing. Water beautiful, but a little warm. We reached
Suwaïníyah about 5 P.M.; a large encampment was here before us,
and the káïd of Azamór had still to come up. We pitched our tents
near the aqueduct and tank, with some tents from Fez, and at about
100 yards from the káïd of Azamór. The same immense plain as the
one mentioned before was covered with agates and jaspers; there
were no trees, but a great quantity of a strong shrub. I felt a
presentiment that something would happen; I therefore took down
my sword and looked at my pistols, and turned in early, although not
sleepy.
Thursday, Jan. 13.—Therm. 50°. I was right in my conjecture. At
half-past twelve, the soldier who rode the white horse, and whom I
had always suspected, gave an alarm of thieves. We got up in haste,
and a fellow called ’Abd el Kerím stated that he saw a man run
between them. We turned in again, and at four A.M. poor Abú came
to me and said that he had been robbed of his jacket, which he
always put under his head for a pillow, in the pocket of which was my
gold watch, which I had given him to carry for safety. The káïd, in
whose tent he had been sleeping as usual, could not account for the
loss, and all wanted me to start. This I refused, and stated that I
should wait till daybreak. I then dispatched all but three mules, and
determined to go to the káïd of Azamór; but as the people assured
me they had already told him, I started, leaving behind my káïd, the
soldier on the white horse, and ’Abd el Kerím. Another káïd, who had
the command of five soldiers, agreed with me in my suspicions that
all was not right. After an interval of two hours, up came the
remainder of the party with Abú’s jacket, but no watch in it. They said
they had found it near the tank, and my káïd asked, with great
effrontery, if I did not mean to let the matter drop, as it was God’s will
that I should lose the watch. I replied, by bidding him come
immediately to the káïd of Azamór, whom we had overtaken, and
told him he should answer for the loss with his head. I then passed
on, the fellow crying, and we shortly arrived at a fine mountain pass,
on issuing from which we had a view of Morocco. As soon as we
reached the date-grove, we found the Sulṭán and his troops ready to
receive us with all honours. We passed the Tensif by el Kantarah, a
bridge of eighteen arches, and stopped, according to custom, to
wash ourselves. I observed my káïd and ’Abd el Kerím in company
with the Rifman who had the charge of the mules. They passed on
without saying a word, when up came a soldier with a lad, who had
confessed to the robbery, and stated that he had concealed the
watch under the bridge. A pardon was promised him if he would
point out the spot; but when he was let go, I felt sure that he was not
the culprit, and sent after him. Upon his return, I told him that he
would lose his hand, and perhaps his head, and I requested the
person who was sent by the Sulṭán to bid me welcome and to
conduct me to his garden, to inquire of the lad where he had found
the watch, and what he had done with the waistcoat. The lad replied
he never saw the waistcoat. All of them, however, admitted that they
had seen Abú put the watch into the pocket of the waistcoat, and
both under his head, and that he had so slept during the whole
journey. The boy likewise added, he had put the watch into a tree,
while ’Abd el Kerím said, he found the waistcoat under the bridge.
This convinced me that the lad had nothing to do with the robbery,
and I bade them let the boy go, saying that he was not the thief. On
this the blood of the soldier rose up, and he muttered a threat. I told
him I cared nothing for his threats. They then charged him with
having stolen other things, and pretended to put him under
confinement. I arrived at the gardens of Múláï Músá at four P.M., after
making the circuit of the city, and was ushered into the ruins of a
palace. I was hardly off my mule, when the soldiers who
accompanied me came first to demand a present, then the káïd, who
had conducted me, and, lastly, the cleaners of the place I was to
inhabit. The Sheïkh of the Jews likewise made his appearance to
receive orders for what I wanted; and as I am unfortunately to live at
the Sulṭan’s expense, it will cost me about four times as much as if I
had to buy every thing. I continued to pay, however, till my pockets
were empty. In my way to this place I had passed the village of
lepers, and a sad sight it was. I then got rid of all the people, and laid
down on the still wet floor of my large room, and was soon asleep,
sadly disappointed with my first night at Morocco.
