Internet Archiveopen access

Galen on anatomical procedures [electronic resource] : de Anatomicis administrationibus

GALEN

On Anatomical Procedures

TRANSLATION WITH INTRODUCTION AND NOTES BY

CHARLES SINGER

Until recent years the works of Galen, the greatest and most prolific medical writer of antiquity, were closed books to the modern reader. Professor Singer has now added another to the very few works of Galen which have been translated from the Greek into English. Galen's work entitled De anatomicis administrationihus is the text of lectures on anatomy delivered in Rome about a.d. 177. The Greek text was translated into Latin in 153 1, and in this form the work had a profound influence on Vesalius and other great Renaissance anatomists. Although Galen had some knowledge of human anatomy, especially of the bones, most of his dis^ section was done on the Rhesus monkey and the Barbary ape, in which many parts show marked differences from their human counterparts. Professor Singer has not only provided a scholarly translation of Galen's text, but he has also identic fied wherever possible the structures men^ tioned, and has attached to them their modern anatomical names. The book provides a basis for the study of the sources available for the foundation of modern anatomy.

The dissection scene on the front of this jacket illustrates Galen demonstrating on a pig. Itjirst appeared on the title page of the Giunta edition of Galen s Works, Venice 1541-2.

^js. 6d. net

Digitized by tlie Internet Arcliive in 2014

Iittps://arcliive.org/details/b20457194

PUBLICATIONS OF THE WELLCOME HISTORICAL MEDICAL MUSEUM

NEW SERIES, NO. 7

GALEN

ON ANATOMICAL PROCEDURES

PUBLICATIONS OF THE WELLCOME HISTORICAL MEDICAL MUSEUM

NEW SERIES

{General Editor: Dr. E. Ashworth Underwood, Director of the Museum and Library)

1. Charles Singer and C. Rabin: A Prelude to Modern

Science: being a discussion of the History, Sources, and Circumstances of the Tabulae Anatomicae Sex of Vesalius. (Cambridge University Press, 1946)

All the following published by the Oxford University Press:

2. Barbara M. Duncum: The Development of Inhalation

Anaesthesia, with special reference to the years 1846/1900. (1947)

3. J. H. G. Grattan and Charles Singer: Anglos

Saxon Magic and Medicine, illustrated especially from the semi'-pagan text 'Lacnunga'. (1952)

4. Charles Singer: Vesalius on the Human Brain. (1952)

5. F. N. L. Poynter: Catalogue of Incunabula in the

Wellcome Historical Medical Library. (1953)

6. A. D. Lacaille: The Stone Age in Scotland. (1953)

7. Charles Singer: Galen On Anatomical Procedures,

Translation of the surviving books with Introduction and Notes.

GALEN

ON ANATOMICAL PROCEDURES

TTspi AvaTOiJiiKCov Eyxeipriaecov De Anatomicis Administrationibus

TRANSLATION OF THE SURVIVING BOOKS WITH INTRODUCTION AND NOTES

BY

CHARLES SINGER

PUBLISHED FOR THE WELLCOME HISTORICAL MEDICAL MUSEUM BY GEOFFREY CUMBERLEGE

OXFORD UNIVERSITY PRESS

LONDON NEW YORK TORONTO 1956

Oxford Unwersily Press, Amen House, London E.C. 4

OlASGOW NEW YORK TORONTO MELBOURNE WELLINGTON BOMBAY CALCUTTA MADRAS KARACHI CAPE TOWN IBADAN

Geoffrey Ciimberlege, Publisher to the Universky

Copyright of

The Wellcome Historical Medical Museum

WELLCOME COLLECTION

PRINTED IN GREAT BRITAIN

ACKNOWLEDGEMENTS

I OFFER my grateful thanks to the Wellcome Trustees who have made this research possible for me. I am grateful also to the Wellcome Historical Medical Museum for publishing this work, and to the Wellcome Foundation for defraying the printing and publishing costs. Dr. E. Ashworth Underwood, Director of the Museum, has taken great interest in the work throughout and has made innumerable useful suggestions. I am very much obliged to Professor W. E. Le Gros Clark of Oxford for many hints. He has provided me with bodies of Rhesus monkeys, as have both Professor S. Zuckerman of Birmingham and the Zoological Society of London. My former pupil, Mr. Richard West of Clare College, Cambridge, has made many dissections for me which have been of the greatest use and have saved me much time. The editors and publishers of Professors Hartman and Straus's Anatomy of the Rhesus Monkey have graciously given me permission to use a large number of figures from that work. My debt to Mr. J. F. Grace and Professor Benjamin Farrington is acknowledged on p. XXV of the Introduction. To Professor A. J. E. Cave of St. Bartholomew's Hospital Medical College I am particularly indebted. He has read the proofs, and has acted as my mentor on anatomical matters. He has saved me from many errors, but those which will, in due course, be discovered by my critics are, I am quite sure, not of his but of my own making. I am very much obliged to Mr. C. A. Earnshaw for the immense amount of care which he has devoted to the preparation of the very full index.

C. S.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS V

INTRODUCTION xiii

BOOK I

On Dissection in General and on Muscles and Ligaments of Upper Limh in particular