Friday, Jan. 14.—Here in the ruined palace of Múláï Músá,
situated in a garden on the south side of the city of Morocco, but
within the walls, am I a sort of state prisoner. My large audience-
chamber has two hutches in it, like the cabouses of a Dutch galiot;
these are intended for sleeping places. I have, however, taken up my
quarters in the middle of the room, from which there is a view of a
large court-yard. The room has once been very splendid. It is 38 feet
by 17, and 30 high. The roof and sides were highly ornamented. At
the east end is the kiblah,[43] the Moorish arch, and at the west a
small chamber, but without any window, occupied by Abú as a bed-
room. In the centre of the court-yard, which is about twice the size of
the room, is an immense vase for water. On each side of my room
are large chambers, occupied by my two káïds and soldiers, and a
large kitchen, &c.; and at the corners are the sleeping-places for the
servants, forming a kind of fanál,[44] from which run rooms
overlooking the garden, which is now overgrown with weeds. I saw
there a great quantity of gold fish, a grove of orange, date, and olive
trees, a small mosque, and a splendid tank well supplied with water,
which, as it overflows, is carried through the garden in channels that
are bounded by trellised walks covered with vines. Outside of the
garden is a grand building with gates, strong enough for a fortress.
Got up early. Therm. 50°; the day fine. Paid my soldiers. The poor
fellow who had been charged with the theft was brought out and
bastinadoed. I received a visit from a female saint, who was dressed
in green, as being a relation of the Sulṭán, and of an old family; she
wanted and received a trifling present. The soldiers have expressed
themselves dissatisfied, although I have paid them as much as the
Sulṭán does. Wrote to Mr. Hay, and received a visit from the Sheïkh
of the Jews, who is to provide for me, and the expense is to be
deducted from their tax, which is only 1,000 dollars a-year, paid
according to the means of the people. There are here about 5,000
Jews, exclusive of the children, who are very numerous. I was visited
by lots of patients; among the rest was the court eunuch, and the
son of Levi Yákoút, the British agent; the former of whom was
affected with a disorder in his feet, and the latter in his eyes.
Saturday, Jan. 15. Therm. 51°.—Received a message from the
báshá of the district, to know if I was comfortable. Amongst the
visitors to-day were several saints, but they could not squeeze a
drop from me. Visited the Millah or Jew’s quarter; it was filthy to a
degree. Had far more patients than I could attend to. Returned
home, and got rid of the vermin I had picked up by way of fees. This
is a great day with the Moslems; it is the 27th of Ramadán, when
free license is given to men and women. Received a present of cold
food from Yákút, whose family I am attending. I had a long and
interesting conversation with him. It appears that I am the only
Christian in the place, with the exception of four French prisoners,
who have assumed the Moorish dress. I went to a large house in the
Millah, where I had a fine view of the city, with its palace, mosques,
and granaries. I have been pestered by more saints, and my soldiers
are quite horror-struck at the manner in which I treat these
impostors. Another disturbance amongst the soldiers about the
watch. Káïd ’Alí thinks I shall not be safe unless I take some
precautions; I have, therefore, placed his bed across my door, which
he requests may be securely fastened.
Sunday, Jan. 17.[45]—Therm. 51°. Cohen was sent for by the
minister before I was up. The interview was very satisfactory, with
great offers of kindness. I went again to the Millah to see my
patients. The lad who was said to be implicated in the theft was
brought again to be bastinadoed, but I prevented it, and threatened
to go to the minister. At this the soldiers were frightened, and, after
loading my pistols, I threatened to shoot any man who presumed to
come into my rooms. I then read the service of the day, and, after
making up my medicines, I received an order to visit the minister. As
soon as it was dark a guard was sent for me; when, wrapped up in
my zulham, I was led through the crowded bázár, and after turning
and turning again, that I might not know the way, came to an
enclosure, where several horsemen were waiting. I then went from
door to door, till at last I reached one strongly nailed and barred,
where my guide having knocked, a negro’s head popped out, and
after hearing the words el Hájí, whispers were exchanged, and
Cohen and myself were led up a dark passage. The four Moors to
whom the horses belonged were then let out, and the minister came
into the passage and ushered me into his room. Sídí Mohammed
Ben Alí is a middle-aged man, of low stature, and dirty in his dress;
his room was filled with papers. After bringing in a chair for me, he
seated himself in his alcove, with Cohen on his left. He then ordered
tea, and began to converse with great freedom, expressed his
pleasure at seeing me, assured me of the Sultán’s favour, and
begged I would command his best services. He questioned me on all
points of medicine and surgery, of which he knows something. He
referred to several medical works, and spoke of the practice of other
countries, and was much better informed than I expected. He asked
me to examine his two black women; for, said he, we take as great
care of our slaves as you have done of Abú. While we were with the
females, the clerk of the market came in and the ladies ran away,
and I was left with this porpoise for a patient; I remained about an
hour, during which I had continually tea, tea, tea. I was told that the
Sultán had given orders for me to see his palaces to-morrow, and
that he would see me himself if business permitted, and that I was to
be in readiness for the guard at seven A.M.
Monday, Jan. 18.—Therm. 46°. The weather very cold. I was up
early, to be ready for the visit. It was already past nine, when the
Lieut.-Governor of the Meshwá arrived, accompanied by an escort of
soldiers, with the Sultán’s orders to conduct me to his palaces and
gardens. The mules and horses were got ready, and off went the
cavalcade—poor Cohen on his ten toes—through heaps of ruins. We
passed the finest arch I have yet seen, and the horse on which my
hader[46] rides is the most splendid animal I have yet met with.
Arrived at the palace, I found court after court filled with soldiers. The
Sultán had stationed himself at a window to see us as we passed.
We dismounted at the house of the minister, of the court jester, and
of the commander of the forces, and then mounted again, and
proceeded by the lateral squares, which were filled in like manner
with soldiers, to the saluting battery, where we saw guns of all
shapes and sizes, but without carriages, whose place was supplied
by pieces of wood. We then visited several kiosks, very beautifully
painted, and afterwards the garden of[47] : from thence to Dar
el Beidá, which is rather pretty, and then to the new palace, which is
the most tasteful of all. Our route lay afterwards through a series of
orange and olive groves to the ruined palace of Múláï Músa with its
immense tank, and we went out at the gate, from whence we had a
fine view of Mount Atlas. We then proceeded along a covered walk
of laris,[48] extending above half a mile, and passing a fine aqueduct,
entered a second walk formed of a wood of dates, and a third of
pine, which was at the back of the palace, and from thence we
returned home. After this I visited my patients at the Millah, where I
found a whole host of fresh ones, ready to devour me. I received
also a visit from the Hakím Bashi (the chief physician), who came to
examine me; but I posed the old fellow by my long names and hard
words. He had brought with him a quantity of leaves of plants, of
woods, &c. to ask me their names and uses. I humbugged him
considerably. He has promised to bring me all their works on
medicine and surgery, and, after saying a great deal about my
talents, &c. he seemed to expect a present; whereupon I told him
plainly that I would give him nothing. I suspect, however, that I did
him an injustice, for he asserted that he came merely for information
respecting one of his patients who is frightened at his own danger.
The most curious part of my practice is, that I am compelled to taste
my own medicines, to prove that they are not poisons. Two of the
Frenchmen who were taken at Telemsán called upon me to state
their case. They complained of their hardship, in being duped to
change their religion. I gave each of them a dollar; but I cannot
interfere in their behalf. I am to have an interview with the Sultán as
soon as the fast finishes. The small-pox has broken out in the Millah,
and I have been attending the sick until I am sick myself.
Tuesday, Jan. 19.—Therm. 50°. Not very well. My door is actually
besieged with patients. The father-in-law and the brother-in-law of
the Sultán, the Sherríf, all are ill, or fancy themselves so. The son of
the physician who visited me yesterday called to-day; by all these I
was detained at home till 4 P.M.; I then went to the Millah. I find it is
quite impossible to attend to all the patients; while I am in one house
the inmates of the whole street collect at the door. The diseases that
puzzle me most are disorders of the eye and sterility; and scarcely
less perplexing is the complaint of the Moorish men. I must really
shut up shop, or I shall be knocked up. In the evening there was a
deafening roar of guns, trumpets, &c., as the moon is visible and the
fast over. I suppose this will confine me at home to-morrow, although
I have promised to go early to the Millah, where I have two very
pretty but very troublesome patients. After to-morrow I shall see the
Sultán, and this will decide my future movements.
Wednesday, Jan. 20.—Therm. 51°. The house crowded with
patients. I am quite tired of my trade. The garden is swarming with
soldiers, as it is the first day of the feast. After dispensing medicines
all the morning, I went to the Millah, where I found lots of lady
patients, whose chief complaint was the want of children. Saw some
very bad cases, and returned home, where I was pestered till dark.
Received presents of cold fish. Feel not very well. Had a message
from the Sultán to say that I was to go to-morrow to see the city,
upon one of its grand market-days.
Thursday, Jan. 21.—Therm. 50°. It has been very cold during the
night. During the whole morning the house was crowded with
patients. At noon, El Hájí came to take me to the Sultán’s garden in
the city. Having first paid a visit to the Káïd of Azamór, where there
was a large party at tea and talk, I proceeded to the garden of the
Sultán, where I found the Minister, the chief Taleb, the Clerk of the
market, and the tenant of the gardens, Múláï Ben Ali Ben Musúl, a
great friend of the Sultán. Here I had to take tea again, and was then
asked to dine. The conversation was entirely on medical subjects,
and, as all said they were ill, I had to prescribe for them all. I was
then taken into the garden, and asked if I could procure abortion,
and how it was effected. I told them it was death by the English law
to make even the attempt, at which they expressed their surprise. I
was then asked, as I would not eat, to continue my walk in the
gardens, where I felt certain the Sultán was [although I did not see
him]. After he was gone, I was shewn the ladies of all colours and
ages, who were more pleased with me than I with them. I was
detained there till four P.M., when I was told that the city gates were
closed, as this was the day of the great feast. I then went to the
Jewry to visit my patients. In the evening I received a message from
the Sultán to say that all the city would be closed on Sunday, but that
I had permission to go when and where I pleased, and that I should
always take soldiers with me, to command respect. I have been
asked to visit the governor of the Meshwá to-morrow, to see what
was his complaint. Retired to rest, quite done up, and unable to write
any letters.