1. Galen's Reasons for writing i

2. How to study the Skeletons of Men and Apes 2

3 . Distinctiveness of Muscles and Neglect of the Ancients in dissecting 5

Them

4. Certain of Galen's Differences from his Predecessors 9

5. Muscles of Flexor Surface of Forearm 12

6. Muscles of Extensor Surface of Forearm 17

7. Origins of Wrist Muscles 19

8. Insertions of Internal and External Muscles of Forearm 21

9. Small Muscles of Hand 23

10. Ligaments of Wrist and Hand 25

11. Extensors and Flexors of Forearm 27

BOOK II

On Muscles and Ligaments of Lower Limh

1. Why the Ancients wrote no such Books 31

2. The Particular Uses of Dissections 32

3. Why Anatomy is neglected or mistaught 34

4. Muscles of the Thigh inserted on the Tihia 36

viii TABLE OF CONTENTS

5. Muscles moving the Knee-joint 41

6. Muscles of the Hip 43

7. Muscles of the Leg 48

8. Muscles arising from the Fibula 51

9. Muscles of the Foot unknown to Galen s Predecessors 5 3

10. Some Ligaments of Leg and Foot 55

11. On the Nails 57

BOOK III

NerveSy Veins, and Arteries of Hand and Foot

1. Need for Anatomy of Surgically Accessible Parts 60

2. Precautions in removing the Skin 63

3 . Nerves in Upper Arm 65

4. Nerves to Forearm and Hand 70

5. Veins of Axilla and Arm 74

6. Venesection 77

7. Deep Veins of Forearm 79

8. Deep Arteries mid Veins of Arm 79

9. On the Care needed in investigating Nerves and Vessels 81

10. Nerves in the Thigh 83

11. Nerves of Leg and Foot 86

12. The Two Veins of the. Leg 87

13. Arteries of Lower Limb 89

BOOK IV

Muscles of Face, Head, Neck, and Shoulders

1. Function and Order of Anatomical Works 91

2. The Five Kinds of Muscles of the Mouth 93

TABLE OF CONTENTS ix

3. The Six Kinds of Quadrupeds, The Lips and their Movements. 97

4. Masticatory Muscles 100

5. Discussion of Eyemuscles postponed 104

6. Muscles of Forehead and Neck, and Movers of the Head 104

7. Four Small Muscles behind the Skull and on the First Two Vertex

hrae 109

8. Movements of First and Second Vertebrae 112

9. Muscles uniting the Skull with Sternum and Clavicle 114

10. Muscles which move the Scapula 115

11. The Twin Muscles that open the Mouth 118

BOOK V

Muscles of Thorax, Abdomen, Loins, and Spine

1. Muscles uniting Thorax to Humerus and Scapula 120

2. Shoulder Muscles 124

3. Muscles moving the Thorax 127

4. The Intercostal Muscles 131

5. The Diaphragm 13 3

6. The Abdominal Muscles 1 3 3

7. The Abdominal Muscles continued I37

8. The Diaphragm again 140

9. The Lumbar Muscles i43

10. The Intrinsic Spinal Muscles 145

BOOK VI On the Alimentary Organs

1. Principles of Comparative Anatomy 147

2. The Three Kinds of Alimentary Organs 150

X TABLE OF CONTENTS

3. The Three Grades of Digestion in Different Animals 152

4. The Peritoneum 154

5. The Great Omentum and Other Abdominal Structures 156

6. The Peritoneum again 160

7. Coats of Stomach and Intestines 161

8. The Liver 162

9. The Intestines 163

10. The Spleen 164

11. Vessels of the Liver 165

12. The Bile Ducts 166

13. Kidneys and Ureters 167

14. Muscles which retain or expel Excrement 169

BOOK VII Heart, Lungs, and Arteries

1. Organs of Respiration 172

2. The Pleura 173

3. Views on the Pericardium 175

4. Views on the Functions of the Lungs 175

5. Coats of Veins and Arteries 178

6. The Great Vessels 179

7. HetTJ'^ 180

8. Substance and Motion of the Heart 181

9. Vessels and Valves of the Heart 184

10. The Coronary Arteries and the Heart^one 186

11. Ventricles and Orifices of the Heart 188

12. Vivisection of Heart and Lungs 190

13. A Slave cured in whom the Sternum was excised 192

TABLE OF CONTENTS x

14. Conclusions from Vivisection of Thorax 193

15. Movement of the Heart investi^gated 196

16. Against the View that Arteries are Empty 197

BOOK VIII

The Remaining Thoracic Organs

1. The Rihs and Boundaries of the Thorax 201

2. Some Errors as to the Movement of the Chest 203

3. Results of cutting the Intercostal Muscles 205

4. Results of injuring the Intercostal Nerves 208

5. Control of Thoracic Movements 211

6. Operations on the Spinal Cord 214

7. Operations involving Loss of Voice 215

8. Further Experiments to illustrate Thoracic Movements 218

9. Transverse Sections of Spinal Cord 221 10. How to see the Site and Movement of the Pleura 222

BOOK IX On the Brain

1. Dissecting the Brain 226

2. Membranes and Veins of Brain 229

3. Chorioid Plexus and Pineal Gland 231

4. The Fornix 233

5. Corpora Quadrigemina and Vermis 236

NOTES ON TEXT 238

ILLUSTRATIONS 255

INDEX 279

ILLUSTRATIONS

(See note on p. 255)

{All the figures refer to the Rhesus monkey, except where otherwise stated)

Fig. I. Distribution of the Rhesus monkey.

Fig. 2. Skull of Barbary ape.

Fig. 3. Skull of Colobus monkey.

Fig. 4. Skull of Mandrill.

Fig. 5. Female pelvis, anterior view.

Fig. 6. Distal end of right radius, showing grooves for extensor muscles.

Fig. 7. Upper end of human femur, contrasting with that of the Barbary ape.

Fig. 8. Panniculus carnosus, and digitations of the serratus anterior muscle.

Fig. 9. Pectoral and abdominal muscles.

Fig. to. Extrinsic back muscles.

Fig. I I. Superficial facial muscles.

Fig. 12. Superficial facial muscles from below.

Fig. 13. Muscles of the head, neck, and thorax.

Fig. 14. Superficial palmar muscles.

Fig. 15. Deeper palmar muscles.

Fig. 16. Muscles of the right thigh, medial view.

Fig. 17. Muscles of the right hip and thigh, lateral view.

Fig. 18. Right femoral artery and branches; arteries of dorsum of foot

Fig. 19. Superficial plantar muscles.

Fig. 20. Deeper plantar muscles.

Fig. 2 1. Right lung with separated azygos lobe.

Fig. 22. The rectum.

Fig. 23. Diagram of right brachial plexus.

Fig. 24. Diagram of lumbo^sacral plexus.

Fig. 25. Lower's diagram of the posterior cerebral sinuses in man.

Fig. 26. Diagram of fourth ventricle and neighbouring parts in man to illustrate the calamus scriptorius.

INTRODUCTION

The reader has before him a translation of lectures, accompany^ ing demonstrations on anatomy and physiology, delivered in the Greek language at Rome in the year a.d. 177. I believe that the text was taken down in shorthand and that it repeats substantially the actual words of Galen. There is no comparable work in ancient literature. The experiments recorded are among those that determined a physiological standpoint which was not improved upon for 1450 years, that is until Harvey pub^ lished his results in 1628. Moreover, this book by Galen has a special place in the modern revival of anatomy, since it was study of the Latin translation of it, published by Guenther of Andernach in 153 1, that started Vesalius on his triumphant career. This, culminating in his Fahrica of 1543, ushered in modern anatomy and did much to determine the line of development of the biological sciences.

It is not necessary to tell here the life of Galen. For that the reader may turn to the scholarly contribution of Professor Mewald in a supplementary volume of Pauly/Wissowa*s great classical encyclopaedia, or to the pleasant series by the late Dr. Joseph Walsh in the Annals of Medical History (i 93 4-9)* or to Professor George Sarton's Galen of Pergamon (1954). These provide ample bibliographies. But a chronological list of events may be useful.

A.D. 129-30. Galen was born at Pergamum, an important centre of Hellenistic culture in Asia Minor, 46 miles due north of Smyrna. His father was a distinguished architect. Galenos means *calm' and was a given name. No other name for him is known: that of * Claudius* is fictitious.

144. Began study of philosophy at Pergamum.

147. Began study of medicine at Pergamum, learning anatomy from Satyrus.

150. Father died. He seems to have left Galen ample means.

xiv

INTRODUCTION

151. Visited Smyrna to study anatomy under the Dogmatist Pelops. In this year he wrote his earliest work that has survived. The original Greek is lost but it has come down to us in an Arabic version which has been translated into English by Dr. R. Walzer, as Galen on Medical Experiencey Oxford, 1944.

152. Went to Corinth to study anatomy under Numisianus who, he found, had moved to Alexandria. Thither Galen followed him and remained for some years.

157. Returned from Alexandria to Pergamum, possibly owing to his mother's death and to attend to his estate. Was appointed physician to the gladiators.

c. 159. Discovered action of recurrent laryngeal nerves and respiratory action of thoracic muscles.

161. The Emperor Antoninus Pius died and Marcus Aurelius suc^ ceeded him.

162. Left Pergamum. After visiting Greece, reached Rome and settled in practice.

164. Became acquainted with Flavins Boethus and Sergius Paulus, and made anatomical demonstrations for them. Proved that arteries contain blood, not air.

165. Boethus appointed Governor of Palestine.

166. Visited various parts of Greece and settled again in Pergamum. During his stay there he visited Palestine and Cyprus.

168. Recalled by Emperor Marcus Aurelius to Aquileia in Venetia to deal with plague in the army.

169. Marcus Aurelius and Galen return to Rome. Galen appointed physician to Commodus, son of Marcus. Sergius Paulus became Prefect of Rome and thus gave Galen another friend at court.

169-75. Spent these years supervising the health of Commodus at the Emperor's palace at Laurium, 12 miles north of Rome, at Lanuvium in the Alban hills, 20 miles south of Rome, and at Ostia at the mouth of the Tiber. This period was his most fruitful for scientific writing. He produced On the Natural Faculties^ On Respiration, and his great treatise On the uses of the parts of the hody, as well as other works.

175. Commodus joined his father in the East and both returned to Rome, where Galen had again settled in practice.

INTRODUCTION

XV

176-7. Became physician to the Emperor. Began to give public lectures on anatomy in Rome. The present work is probably expanded from a shorthand record of a series of these.

178. Marcus Aurelius died.

179. Visited Athens and Pergamum and returned to Rome with his library.

180. Commodus became Emperor.

192. Commodus assassinated. Pertinax Emperor.

193. Pertinax assassinated. Septimus Severus Emperor.

197. Finished his last major work, Methodus medendi.

198. Compiled the catalogue of his own works. 199? 200 ; 201 ? Died.

It may be handy for the reader to have here some information concerning the so/called *Schools' or 'Sects' of medicine. These bulk largely in older histories of the subject and they certainly did form a feature in the medical world of Imperial Rome. Nevertheless, the separateness of these 'attitudes toward practice' — for that is all that they were — has been much over/ emphasized in text/books and dictionaries. This tendency was encouraged by the view, which must now be abandoned, that these Schools arose as heresies from a pure and primitive *Hippocratic' original. Modern critical scholarship, in dispos/ ing of this pristine orthodoxy as a myth, thus necessarily softens the distinctions between the later heresies. Nevertheless, in Galen's time there were fairly apparent four ways of thinking about medicine which may be taken as representing the some-' what over/ written Schools.

The Pneumatic School was the most philosophical and its views accorded with those of Stoic thought. It flourished as early as the beginning of the first century A.D., and traces of it are possibly discernible in both Philo and the fourth Gospel. The representative medical Pneumatist was Archigenes of Apamea in Syria, who practised in Rome in the time of the Emperor Trajan (a.d. 98-117). Some of his works survive, translated into a *Hippocratic' dialect by Aretaeus of Cappadocia

B 2353 b

xvi

INTRODUCTION

during the lifetime of Galen. The Stoics in general, and Galen and the Pneumatists in particular, believed in a general worlds pneuma which all living beings share, as is manifested by their breathing. The physiology of Galen, based on this view, I have set out in my translation of Vesalius on the Human Brain (London, O.U.P., 1952).

The Methodist School had, as traditional founder, Asclepi/ ades of Bythinia (c. iio-c. 40 B.C.) who practised in Rome and, like Lucretius, was an adherent of the Epicurean or atomistic philosophy. He thus held that the body consisted of *atoms*. These, he considered, move in *pores' which penetrate all parts of the body. Disease results from relaxation or constriction of these pores and treatment should be directed at counteracting this looseness or tension. The typical Methodist physician was Soranus who practised in Rome under Hadrian (a.d. 98-1 3 8). The greatest work of Soranus survives in a Latin version of the fourth to fifth century bearing the name of Caelius Aurelianus.

Dogmatist is a term, perhaps introduced by Galen himself, to describe a certain medical group which emphasized theoretic principles. While accepting anatomical knowledge as neces/ sary, it laid a stress on unseen entities and causes. Dogma means only 'doctrine' and the word 'dogmatic' had not then acquired any pejorative meaning. Applied to a school of medical thinkers it might perhaps be translated as 'ratioci native', *given to theoretical reasoning'. Their best representative is held to be Celsus. The Dogmatists considered medicine under five heads: Physiology, Aetiology, Hygiene, Semiotics, and Therapeutics. They might be described as men of the 'middle way' between Pneumatists and Methodists. The putative father of Dogmatism is Diodes of Carystos (fourth century

B.C.).

The Empirics formed a group of non^thinkers, rather than a school of thought. Rejecting theory, or disliking the effort of understanding it, they relied solely on personal experience. They distrusted anatomy of the dead body and were content to acquire anatomical knowledge in the course of their surgical

INTRODUCTION

XVll

practice. In the work of Galen which follows, the reader will frequently encounter the Empirics whom he roundly dislikes.

The number of Schools might be multiplied by adding Sceptics, who doubted the conclusions of one School, or another, or all, and Eclectics, who chose doctrines from several Schools. Again it is possible to distinguish intermediate Schools as those between the Empiric and Dogmatic. Such distinctions would lead to no further understanding of ancient medicine since they would always lead back to Galen's own judgements. For in truth Galen's works are of such overwhelming mass that we are almost forced to look at the medicine of his age through his eyes. We might fairly describe him as a member of the Pneumatist School with leanings toward the Dogmatic.

Forgetting the classical jargon about Schools, the history of Greek medicine may be sketched as having taken a much simpler and more natural course than has been generally sug^ gested. The *Hippocratic' physicians before Alexandrian times based their knowledge of disease direcdy on observation of the sick. When concerned with the theoretical causes of disease they were mostly content with the ancient views of elements, of humours, and of the 'epidemic constitution' of the seasons. Their ignorance of anatomy, both human and animal, was fairly comprehensive, though they had some knowledge of the structure of the parts concerned in the commoner dislocations.

With the establishment of Alexandria as a medical teaching centre by the Ptolemies, about 300 B.C., there was a real change. The best medical outlook began now to be based on anatomy. The distinction from one another of the so/called Schools or Sects depended basically on their attitude to anatomical knowledge. For the next 500 years — from Herophilus and Erasistratus to Galen (and for that matter on to the present day) — the great majority of practical medical men, their trains ing once over, relied for their judgement of disease and for their choice of treatment on tradition fortified or occasionally modified by personal experience. The rare few, among whom were Herophilus, Erasistratus, and Galen, influenced the

xviii

INTRODUCTION

medical traditions of their day in the same sense that physio^ logists, pathologists, and epidemiologists influence ours. Schools differed from each other in the degree to which they were able to absorb this new science, that is, in effect, on their understanding and acceptance of the results of practical anatomy and experimental physiology. Of those two dis^ ciplines the work before the reader is one of the most important survivors from antiquity.

I must say a little on the difficulties, other than linguistic, that have confronted me in the work of translation. Of these I would treat three in descending order of gravity. They are (a) lack of technical vocabulary; (h) false physiological concepts; (c) ascription to man of anatomical features of other animals.

(a) Lack of technical vocabulary. The Greeks, unlike ourselves, had no classical language from which to draw scientific terms. These they made either by combinations of words, or by giving ordinary words a special meaning, or by using short descriptive clauses. Taking examples from our text, one illustrative of the first method is perikranion, *around the cranium'; of the second is konarion, *cone/shaped thing', pineal gland; of the third is o Tou brachionos prosthios mys, the anterior muscle of the arm', biceps. Manifesdy these terms were far less distinctive for Greek speakers than are their equivalents for English speakers. It is especially for the descrip/ tion of muscles, vessels, and nerves that the text presents difficulties to the translator. The obstacles to understanding for those ancient readers who did not dissect and had no anatomical figures were insuperable. Until modern times, and until the revival of the practice of dissection and the introduction of representational art, the anatomical works of Galen were almost incomprehensible.

(h) False physiological concepts. Certain of Galen's theoretical concepts present the translator with special obstacles. Examples of three may suffice.

I. The veins are described as arising from the liver and pro/

INTRODUCTION

XIX

ceeding peripherally, that is the reverse way to that adopted by a modern anatomist. Incidentally the pulmonary artery is, for Galen, the 'arterial vein and the pulmonary vein the 'venous artery'. The trachea is a special kind of artery.

2. Even greater difficulty arises from his theory of the nature of nerves. Galen saw that a nerve, neuron, passes into each muscle and that it then divides. Knowing that many muscles end in a whitish tendon, he thought that the branches of the nerves had reunited within the muscle to form this tendon, which he naturally also called neuron.

3. Again, Galen ascribed various fictitious activities to parts of the brain, notably to the infundibulum and the pineal gland. Fortunately, or rather unfortunately, this particular difficulty seldom arises for our text, since most of the section that deals with the brain is missing.

(c) Ascription to man of anatomical features of animals, Galen had perhaps some slight direct knowledge of human anatomy, certainly of the bones. This text is, in general however, a description of the soft parts of the ape imposed on the skeleton of man. For the gluteal region and the pelvis the misfit is of a gross order. For the hand and arm, to which the modern anatomist will think Galen gives quite undue attention, the difference is less, though there are many divergent details. The hand of the Barbary ape happens to differ from that both of man and of the Rhesus monkey in that the fourth finger instead of the third is the longest and most powerful. This is a very obvious difference. That Galen does not refer to it in this text itself suggests to the translator that he was working mainly on Rhesus. This is the more remarkable in that Galen is, as we might say, almost a 'specialist' on the hand. He uses that member to illustrate his teleological views and the early part of his De usu partium might be described as a long hymn to the Divine Wisdom in fitting the hand for its functions.

The translation which follows needs litde commentary. Galen's great text/book of Physiology and Anatomy is his De

XX

INTRODUCTION

usu partium which was completed by a.d. 175. It is a com^ prehensive theoretical treatise and is being translated into English by Mrs. May of Cornell University. The De anatomicis admimstrationihus, which is presented here, is a practical work. It describes the actual procedure of dissection and of physio/ logical experiment. I believe that it is a shorthand record of actual lectures, though doubtless lightly revised by its author. If so, it is unique as the record of the actual words used in the lectures of a teacher in antiquity.

The text is in a tolerable state, despite long neglect and the absence of any effective editing since 1541. My translation is based on the edition of Kiihn as being by far the most con-' venient. The relevant section (vol. ii, pp. 215-731) of his Opera omnia of Galen dates from 1821 and there is no later edition. Despite the many aspersions on Kiihn's text, I have found very few misprints and no large number of passages either gram^' matically or anatomically unintelligible. This, however, is no merit of Kiihn, for both his Greek version and its accompany^ ing Latin rendering are taken bodily from vol. IV of the immense production of Rene Chartier (1572-1654), which contains all the works ascribed to both Hippocrates and Galen and was issued at Paris in thirteen folio volumes between 1639 and 1679. Nor must great credit be given to Chartier for the state of this work. The Greek text in Chartier's edition was taken direct from that of the Opera omnia Galeni, which Andreas Cratander issued in five folio volumes at Basel in 1538. The Cratander Greek text was prepared for the press byjohan Kam^ mermeister (Camerarius, 1500-74), Leonhard Fuchs (1501- 66), and Jerome Geschmauss (Gemusaeus, 1505-43), all scholars of high standing. The Latin version of Galen On ana^ tomical procedures of Chartier is taken from that of the Giunta edition of Galen's works. It is that of Johannes Guenther of Andernach (1487-1574), published originally at Paris in 15 3 1, revised by Vesalius, and edited by Agostino Gadaldino for the Giunta (Venice) edition of 1541 and for the verbally identical Froeben (Basel) edition of 1542.