Friday, Jan. 22.—Therm. 51°. El Hájí came to take me to Kaid
Jelábí Ben Boaza, governor of the Meshwá. There was little the
matter with him, except that he felt cold in some parts of his body
and had bad eyes. His wife was in a very indifferent state of health. I
promised to make up some medicines, and received a present of
twenty fowls. Patients are increasing till I am ill myself. Went to the
Millah and found more people ill, and so am I. On my return home, I
was ordered to attend the minister this evening, but stated I could
not do so, and went to my carpet very unwell.
Saturday, Jan. 23.—Therm. 50°. Tried hard to write a few lines,
but found it impossible to do so. Passed a very bad night, and was
obliged to send away all my patients. Kept my carpet till two P.M.
Went to the Jewry to dine with the British agent; found all my
patients worse. Had a visit from Múláï Hijází, the court jester, who is
the second person in the empire; but I make no presents, and he
gives no help without them. Our dinner was a curiosity. A Jew must
not light a fire from Friday evening to Saturday evening; hence their
whole food for the Sabbath is put upon the fire and kept there for
twenty-four hours, a large quantity of fuel having been previously
placed there for that purpose. The dinner is rather curious than
palateable. On my return home received a message to go to Sídí
Mohammed Ben Alí, where I had tea, &c., and was questioned for
two hours on medical points, with the view of making a physician of
him. I quite tired out the Moorish doctor, whose materia medica was
a certificate,[49] that Abú, had he been quick, might have copied out;
but he has become slower and slower. It took the Moorish doctor half
an hour to learn how to take two pills every other night. My
hypochondriac patient worries me to death, and I shall make an
excuse and get away, if possible, next week. I mean to go to the
Kaïseríyah (bazar) to-morrow, and shall afterwards lose no time in
asking permission to depart. I fear I have little chance of getting on
by this route; but I will bring matters to a crisis speedily.
Sunday, Jan. 24.—Therm. 47°. It feels rather cold. Patients out of
number; I was called out of bed to attend three: continued actively
engaged till half-past eleven P.M., when I began to sink, and was
obliged to order the door to be shut. Visited the Kaïseríyah; a very
poor thing: was sadly disappointed with the city. The Sultán would
hardly believe that I gave advice and medicine gratis. The people
here are very insolent. Went home and read the Bible. Visited my
patients in Jewry, where I found several new and bad cases. I fear I
shall lose one patient to-night, as I cannot obtain permission for the
gates of the Millah to be opened for me after dark. Returned home;
but did not get my meal in peace. Cohen was sent for by the
minister, who was surprised at my pieces of the Korán.[50] I mean to
go to the Moorish part of the town no more; have a great quantity of
work to do to-morrow.
Monday, Jan. 25.—Therm. 47°. Up at break of day to see my
patients; kept hard at work till half-past eleven A.M. Got my breakfast,
and had a visit from the minister. Went to see the Sultán’s father-in-
law, and then to the Millah; was so tired, that I determined to give up
all my patients. Cohen went in the evening to the minister.
Tuesday, Jan. 26.—Therm. 50°, and rising to 80° at noon. Up at
day-break again. Heartily sick of medicine, and threaten to throw
physic to the dogs and burn my chest. Received a message from the
Sultán, requesting me to go and see his friend the Báshá Ben
Ibráhím; found him with at least one hundred men; then to the
Sultán’s barber and bed-maker. After these, a Kaid came with twenty
people. He was the first person who wanted to pay me. Afterwards I
saw much of the city, the tomb of Sídí Ben ’Abbás with its green roof
and sides. The rats were crossing the road continually. The bashaw
had fallen from his horse three months ago, when he received some
bruises, for which he had been cupped and was covered with
charms; but I think my physic will do more than all. He spat upon his
arm and hand before I was allowed to touch him. Upon my making
some inquiries as to the state of his bowels, he was completely at
loss; nor could he understand what the stomach had to do with the
pulse. I explained to him that there was the same connexion
between the heart and other parts of the body, as there is between
the root and branches of a tree, and between the spring and the
works of a watch. I am to see him every day. I have been obliged to
beg to be excused from waiting on the minister, as I am quite
knocked up and ill.