INTRODUCTION

xxi

Thus in the early sixteenth century this Greek text and its Latin translation occupied several men of great and exact learning. It is doubtful whether there are any important manu/ scripts of it that were not accessible to them. For what modern scientific scholarship can do for it, we must wait until Greek specialists see fit to turn from their other activities, often over/ exercised on familiar grounds, to topics in more urgent need of attention. But as regards the Greek of this particular work, to me it seems remarkable that it should have emerged in rela/ tively so good a state. Between Galen s death and the issue of the first (Cratander) printing of the Greek text in 1538 there was no dissection in the Greek/speaking East, and therefore no one could have understood it. To the scribes who wrote the manuscripts it was certainly quite unintelligible. The publica/ tion of Guenther's Latin translation in 15 31 and the revival of dissection in Italy and France in the sixteenth century gave it, at last, some real meaning.

Galen based this work chiefly on the anatomy of apes. He evidently had no difficulty in getting large numbers of them and he knew many different kinds. He advised the use of *those most like man' and, attaching importance to the absence of a tail, preferred the Barbary ape.* This creature was, however, never as common or as widespread as the Rhesus monkey (Fig. i), which is smaller and is much easier to handle. For this and for other reasons I think that Galen must often have used Rhesus monkeys. Thus his very extensive descriptions of the hand accord better with that of the Rhesus than that of the larger animal (p. xix). I have dissected the Rhesus which is much more accessible, and here use illustrations of its parts. Galen dissected many other animals also. In this book he mentions pigs, especially for experiments on the breathing and vocal apparatus and on the spinal cord, other ungulates for the brain, and one elephant.

Had Galen any knowledge by dissection of the structure of * It should be understood that he knew nothing of the anthropoids.

xxii

INTRODUCTION

the human body? I have thought much on this topic and have several times changed my views but now think that he had such knowledge. The matter requires some consideration.

Objection to dissection is neither of philosophical origin nor perhaps is it based on 'religion', as that word is understood in our society. Even the least reflective must be aware that after death the body is dissolved into its elements. The objection is not of rational origin at all. The fear and disgust aroused by a dead body are linked to age/old chains of awareness and of feelings that go far beyond and are far deeper than any formal belief or reason. Medical men know too well that the processes of post/mortem examination have to be hidden and can hardly be spoken of beyond the professional circle. We cannot suppose that it would have been otherwise in the days of Galen. What he may have said about human dissection he would not have wished or allowed to pass into 'publication', even in the limited sense in which that word can be used of his age. Can we then anywhere read between the lines of Galen's text ? Does he ever betray that he has a knowledge of points in human anatomy reached by direct contact with the object ? I now think the answer should be *Yes'.

There is no evidence that Galen or any other of the ancients appreciated the value of graphic methods in anatomy. He never indicates that he used figures in our sense of the word and he very seldom employed even diagrams. In two cases in this book he does refer to diagrams which can be reconstructed (pp. 28, 105) but, except for them, he avoids graphic methods here, though it would seem to us that figures are demanded. In their absence the three/dimensional impression created by view^ ing and handling the dissected part is the only way in which the relations of organs, tissues, and vessels to one another can be memorized or even grasped. Galen repeatedly urges dissection and the handling of dissected parts and suggests from time_to time that they should be human.

There are a number of passages in this book which, read together, yield the impression that Galen knew more about

INTRODUCTION

xxiu

human anatomy than he cared to have written down. The reader should study in succession the following passages:

Page 3, paragaph 2, to page 7, end of paragraph i.

Page 31, paragraph i, to page 36, end of paragraph 2.

Page 39, paragraph 3, to page 40, end of paragraph i.

Page 51, paragraph 3, to page 52, end of paragraph i.

Page 163, paragraph 2, to end of paragraph 5.

And others given in Index under *Galen, human anatomy'.

It may be that there are many comparable passages in other works of Galen. Mrs. Frederic May of Cornell University draws my attention to one in the De usu partium (vi. 4; K. iii. 423). Here Galen had been discussing the varying number of lobes of the lungs in different animals, and he says: *If death come not to me too soon, I shall some day explain construction in animals too, dissecting them in detail, just as I have done for man.'

Galen's anatomical and physiological lectures — for such they are — reveal a vivid and understandable personality. He is an enthusiast for his subject, of great industry, ardent for the experimental method, and full of anger against those who do not appreciate it. On the other hand, he is arrogant, self/centred, contentious, and a wearisome word^'Splitter, once his argu^ mentative tendencies are roused. One would naturally think that, with his manipulative skill and his desire to impart both his knowledge and his method, he could not fail to have many pupils. Several times he refers to these and to his way of instruct^ ing them. It would be quite understandable if he had had successors and followers. Yet it was not so. When he died experimental science too fell dead. Galen was heir to 500 years of physiological research. How was it that all this hoarded physiological wisdom of antiquity came to this sudden dramatic end? This question may perhaps one day be profitably discussed but hardly until the main writings of Galen himself are pre/ sented in a form that can be easily studied.

Galen presents at times — though at times only— a very

XXIV

INTRODUCTION

modern attitude to research. But it would mislead the reader grossly if this Introduction were to leave him with the impress* sion that this attitude was quite typical of the man. He showed himself not seldom to be gullible and superstitious, and some/ times, as it must seem to us nowadays, merely foolishly em/ pirical. He mixed moral judgements and personal animosities with his science in a way which would now be thought scienti^ fically indecent. His methods of controversy are detestable. His experiments, though often very well designed, were not accom/ panied by controls — a procedure almost unknown in antiquity.

The very bulk of Galen's writings cuts us off from adequate historical judgement of his predecessors. His surviving medical works are more voluminous than those of all earlier physicians. He is obviously the heir to a long line of experimental research and it is possible that some of his predecessors were as good or better men of science than he. He is far from generous in his acknowledgements. At any rate, if we would form a true picture of Galen, we must remember that he was a contentious, verbose, acrimonious fellow and that his science was but one side of him. His best thought-out and scientifically most complete work is his De usu partium. His Anatomical Procedures, here pre/ sentedj has less literary and philosophic merit but has the unique distinction of preserving the very words of an ancient teacher.

It is necessary to explain how this translation has been evolved. It has occupied a part of my time, on and off, for fifteen years. At first I prepared a quite literal translation, with the help of the late Miss Margaret Meldrum, of Somerville College, Oxford. I worked on this at intervals for some years while I was studying the anatomy of the Rhesus monkey and improving my knowledge of medical Greek. Gradually nearly every sentence in the book began to take rational form and to assume anatomical intelligibility. This naturally involved endless adjustment of the English against the Greek. The passages that remain untrans/ latable are almost certainly corrupt. Some unintelligible passages proved, on long examination, to be merely displaced.

INTRODUCTION

XXV

When I had at last got the English text into a generally intelligible form, I invoked the aid of my friend and neighs hour, Mr. J. F. Grace, late of King's College, Cambridge, and Eton College. Together we revised the translation, sentence by sentence. I am most grateful for his help. I have also received much kind assistance, especially for Books VIII and IX, from Professor Benjamin Farrington of University College, Swansea.

A few words on the text as here presented. The arrangement of the Books is less haphazard than it seems, if the standpoint of Galen be kept in mind. Book I, after four introductory chapters, launches into Galen's favourite theme of the muscular construction of the hand and forearm, as a specially favourable demonstration of the Divine plan, which is fundamental for his philosophy. Book II is devoted to the structures of the leg and foot which afford parallels to those of hand and forearm. In Book III the vessels and nerves of both arm and leg substantia ally complete the treatment of the limbs. In Book IV the muscles in the head, shoulder, and neck, and in Book V those in the torso are treated. Books VI, VII, and VIII deal with the organs which illustrate Galen's physiological scheme and the evidence on which that scheme is based. Of Book IX, devoted to the brain, only a fragment of the original Greek remains.

An Arabic translation of the whole work survives. This is important for Books X to XV, which are wanting in the Greek. These six missing Books, together with Book IX, have been rendered into German from the Arabic, with valuable introductory matter, by Max Simon, Siehen Bucher Anatomie des Galen, Leipzig, 1906. They were also translated into French by G. Dugat about 1850. Dugat's version is unpublished but exists in a very legible manuscript now in the library of the Royal College of Physicians of London. I have not included these *lost' Books in my version because, being unknown to scholars till the nineteenth century, they had no influence on the history of anatomy or physiology. The Arabic version of the first nine Books, however, might well throw light on difficult or corrupt

xxvi

INTRODUCTION

passages in the Greek text and would be worth investigation for that reason. I have published a note on Dugat's manuscript in the Journal of the History of Medicine, vol. vii, p. 85, New York, 1952.