Wednesday, Jan. 27.—Therm. 54°. Evident symptoms of a
change of weather. I got up early to visit the bashaw; while I was out
of the room, he told Cohen that I should be well paid if I cured him,
and expressed no little surprise when he heard I would not take any
thing. Returned home, and received another message from the
Sultán, to go to see the Káid of Shragna. Feel very ill. I have now
two great out-door patients, and at home I found such a crowd that I
could hardly get into the house. Amongst the rest were four very
finely-dressed Moorish women, one of whom would conceal nothing.
I fear I cannot do much for them, and but little for the Jewesses, who
came in shoals. My stock of medicines is diminishing fast. Went in
the evening to the minister, by whom I was complimented highly. He
had seen Grenade and his son, who had come to witness the art and
mystery of compounding medicines. The minister told me I was to go
when and where I pleased. He requested also to know whether I
preferred riding on a mule or a horse, as his master wished to make
me a present. I told him that I had always found a mule the most
useful in my journey. I then offered to have the Physician’s Vade
Mecum translated. He next asked me if I would settle at Marocco,
and proposed my bringing my wife and family there; said that the
Sultán would like me to remain for ten months; that I should go every
where, see every thing, and that I might have two months to return to
England. I replied that it was impossible for me to do so, as I was to
be absent from England eighteen months, six of which had already
elapsed, and the rest was to be devoted to further travelling. I then
went to the Káïd of Magodor. He was pumping me; so I gave him
some clear water and stopped him.[51] I find he is a bit of a
diplomatist, and has been set on to worm out my design in coming
here. He talked much of Mr. Willshire, so I must be on my guard.
Thursday, Jan. 28.—Therm. 54°. Up early to see my patients, all
of whom are doing well. Have been obliged to order my doors to be
closed. I cannot endure it any longer. I have not even time to take
refreshment, and my head too is overworked. Went to see Ben Idris.
There were four other persons there besides the minister; neither the
conversation nor inquiries could be put with propriety on paper. My
answers, however, were such as not to make them my friends.
Heard again from Mr. Willshire. I have some suspicions of the Káïd
of Mogador.
Friday, Jan. 29.—Therm. 57°. Up early to visit my patients. I have
quite won the bashaw’s heart. I had this morning to examine all his
ladies; Zara, Ayishah, Embrica, Henia, Mirima, Bettoula, Iemola, &c.
&c. They were more pleased than I was. They were of all sizes,
colours, and dresses. I was kept there two hours, and was nearly
sick and somewhat excited. There were above two hundred of them.
Went home and found there Káïd Músa; afterwards visited Káïd
Abdallah, from whom I heard much of the high favour I was in with
the Sultán. Went in the evening to see Káïd Jelábí, and on my return
home found poor Abú very ill, with symptoms of dysentery.
Saturday, Jan. 30.—Therm. 55°. Went early to Káïd Abdallah, and
thence to Káïd Músa, and then to El ’Arabí, while three persons
carried the medicines. Returned home, and found a message from
the palace. Dressed, and after a row with my Káïd, I went to the
Meshwá, and was then summoned to the palace. Passing through
court after court, I came into the presence of the Sultán, who was
seated in an arm-chair in the blazing sun. Approaching respectfully, I
tendered him my thanks for the kindness shewn to me. After making
some inquires about me, he requested me to feel his pulse; and he
then ordered his people to take me round his garden, after which I
was called back, and found that all his ladies were to be gratified
with a sight of us. During the promenade we met some slaves
carrying dishes along the shady side of the garden, that had been
sent from the Sultán; another with sweetmeats; others with flowers:
and at the gate there was a fine gold-coloured horse, the Sultán’s
present to myself, and a mule to take me home. Congratulations
came thick upon me, while my Káïd was sadly in the dumps, to be at
the palace to-morrow at ten A.M. I had no sooner reached home than
fresh slaves were sent with fruits, and one with a china jar of dates,
and an order for all the money that I had given away to be returned
to me, and that if any one took money from me, his hand should be
cut off, and if any one insulted me, his teeth should be drawn; and
that I was to have one or a hundred soldiers, as I liked, and might go
where I pleased.