I have recendy learned that the first nine Books were trans^ lated from Greek into French by the physician and botanist Jacques Dalechamps (151 3-1588) of Lyons. I have not seen this extremely rare book. It was printed by Pierre Roussin and published by Benoist Rigaud at Lyons in 1572. The only copies I have traced are a copy recorded by Graesse, and copies in the Bibliotheque Nationale, Paris, the Gushing Collection, Yale University, and the Hunterian Museum, Glasgow Uni^' versity. The Hunterian Catalogue gives the date of publication as 1573, but Mr. R. O. MacKenna, the Librarian, to whom I am indebted for details of the copy, considers that the final *J' in the date is a later addition. An edition of 1566, men^ tioned by certain biographers, is probably a ghost.

The following typographical devices are adopted here:

Greek words are normally spelt in Latin capitals.

Proper names are given in Latinized form.

Titles of Greek books are given their conventional Latin forms.

My own emendations of the Greek text are indicated at the foot of the relevant pages. Omissions are indicated in the text and/or at the foot of the relevant pages.

Explanatory passages or words added by me to the translation are printed within square brackets. Passages or words in round brackets are translated from the original but are either scribal additions or additions added by Galen himself as afterthoughts. Modern anatomical terms for structures described by Galen are usually added to the text in italics enclosed within square brackets.

The division into Books is the work of Galen himself The tides of Books and Chapters have no manuscript authority but follow roughly the indications of the Renaissance editors.

BOOK I

[On Dissection in General and on Muscles and Ligaments of Upper Limb in Particular]

Chapter i

[Galen s Reasons for writing] Anatomical procedure was the subject of a previous work 215 written on my coming to Rome [a.d. 162] not long since. That was at the beginning of the reign of our present Emperor, Antoninus^ [reigned 161-80]. I have now resolved to write again on the subject, for two reasons. Firstly because Flavins Boethus, the Roman Consul,^ as keen an anatomist as ever lived, on leaving Rome for his native Ptolemais [a.d. 165], urged me to record these 'procedures'. I gave him, among 216 other works, my De anatomicis administrationihus lihri duo.^ These were of notes [only] for, while he was with us [162-5], he had made many observations in a short time and had asked me for some such records as memoranda. But since he is now dead"^ and I have no copies (for those I had in Rome were destroyed by fire), at the urging of friends I decided to write others to give them. I was the more inclined thereto because the work would be much better composed, for meanwhile I have made many new observations. For clarity it is enlarged into a more detailed and accurate account.

While Boethus was still in Rome, I wrote De Hippocratis et Erasistrati anatomice,^ and also De vivorum dissectione^ with De 21J mortuoYum dissectione'^ and added De causis respirationis^ and De voce,^ When he left I was engaged on a long work, De usu partium lihri XVII.^^ This finished, I sent it to Boethus, then still alive.

De thoracis et pulmonis motu lihri tres^^ I wrote long ago, as a youth. It was for a fellow^student, returning to his own country after a long absence. He wished to display his talents

B. 2353 B

2

BOOK I

in public, but lacked lecturing ability. He, too, died and thus this book became public property, so that many got hold of it, though it was not for publication. I had indeed written it while still in Smyrna, to be with Pelops,^^ my teacher after Satyrus^^ the pupil of Quintus,^'^ before I had made any important or original contribution. Later I went to Corinth [a.d. 152], to hear Numisianus^^ 218 the most famous pupil of Quintus. Then I visited Alexandria [152-7] and several other places where I heard that Numisianus was living. Next I went home, but after no long time came to Rome [162], where I made many anatomical demonstrations for Boethus. He was constandy accompanied by Eudemus the Peripatetic,^^ by Alexander of Damascus,^'^ official exponent of Peripatetic doctrines in Athens, and often by other important officials, such as Sergius Paulus the Consul, present Governor of Rome,^^ a man as distinguished in philosophy as in affairs. But the treatise that I wrote for Boethus falls far short in lucidity and accuracy of what I propose now. And so to the opening.

Chapter 2

[How to study the Skeletons of Men and Apes]

218 As poles to tents and walls to houses, so are bones to living creatures, for other features naturally take form from them and

2ip change with them. If an animal has a round skull, its brain must be round; if elongated, so must the brain be. If jaws be small and face oval, the muscles must correspond. So too, if jaws be large, the creature will have a great muzzle with muscles in keeping. Now of all living things the ape is likest man in viscera, muscles, arteries, veins, and nerves, as in the form of the bones. From the nature of these it walks on two legs and uses its fore^limbs as hands, and has the flattest sternum of all quadrupeds, and clavicles similar to man's, and a round face with narrow neck. With these characters its muscles must accord, for they are extended over the bones, reproducing their

HOW TO STUDY SKELETONS

3

size and shape [Figs. 2-4]. So also arteries, veins, and nerves 220 conform to the bones.

Since, therefore, the form of the body is assimilated to the bones, to vv^hich the nature of the other parts corresponds, I would have you first gain an exact and practical knowledge of human bones. It is not enough to study them casually or read of them only in a book: No, not even in mine, which some call Osteologia, others Skeletons y and yet others simply On Bones though I am persuaded that it excels all earlier works in accuracy, brevity, and lucidity.

Make it rather your serious endeavour not only to acquire accurate book^knowledge of each bone but also to examine assiduously with your own eyes the human bones themselves. This is quite easy at Alexandria because the physicians there employ ocular demonstration in teaching osteology to stu-^ dents.^^ For this reason, if for no other, try to visit Alexandria. 221 But if you cannot, it is still possible to see something of human bones. I, at least, have done so often on the breaking open of a grave or tomb. Thus once a river, inundating a recent hastily made grave, broke it up, washing away the body. The flesh had putrefied, though the bones still held together in their proper relations. It was carried down a stadium and, reaching marshy ground, drifted ashore. This skeleton was as though deliberately prepared for such elementary teaching. And on another occasion we saw the skeleton of a brigand, lying on rising ground a litde off the road. He had been killed by some traveller repelling his attack. The inhabitants would not bury him, glad enough to see his body consumed by the birds which, in a couple of days, ate his flesh, leaving the skeleton as if for demonstration.

If you have not the luck to see anything of this sort, dissect an ape^^ and, having removed the flesh, observe each bone with care. Choose those apes likest man, with short jaws and small canines. You will find other parts also resembling man s, for they can walk and run on two feet. Those, on the other hand, like the dog/faced baboons, with long snouts and

4

BOOK I

large canines, far from walking or running on their hind/'legs, can hardly stand upright. The more human sort have a nearly erect posture; but firsdy the head of the femur fits into the socket at the hip/joint rather transversely,^^ and secondly, of the muscles

22^ which extend downward to the knee, some go further [than in man].^"^ Both these features check and impede erectness of posture, as do the feet themselves, which have comparatively narrow heels and are deeply cleft between the toes [Figs. 7, 16-20].

These are but trifling differences and only slightly interfere with standing upright. But such apes as the dog/'faced baboons not only differ very greatly from man in form, but also have an obvious unlikeness to him in their bones [Fig. 4].

Of apes choose, then, those likest to man, and meanwhile read my writings, getting from them an exact knowledge of the bones. For from the start you will gain from having grown familiar with the terms for them. These will be useful for learning the anatomy of the other parts also. Moreover, should you light on a human skeleton, you will more easily recognize and recall all that you have learned. But if you rely on reading, without constandy observing these bones, and on a sudden

22^ come on a human skeleton, you may be at a loss. For to recall observed phenomena demands continued familiarity. Do we not readily recognize those we often meet, while passing by those seldom seen? Hence the much/vaunted ^empirical' anatomy,^^ to which some physicians attach special value, must fail to explain the nature of the observations which have been made. For to understand [a dissection] when suddenly seen, one must have observed each part at leisure beforehand, preferably in human subjects^^ or, failing these, in animals similar to man.

In an epidemic of the anthrax in many cities of Asia, a number [of patients] presented parts stripped of skin and even of flesh.^7 I was then still at home [i.e. before a.d. 152], study/ ing under Satyrus. He had been three years in Pergamum with Costunius Rufinus,^^ who was building for us the temple of

22^ Zeus Asclepios. Not long before there died Quintus,^^ the master of Satyrus. All of us, who saw Satyrus demonstrating

HOW TO STUDY SKELETONS $

on exposed parts, recognized them explicidy and completely, telling the patients to make this movement or that, such as we knew was effected by this or that muscle, sometimes contract/ ing or displacing the muscles a litde to observe a large artery, nerve, or vein lying beside them. We then saw some students, as though blind, unable to recognize the parts, uselessly raising or displacing the exposed muscles (which needlessly distressed the patients), or even making no attempt to observe. Yet others, who had had more practice, knew how to direct the patient to move the part appropriately. Thus I perceived that, in observing wounds, those are confirmed who already know what to expect, but the ignorant learn nothing thereby. 226

I therefore maintain that the bones must be learnt either from man, or ape, or better from both, before dissecting the muscles, for these two [namely bones and muscles] form the ground-' work of the other parts, the foundations, as it were, of a build/ ing. And next, study arteries, veins, and nerves. FamiHarity with dissection of these will bring you to the inward parts and so to a knowledge of the viscera, the fat, and the glands, which also you should examine separately, in detail. Such should be the order of your training.