Sunday, Jan. 31.—Therm. 54°. My patient, the Káïd, getting
better, I went at ten P.M. to visit the Sultán, where I had to make a
dose for his taster. Remained there some time, and left my bottle
and one of my best handkerchiefs. Had my dinner sent home with
me from the palace. Saw the chief eunuch and Jelábí: prescribed for
both. Met with some patients, who nearly drove me mad. They have
a strange idea that women can keep dead children in the womb for
years. Went again to Káïd Jelábí, and heard the same disgusting
application. The news of the fall of Tlemsin was brought in seven
days, which was considered quite wonderful. A telegraph would have
done it in seven minutes. I had scarcely finished reading the service,
when I was driven almost mad by the music sent to do me honour,
and which I was compelled to endure till past midnight. The Sheik of
the Jews, and others, were however highly delighted, and the beasts
will remain continuing the noise till morning. I took up a fellow who
had insulted me; I believe they would have cut out his tongue had I
persisted. Grovelling wretched curs, they come to kiss my knees.
Oh! that I could get away. Never was I so sick of any place as this. I
am literally worn out. I hear there are some letters for me, which
have gone by this place. Sunday, alas! no day of rest to me, and the
noise greater than on any other day.
Monday, Feb. 1.—Therm. 56°. Before I was up, Hájí Hassan, the
Sultán’s tea-maker, was here from the palace with mules to take me
to Ben Ibráhím, called the Sultán’s Heart. I found him on the eve of
departure; prescribed some medicines; gave directions about his
diet. He would make me accept a haik and a sulham, the fabric of
Dukálah, of which place he is the Káid. I then went to the Káid of El
’Arabí, who was not so well. From thence to Sídí Mohammed, the
Sultán’s father-in-law, who gave Cohen three dollars as a fee. I then
went off to the Sultán’s, where I remained two hours to set about
making some syrup of violets, which I am to finish to-morrow. I
ordered a saddle and bridle, and gave Káid ’Alí half a-dollar a-day to
break-in my horse, who is very unmanageable. Have been hard at
work all the afternoon in preparing a plaster for the Káid of El ’Arabí’s
arm and shoulder. It is a sad business. He is really very bad. But at
the palace they will all have physic. Saw the chief eunuch, a very old
man; had lots of fun with him. I shall have to examine the second
eunuch to-morrow. I was asked to look at the gate-keeper’s foot: it
was in a state of mortification. The cold in the [52] I have
refused to attempt to touch, and have made many enemies by it; but
I have some little character to lose. Every body here is sadly
dispirited by the fall of Tlemsán.[53] How I contrive to stand all this
work I know not. I am extremely anxious to be off again.
Tuesday, Feb. 2.—Saw to-day more of the city than ever; the
gunpowder manufactory, and the leather-dressing. The powder is
made in the open air. Within four large mounds of earth, all kinds of
offal, the carcases of camels, dogs, &c. are left to putrify, for the
purpose of yielding the nitre. Their process is a very simple one, and
the powder not bad. Some of the fair sex look very comely in the
street. My soldiers got a dollar a-piece for carrying the medicine.
Went after Adáj to see Sádik, Abú’s namesake. Such a set of beasts
I have never seen as I met at his house: he would have me take a
sulham from him, which I gave to Cohen. Saw lots of the fair sex,
and one poor devil of a renegade, for whom, however, I could do
nothing but give him some pezetas. Went to the palace, where I
found many patients. One of the Sultán’s children was sent to me
with a message from its mother; but I will not prescribe without
seeing her. I remained at the palace four hours, working at a syrup of
violets and preparing things for the Sultán. Was asked to eat and
drink, but refused every thing, except water. When I returned home
three different cargoes of food were sent; but I have been worked
too much to have any appetite. Thank heaven, many of the Sultán’s
friends are going away. For some days past I have been compelled
to neglect the poor Jews.
Wednesday, Feb. 3.—Therm. 57°. Went early to Adáj. Not so well.
Pilula et haustus.[54] Returned home, and found a greater crowd
than ever; mostly women. The story of the dead child was repeated
by some dozen of them. A very pretty creature from Tangier was
afflicted with a strange complaint. My examination of the women is a
bitter pill for the Moors; the women, however, are highly delighted. I
am much puzzled with the pretty Jewess and her husband; it is the
seventh year of her marriage, and he can put her away if she has no
child. I gave them each something to take: it satisfies them and can
do no harm; and I have buoyed up the man with hopes, although, by
all accounts, the fault lies with him. Too tired to write my letters,
which is the more provoking, as couriers are going daily: have seen
above sixty patients to-day. My own health, I find, is suffering from
having too much to think of; I hope, however, that I have done some
good. The case, or rather the result of the diagnostic by the egg and
blood is obtained by the process following:—take an egg laid on a
Thursday, write upon it ü ϋ 99̂9 oo 8999 ξχρσγ[55] ta a; put the
egg in the moon and dew; break it in the morning: if you find blood in
it, the patient will die; if no blood, he will recover; and if he does, he
must write upon the ceiling a verse of the Korán, which is not to be
carved previously, nor is he to use any light to write it by, &c.