As I have already said, you should seek in demonstrations to uncover the part for study as rapidly as possible, and to dis/ play it in many aspects, adopting various methods of handling. If you have no ape, bodies of other animals must serve, making 22 j clear from the start wherein they differ from an ape, as I shall presently explain.

Chapter 3

[Distinctiveness of Muscles and Neglect of the Ancients in dissecting Them]

First read my exposition De ossihus^^ so as to have it at your 227 finger/tips, not only as regards the facts, but also the names, for I cannot discuss incidental points during my argument.

6

BOOK I

Not long ago I wrote also my De musculorum dtssectione, a separate work.^^ This was at the instance of colleagues who needed memoranda when travelling. They particularly re/ quested this as there had just reached us a tedious compila^ tion by Lycus.^^ It was of about 15,000 lines and contained nearly as many errors, even omitting many muscles. My work is probably but a third as long, but explains all the muscles. It deals faithfully with Lycus, a man ignorant of the function

228 of many muscles and missing some completely. By dissecting an ape guided by my book [De musculorum dissectione] any so minded may gain experience, but he will learn better from this present one how to handle the muscles in each part.

On the body let your practice be first to discern the origin and insertion of each muscle, and whether it be uniform throughout its length or diversely compounded. You will find some muscles of a single nature, others of a multiple. The latter may look like several muscles superimposed on one another, criss/'crossed in their length. Such observations are useful to you both in surgery and for investigating function. For in operating we must sometimes sever muscles, because of deep abscesses,

22^ or necrosis or sepsis. By knowledge of the action of the severed muscle you may forecast the function destroyed and thus escape the charge that the disability is due to the treatment rather than the lesion. Surgical precision, too, demands knowledge of the action of the muscles, for the action of some is so important that, if they be inactive, the whole part becomes useless, whereas others initiate only insignificant actions. It is better to acquire this knowledge beforehand, so as to cut cautiously or dras/ tically according to need.

Muscles are best divided along the fibres. Transverse incu sions, that is across the fibres, paralyse them but are sometimes necessary for the extension of narrow wounds which go deep. Such would be a stab wound at either end of a tendon; where

230 there is a risk that, while the parts on the surface close, those deeper may remain separate. Sometimes we are driven to sever the muscles for drainage, for the position of the wound is often

DISTINCTIVENESS OF MUSCLES 7

such that the injury in its depth disappears from sight. Thus, for example, if a wound be received with the arm completely extended, obviously the patient cannot maintain that position during treatment, and the easiest position is that in which the deep injury is hidden. No medicament can then reach it nor can pus drain therefrom. It is then necessary to incise the wound again, and for that it is essential to know the direction of the fibres and the action of the muscles.

The student must carefully do everything himself, even to 251 removing the skin. My predecessors actually remained in igno^ ranee of eight muscles, because they left to others the flaying of the apes, as at first I did myself Of these eight muscles two are designed to move the jaws [platysma faciei] and two join arms to chest [panniculus] [Figs. 11-13].

They erred also as to the other four and their tendons, for though all pass into tendons which are quite round, yet these expand to the thinness of a membrane, as happens under the sole of the foot and in the hand [in the plantaris and the paU maris lon^us]. All the anatomists have maintained, with some show of reason, that these tendons in the hands flex the fingers, whereas those in the leg draw back the heel. For in the foot there is no single muscle which Nature has designed as the origin of this tendon. However there is a bipartite muscle in 2^2 the calf of which one portion gives rise to this tendon ]_gastro^ cnemius].^^ In the hands the attachment of the tendon is [more] obvious, though in skinning it is inevitably torn away with the smooth part of the palm [palmaris longus]. Finding the tendon plainly extending from the muscle and seeing its lower end torn, and reasoning rather than carefully dissecting, they thought that it, too, moves the fingers like the muscles that lie under it [Fig. 14].

Many such facts have been discovered throughout the body, which the anatomists disregarded, shirking detailed dissection and content with plausible ideas. It is thus no wonder that they were ignorant of many things in the living animal. For if they pass as unimportant what is demonstrable only by careful

8

BOOK I

dissection, would they trouble to cut or ligate parts of the living animal, to discern the function thus impeded ?

255 At first I too had an assistant to skin the apes, avoiding the task myself as beneath my dignity. Yet when one day I found by the armpit, resting on and united to the muscles, a small piece of flesh which I could not attach to any of them, I de/ cided to skin the next ape carefully myself I had it drowned, as I usually do, to avoid crushing the neck, and tried to remove the skin from the surface, avoiding the organs beneath. I then found, extended under the whole skin of the flank, a thin membranous muscle [panniculus carnosus]. This was continuous with the covering of the spinal muscles at the loins as a fascia (syndesmon) from the bone of the spine. (I give this name SYNDESMON to all that extends from the bones, just as I call the offshoots of the brain and spinal cord nerves (neura), and the extensions (aponeuroseis) of the muscles tendons (tenontes).) Having found this muscle — the nature of

234 which will be fully and duly explained — I was the more anxious to skin the animals myself, and thus I discovered that Nature had wrought these aforesaid muscles for important functions [Fig. 8].

First I shall consider those muscles under the lower, smooth, hairless part of the hand, since it seems to me better to begin with the hand as a whole, following the order of my De usu partium.^^ For my earlier De anatomicis administrationihus lihriduo^ had followed the same order as that of Marinus^^ (and this I have mentioned in my De usu partium),^^ Now I return to the task after a long interval throughout which I have studied dissection.

Thus I have now much new and more detailed knowledge, particularly in the subjects treated at the beginning of that work. For then I knew nothing of the fine muscles at the 23s extremities of the limbs which flex the first joint of each finger and toe [lumhricales]. I thought that this action was performed solely by the membrane which encloses on the outside the

DISTINCTIVENESS OF MUSCLES

9

tendon running down to the end of their internode [fexores di^u tOYum suhlimis et profundus]. I also thought the tendons which move each finger sideways [interossei] to be analogous to those which extend and flex them, in that they are attached only to the parts of the bones at the joints. Yet that was not the case, for they [i.e. the tendons of the flexores digitorum profundi] each extend to the tip of each finger, attaching their own tiny fila^ ments [uincula longa] like a cobweb to the bones beyond the joints. These discoveries I made in the hand and foot, but throughout the rest of this treatise there are many comparable points, of which I shall duly speak.

Chapter 4

[Certain of Galen's Differences from his Predecessors]

Since it will be thought that on many points I am contradict/ 255 ing eminent anatomists, I think it wiser to say in advance a little on this. Controversy between physicians did not start 2^6 with me but has long existed among them. For this there are two reasons — first, because some of them had made erroneous statements, but second, merely because they used different ways of expression. Thus some, who agreed in recognition of observed facts, gave an illusory impression of disagreement to readers who themselves have never dissected. I have discussed such matters more extensively in my earlier work De dissentione anatomica.^"^ Now I shall state briefly only what bears on the present theme.

Some anatomists consider that there are as many muscles as there are muscle/origins. Others neglect the origins but consider the insertions (teleutai), emphasizing the body of the muscles. For them many short heads, coalescing and producing a uniform outline, are not necessarily many muscles. [Even] if the insertions be multiple and have a uniform motion, they say 257 that it is better to treat them as one muscle, and the more if it be impossible to divide them in a linear fashion into several parts. This is illustrated with the muscle in the middle of the lower

10

BOOK I

arm on the outside [i.e. extensor surface]. Pqj- being continue ous with itself and single in the strict sense, it is split at the wrist into four tendons [extensor digitorum communis which is, how^' ever, variously divided in different species of ape] producing a uniform movement, each extending the relevant finger. With reason, then, all anatomists treat this muscle as one, disregard/ ing the multiplicity of tendons of insertion.

For the same reason, they regard as one the muscle lying next to it which moves the litde finger laterally [extensor digiti minimi]^ though it has two tendons of insertion, for when the belly which lies above the tendons contracts it gives the ap/ pearance of one muscle. So if, like the tendons, the muscles also

238 which lie above them had a twofold oudine, they would have maintained that the muscles that initiate lateral motion in the little finger were two. However, the muscle that gives the other three fingers the same motion [extensor es digitorum II, 111, IV] they do not regard as one. Yet if likeness of motions justifies treatment of them as a unity, surely since all regard the muscle that extends the four fingers as one, they should reckon also as one those that initiate lateral movement.