Thursday, Feb. 4.—Therm. 54°. Felt rather ill, worse, indeed, than
most of my patients; suffering from want of rest: am pestered with
the same host of people, and puzzled with their extraordinary
complaints. Went to the palace, where I was tired out with questions;
returned home, too ill to sleep.
Friday, Feb. 5.—Therm. 52°. Much rain during the night. Adaj
getting well: I am longing to be off. Prepared medicines for the
Sultán. Am sick of the folly and ignorance of these people. Have sent
to ask permission to see the Sultán to-morrow.
Saturday, Feb. 6.—Therm. 57°. Found the bashaw so much
better, that I sent to Ben Alí to request an interview, in the hope of
being able to get away next week; my patients, to-day, have
exceeded all that I have as yet experienced. I have now made a
serious complaint, and have determined to shut up shop. Went to the
Millah, and saw two Jews’ weddings; at one of them the bride was
not twelve years old. Received a letter from Mr. Willshire.
Sunday, Feb. 7.—Therm. 50°. Felt too ill to go to Adaj. Cohen
brought good accounts. Read the prayers, and afterwards went to
the palace. Saw the Bó-áb, who will die; had some differences with
the Sheríf, and sent a message to the Sultán: saw Sídí Ben Alí, who
promised to pay me a visit this evening, but as he did not come, I
took a light dinner at 7, afterwards wrote some letters, and retired
early to rest. Very cold. To a message from the Sultán, requiring to
know if I had every thing I wanted, I sent an answer in writing.
Monday, Feb. 8.—Therm. 54°. Went to Jelábí; saw a few patients.
Felt by no means well; returned home, when I received the two
decalogues[56] for the head and arm; three turns above the elbow,
and seven between the elbow and wrist, thus making the ten
commandments; tyed on the second finger of the left hand in hopes
of getting a Saffir.[57] I feel very desirous to be off: received letters
from Mr. Hay, &c., and sent an order for the medicines[58].
Tuesday, Feb. 9.—Therm. 54°. Up early, and went to see Muley
’Abḍ el Wáḥed (the servant of the Only One), the uncle to the Sultan.
No contrast could be greater than that presented by the two
residences. Abd el Wahed preserved, nevertheless, his commanding
aspect and smiling face. He was seated in a yard, with a water-skin
lying in the middle of it; his room was without even a mat. The fine
old man, who was well dressed, was reclining upon the remains of a
carpet, with a small green velvet cushion to lean against, the last
remnant of his former greatness. He requested me to feel his pulse
and order some medicine, and afterwards to visit his sister-in-law.
On my consenting to do so, I was ushered into a side-room, where
there was no mat or carpet, and only a small pot of charcoal, at
which sate a woman who would have made a mother of Coriolanus.
She was in rags; but here and there was seen a jewel to mark her
former state. Covered with a few blankets, the sick woman was lying
on the ground; she was very ill. I promised to pay her every
attention. I then asked for some bottles for the medicines, but they
had not one; I then gave them directions about taking them, when
the poor suffering creature said, “If it must be, make the time of
taking them the time of prayer, as we have no watch—no anything.” I
promised to send them a bottle, and asked for a cup to shew the
quantity in each dose. A small teacup was brought, all that remained
for the use of the party. This was the only house where I entered
without a soldier. I did not see a child. It was the very personification
of misery; I hope I may be of some service to the poor creature. I
shall never forget the scene; the woman at the fire, who might have
been seventy years old, had a look which cannot be forgotten; and
the words “God will reward you,” were pronounced in a tone that still
rings in my ears. Went in the evening to the Jew’s wedding: first to
the house of the bride’s father. Here I found the poor creature seated
on a raised chair, at the upper end of the long narrow room, which
was filled with Jews, who were eating before her to the sound of
timbrels and music, and around her the women were screaming. Her
dress was beautiful and jewels fine; but her face was bedaubed with
paint, and her whole person covered with a thin veil. She had been
kept about an hour waiting my arrival: she was then carried out of
the house, preceded by the timbrels, the Rabbis taking the lead and
chaunting; all the persons, but myself and my soldiers, carried a
light. In this way she was led to the Sók, where the friends of her
husband claimed her, and she was carried to his house, where he
had been undergoing a similar ceremony. Descending from his chair
she was placed in it; the Rabbi then chaunted the service, and taking
a glass of wine, he tasted it, blessed it, and gave it to the bride and
bridegroom; he then put the ring into the hand of the husband, who
placed it on the finger of the wife. The contract of marriage was then
read, a psalm sung, and the bride was carried to the nuptial
chamber, where she must remain seven complete days, nor leave
home for a month; and then only to dine with her father. Slept in the
Millah.