Moreover, not even when several heads of a muscle coalesce near their origin into one belly with its own outline, do they consider the number of heads. Thus they have all taken as single the muscle in front attached to the arm, which starts from two heads [hiceps hrachii], because it has but one insertion and has necessarily a single motion and uniform outline. But they do not regard as single those muscles which move the calf [gastrocnemius], though they accept that they are fastened to the heel by a single tendon [tendo calcaneus], because their heads

239 extend a long way before uniting.

If then they be right, though their teaching about other muscles is often wrong, they should not be charged with igno^ ranee on this ground alone, nor need it be suspected that they disagree [on matters of fact] with those who enjoy better doc^ trine. I shall state in turn two methods of teaching the same subject, which differ in appearance more than in reality.

CERTAIN OF GALEN*S DIFFERENCES II

One may be put thus. The three larger digits, thumb, index, and middle finger, are moved sideways toward the litde finger by a single muscle [extensor pollicis longus, extensor indicts plus extensor digiti tertii proprius, the last absent in man]. This arises from the bone in the forearm, but produces three tendons of its own near the wrist. These pass into the side of the hands and cause their oblique motion.

Another way may be put thus. Two muscles resting on the forearm on the outside^^ initiate the lateral movement of these 240 three fingers. One muscle is inserted into the middle/finger [extensor digiti tertii proprius] and index/finger [extensor indicis] with a single tendon, being attached to the bone of the forearm over a very large area. The other muscle extends with a single tendon, just as it itself is single, and draws the thumb as it were towards the index [extensor pollicis lon^us]. Its head is in the upper parts of the arm, near the elbow^joint, and after a short distance it ends in a tendon which extends by the side of the muscle that moves the middle and index fingers.

The two methods differ less in what they seek to express than in their way of expressing it. The second, which says that two muscles are involved, is more accurate, since the muscle moving the thumb obviously has its own outline, but the first is not to be rejected entirely, seeing that the muscles have some/' thing in common and lie together, united by thin fibres.

Still more will a false impression of disagreement arise from the accounts of the tendon which moves the thumb and wrist. 241 For here too one can say that the muscle is forked — as in fact the anatomists have said — because it obviously has both a single head and a single outline, though at the end of the radius, by the wrist, it yields two tendons [one for the thumb and one for the two adjacent fingers]. However, anyone concerned about precision would do better to say that there is not one muscle here, but two, however closely united from the head to the point of divisions into tendons. It is fair to treat them as two, both because, if properly separated, they are found completely distinct, and also because they move parts different in nature.

12

BOOK I

For one tendon moves the thumb, the other the wrist; the motions are alike but the parts moved unlike.

[The anatomists] have made it clear that they generally dis/ tinguish muscles by differences in their motions rather than by their places of origin, v^hen they say that there are two muscles bending all the fingers, not one only, although their motion is almost alike in kind, and what is more they have a single origin. For since one head of the tendons bends the second joint, the other the first and third, they say that there are two muscles here. These, they say, are completely united through the whole length of the forearm, until they end in the branching tendons [fexores digitorum suhlimis et profundus], but are perceived to be double from the difference in their motions. [In the ape the fexor suhlimis gives off a fleshy branch to the fexor profundus.]

The most accurate method of teaching looks to these points. Yet one must not quarrel with those who follow a second method for any small departure from the first. It is preferable, when we find a statement made by many accepted authorities that departs slighdy from the best method, to accept it tem/ porarily, so as to avoid confusing the hearers by raising an appearance of disagreement. If you insist on precision, either you add to your account, if you are following the accepted method, that it is preferable to suppose that there are, say, two muscles, for the reason given or, if you follow the best method again you will add that these two muscles are really one, on the ground that they coalesce for a large part of their course. It is better that this should be said right away about all the muscles.

Chapter 5

[Muscles of Flexor Surface^^ of Forearm]

243 It is now time to explain how to proceed if one would gain experience oneself and give demonstrations to others. I have

MUSCLES OF FLEXOR SURFACE 13

already shown the common error of many who claim to be anatomists, in dissecting animals long dead, with parts dry and tense. They stretch the overlying skin, or the membranes or other tissues, and thus displace the underlying parts, or again pull and bend the fingers by the tendon inserted into the palm [palmaris lon^us]. Yet they themselves say that muscle or tendon must be attached to the bone that is to be moved. They speak erroneously (forgetting what they have themselves rightly said) when they assert that the fingers are bent by the tendon even when it has no attachment to the bone.

We must now explain how to proceed, avoiding their errors. 244 Obviously we must first of all remove all the outer skin from the arm and fingers excepting only the palm, then carefully strip the parts in the region of the wrist/joint. The sharp lancet is suitable for removing such tissues so that no membrane may be left behind after removal of skin, just as the blunt is useful for sundering muscles.

The membranes being removed, the first muscle [encoun/ tered] is on the surface of the mid forearm [palmaris lon^us]. Of it I shall speak more fully later [pp. 14^15]. You will see liga^ ments [retinacula] lying across the articulations, both on the inside [flexor surface] and on the outside [extensor surface] of the limb. Under them lie the heads of the tendons, on the inner^^ side those that flex the fingers, on the outer those that extend them. On either side of the ligaments on the inner side [of the arm] is a muscle flexing the wrist. The one is in a line with the little finger [flexor carpi ulnaris] the othct with the index [flexor carpi radialis]. On the outside, there is the single muscle 24s in the forearm which extends the wrist [extensor carpi ulnaris] as well as two in the ulna* both moving the wrist. The latter move also the thumb, and I said [p. 11] that it was better to describe here two muscles rather than one. The tendonsf of all the muscles on the outside which I have mentioned have liga/ ments transversely round them [extensor retinaculum],

* Text says 'radius*, f Text says 'heads'.

14

BOOK I

There is also a muscle descending from above the radius [hrachioradialis] which in the ape does not end below in a tendon, like those so far mentioned, but somewhat membra/ nously. By it this part is turned inwards [i.e., flexed]. No retinacular ligament surrounds this muscle, any more than the muscles inside which move the wrist [flexor carpi ulnaris]^ but it becomes both fleshy and membranous at the lower end of the radius and turns inward near the wrist/joint. You may call the fibrous end ( A p o N E u R 5 s I s) a * muscle/tendon (h y m e ODE tenonta). This muscle has a middle position, being neither among the muscles of the outside of the limb nor among 246 those of the inside when the hand is in its natural position, for it rests on the whole Hmb and on the radius. Since anatomists divide the parts in the lower arm into two regions, caUing some of them ^exterior' and others *interior',^^ we must follow their example to avoid the impression of making innovations. This muscle we think should, on the whole, be classed with the exterior muscles.

Another muscle within the forearm, of which I shall speak more clearly later, has a function unlike that of any muscle throughout the whole body, unless we except the calf It is on the surface inside the hand under the skin, between ulna and radius. It ends, as I have said [p. 7], in a flat tendon, extend/ ing under the smooth, hairless part of the hand [palmaris lon^us]. On removing the skin this muscle is seen in the middle of the muscles on the inner side. You may, if you choose, dissect the outer parts first, but let us begin from this muscle which extends under the skin with an expanded tmdon[palmar aponeurosis].

This tendon begins obviously to widen alitde above the wrist/ 24J joint. There one had best begin its dissection. It is plainly marked off from the muscles around and under it, being sur/ rounded with fine fibres which you can strip off even with your fingers and easily with a blunt lancet, raising the head of the tendon with the fingers or by inserting a hook. Then dissect it upwards to the joint at the elbow whence it issues. (For this

MUSCLES OF FLEXOR SURFACE 15

work the blunter sort of lancet is best.) Then, with the upper attachment still adhering, cut it across.

Now pull upward the lower part (which you have severed from the tissues by transverse incision), so as to stretch the 'roots'. Give special attention to what you now do, for not far from its end this tendon extends under the palmar skin [palmar aponeurosis]. Here you can proceed in one of two ways. Either remove the attached skin with the flattened tendon, separating 248 the latter from the underlying tissues with a sharp lancet; or free the skin from the tendon, leaving it on the underlying tissues. Either way its nature will become clear. This tendon is set under the inside of all the fingers, having as limit the line where the hairless palm meets the hairy skin. Beyond this tendon you will see flattened vessels (platynthenta) and nerves appor^ tioned to these parts [digital vessels and nerves]. Membranes rest on them, which you will remove with them after dissect/ ing the muscles.