Wednesday, Feb. 10.—Therm. 56°. Visited Adáj, who is doing
well; and then went to the káïd Sídí Mohamed Ben el ’Arabí Assoon
or Rhabah: he is a fine old man, but was very poorly. I remained
there some time; afterwards I visited Múlláï ’Abḍ el Wáḥed, who was
better, but still very ill. Returned home; went afterwards to the
palace, where I saw Jelábí and the old eunuch, who shewed me the
bracelets of the ladies, each weighing about one pound: there were
about one hundred of them. A remarkably fine and young
Towáshí[59] has become a patient. The court-yard of the palace
presented a strange appearance to-day: there was a young lion as
playful as a dog, several gazelles, and a large eagle. As the camels
were loaded with muskets for Fez, I saw there were some signs of
preparations for moving northwards. Felt to-day a slight touch of a
coup de soleil: the sun was excessively hot. Called on Jelábí, and
saw the little black.[60] Began making my preparations for departure,
as I hope to be off next week.
Thursday, Feb. 11.—Therm. 58°, and rose to 102°. At eleven A.M.
it stood at 97°. At three P.M. the heat rather oppressive; and yet there
is a fine view from the garden of the snow-crowned Atlas. At six P.M.
the Therm. was 60°: at nine P.M. it had sunk to 57°. Went early to see
my patient at Abd el Wahed’s: found her better, but still very poorly. It
is heart-rending to witness such a change in her fortune, yet as the
poor sufferer appears to be soothed by my visits, I go there most
willingly. Her blessing to-day was pronounced with a fervour I shall
never forget. Saw one of the horses of the desert: these animals are
used to hunt the ostrich; they can perform immense journeys; they
are fed only once in three days; I had this from the mouth of the
groom; its allowance is a large jar of camel’s milk every third day; its
colour was iron-grey, with rather heavy legs, but a spare carcase; it
was very docile. The groom was highly gratified with the notice I took
of it. Returned home, and found the Káïd’s táleb[61] waiting for me. I
am heartily tired of my diploma, and medicines are beginning to fail,
while patients are on the increase. Abú was sent for by the chief
eunuch, and has returned with a story rather too flaming about
myself: but I must bear with it. Poor fellow! he is more helpless than
ever. I could not have got on at all without Cohen, who is most
attentive: he has received some very promising offers, if he will settle
here as a doctor; and if he remains with me twelve months, I think I
should be able to recommend him. I wish, however, he would take
less brandy: it is true that he is never tipsy, but no man can stand
what he takes for any length of time. Had a striped wild boar brought,
to see if I would buy it, and then a fine turkey, a rare bird in this
country. Sent Cohen to the Meshwá: the heat is too great for me,
under the excitement I suffer from overworking. I told him to ask
permission for us to depart: I doubt it will not be granted on the first
application. The second eunuch is much better. I find that medicines
have a more powerful effect upon such persons than even upon
women: three grains of calomel, &c. produced thirteen motions.
Friday, Feb. 12.—From the variation of temperature yesterday, I
determined to watch the thermometer every hour. At five A.M. it stood
at 42°; at six it rose to 47°, but at seven it fell to 44°; at eight it got up
to 48°; at nine the sun reached it, when it rose to 80°; at ten it was
91°; at eleven it had sunk to 90°, but rose again at noon to 91°; at
one P.M. it was 94°; at two it had reached 102°, but at three it sunk to
80; at four to 73°; and at five to 69°; giving a variation of 62°, and a
mean temperature of 74°, during twelve hours; at six it was 60°. I
discovered to-day that five cannot be pronounced before the Sultán:
one must say four and one. His daughter had been sent for me to
see: when I had called her a beautiful child, the person who brought
her immediately put up his hand, and pronounced the word kamsa
(five), which prevents the effects of the evil eye: for a similar purpose
the Jews place a hand over the doors of their houses. Went to Adáj
to take leave: I saw he had a sum of money tied up in a piece of rag,
and this led me to refuse, before he offered it. He said he knew he
was doing wrong; and after some time he gave it to Cohen. I was
sorry he took it, and yet I wished to know what he intended to give:
found, on my coming home, fifty ducats, a sum that Cohen now
regrets he has taken, and means to return it this evening. Went to
káïd Jelábí; dressed his hand; thence to ’Abḍ el Wáḥed’s; found the
good woman much worse. Although I told them she was dying, she
had been eating raw turnips: I now refused to give her any more

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