Springing from two heads, the tendons that flex the fingers lie underneath, at the level of the ligament [fexor retinaculum] to 24^ which the heads of the tendons are applied. Of these heads, the one produces four tendons, inserted into all the digits except the thumb at the beginning of the second phalanx. By these tendons the second joint is flexed [flexor digitorum sublimis]. The other tendon/head [flexor di^itorum profundus], lying beneath the former, splits into five parts in the ape, each reaching to the last joint of the digit, and is there inserted.

Each several tendon is surrounded by a strong sheath, tougher than the tendon itself, and Hke a thick membrane [fibrous flexor sheath]. (You may call this tissue ligament' (syndesmon) or 'membrane' (hymen) or, compositely, 'membranous ligament', or again 'hard membrane'. And you can name the covering of the tendons 'coat' (amp hies ma) or 'sheath' (skepasma) or 'tunic' (chit5n). Beyond the division into branches, you will see each tendon, along with the aforesaid covering, drawn in by the tendons lying under it but themselves passing on to the bones of the fingers, and [you

16

BOOK I

will see] the first and third articulation of each finger bent, as if the tendon were inserted there, and the first bound by the surrounding ligament to the bones.*

It has been said in my De ossihus^^ that anatomists call the bones ofthefingers skytalides or phalanges. You will observe their attachments (emphyseis) if you remove the ligament lying around the tendons. The [five] tendons [of the fexor digitorum profundus] which lie underneath rest on the bones of their fingers and fuse with the third phalanx without splitting. The four [of the jiexor digitorum suhlimis] that rest on them are attached to the second bone, as I have said above, but as each passes over the former larger tendon, each splits in two, encircles the tendon lying under it, and is attached to the sides of the second phalanx. The thumb is pecuHar in that

251 nothing [from the Jiexor digitorum suhlimis] reaches it from above nor from the common head, but it forms attachments else^ where.

Scrutinize the palm and examine in it the tendon which breaks off from the other four [of the flexor digitorum pro/ fundus] to enter the thumb [flexor pollicis longus]. It does not stop at the first joint as do each of its fellows to the fingers, but passes on to the second joint (corresponding to the third of the phalanges). It moves this, as they do, by its attachment to it. It has a separate sheath round it and when you free it of tendons you must cut this sheath lengthwise with a sharp lancet. If you botch the operation and do not cut straight, you will sever the underlying tendon.

For manipulating the tendons from their origins to their sheaths, either let your ape be fairly fresh, before the fingers

252 have time to dry and stiffen and so to resist extension, or freshen them by pouring hot water over them or, if they are only moderately stiff, by kneading and movement. You would learn the function of each more clearly if you were to stretch all the structures around the fingers. Do this with the tendons underlying the [transverse] ligament.

* Three lines of text here obscure.

MUSCLES OF FLEXOR SURFACE 17

For the other two muscles by which the wrist is bent, begin to dissect them a little above the wrist/joint, for there they clearly pass into tendons and have the unmistakable oudines of such. By separating them from the underlying and surround^ ing tissues, both at their upper and lower end, you will see the tendons themselves attached to the articulation of the wrist below and their heads reaching the articulation of the elbow above. One of the tendons [flexor carpi ulmris] is inserted in the straight and cartilaginous bone at the wrist which is in line with the litde finger [^isiform].^^ This lies beside that process of the ulna that anatomists call styloid. The other tendon 255 [flexor carpi radialis] plunges deep immediately after the articular tion so that it has been thought that it becomes attached to one of the carpal bones. If you dissect the ligaments on top of it, however, you will see clearly that it reaches the metacarpal of the index, to the base of which it is attached.

These five muscles [palmaris longus, flexores di^itorum suh limis et profundus, flexores carpi ulnaris et radialis] occupy the whole inner side [flexor surface] of the forearm. If they are removed, those moving the radius will be revealed. Of them I shall speak later.

Chapter 6

[Muscles of Extensor Surface^^ of Forearm]

Meantime I shall touch first on the muscles on the outer 255 [extensor] side of the forearm, adding only that, whether you remove or retain the upper attachments [of the muscles already dissected], you will not prejudice the dissection which follows. Leave, however, the tendons which pass into the fingers so that there may be revealed the small muscles of the hand. These can be found even before the dissection of the outer parts, though it is better to dissect them last, as I shall later make clear.

Dissect the outer parts thus. After the skin come the super/ 25^

B. 2363 C

I8

BOOK I

ficial vessels and nerves. Remove them with the membranes and you v^ill see clearly four ligaments lying obliquely, one which binds the end of the ulna and the radius, the second on the ulna alone below the afore^mentioned, and two others on the radius alone. [These are apparently subdivisions of the deep fascia.] Make a straight incision in them, then fold up on either side, as far as the root of each, the parts of the ligament separated from one another, or else remove them altogether.

Next raise with a hook for its full length first the head of the four tendons [extensor digitorum communis] which move the digits (other than the thumb) — it is placed in the midst of the others — secondly, the tendon^head which draws the two little fingers to the side [extensores di^itorum proprii IV et V] away from the others. This last is divided, of course, into two ten/ dons.^^ (It makes no difference if one says that this draws the fingers to the lower part of the hand, imagining it in its natural 255 position, as Hippocrates taught.) Then you must raise the remaining one, the third, which initiates a like movement in the two* bigger fingers [extensores digitorum proprii II et III]. The first head of the tendons issues from one muscle, just like the second. By dissecting the double tendon of the third, the head which moves the two fingers, the index and the middle, [is seen to] issue from one muscle, while that which moves the thumb [extensor pollicis longus] from yet another. And thus there will be four muscles under the aforesaid ligaments.^^

Next comes the muscle that extends the wrist at the litde finger [extensor carpi ulnaris]. It has its attachment by a single tendon at the back off the fifth metacarpal. It is surrounded by a rather feeble ligament arising in the [styloid] process of the ulna.

At the thumb region, another strong ligament binds the head of the two tendons [of the ahductor pollicis longus and extensor pollicis longus], the bone of the radius being most beautifully carved at the process into a hollow equal to the thickness of the tendon s head.^^ [Fig. 6.] One tendon is inserted into the meta/

* Text says 'three'. f Text says *in front of.

MUSCLES OF EXTENSOR SURFACE 19

carpal of the thumb [on the sesamoid there], the other into the 25^ thumb itself, immediately after the first articulation. Whether you say that these two tendons spring from one muscle or two makes little practical difference, but the preferable view is that the two tendons spring from two closely united muscles. Indeed with care you can separate them, as with the two which pro^ duce lateral movement in the two* larger fingers [p. 13].^^

The remaining muscle on the outer side of the forearm [ex^ tensores carpi radiales lon^us et hreuis treated as one], which extends the wrist, is inserted by a double tendon into the second and third metacarpals, and the head of its tendon is fixed firmly to the radius near the wrist/joint [by the extensor retinaculum].

Thus there are eight muscles occupying the forearm on the outer side, or seven if one holds that the three big fingers are moved by two muscles and wrist with thumb by a [separate] one, that is by the muscle by the radius.

Chapter 7

[Origins of Wrist Muscles]

How each muscle is attached to the bones in the forearm has 257 been explained in my De musculorum dissectione?^ I shall repeat it here, to avoid gaps in my exposition and, as in that book, I shall also describe the attachments of the higher [muscles] for the sake of consistency.

On the outer condyle of the humerus you will find three muscle heads; the highest extends the four fingers [extensor digitoYum communis]; the lowest extends the wrist by the fifth digit [extensor carpi ulnaris] ; the middle [extends] the two lesser digits [extensor es digitorum proprii IV et V].

Under these and deep to them you will find two closely united muscles which belong to the rem^aining three digits. They arise from the ulna; that which belongs to the two fingers [extensores digitorum proprii II et ///], from the greater part of its length; that other which belongs to the thumb [extensor * Text says 'three'.

20

BOOK I

pollicis (lon^us)], from its upper end. On this there lies the muscle, closely united to the muscle of the wrist, which extends

2s8 the head of the thumb but itself occupies the whole depth of the region between radius and ulna [ahductor pollicis lon^us]. This muscle you should begin to dissect, as with the others, from the wrist [upwards]. As you strip it gingerly off the underlying tissues, note the ligamentous membrane between ulna and radius, throughout their length [li^amentum interosseum]. This forms the boundary between inner [flexor] and outer [exten/* sor] side of the limb. You will find this muscle resting on and coalescing with it, or rather, arising from it.

If then you strip this muscle [abductor pollicis lon^us] properly from the membrane which separates one from the other, you will find under it [i.e. under the membrane] a certain small muscle set transversely, extending from ulna to radius [pronator quadratus]. Of this I shall speak later, for you must first turn to the muscle that rests on the aforesaid muscle [ahductor pollicis lon^us] which lies along the radius throughout its length, always adhering to it, while its upper end is applied lightly to the ulna. Dissect higher up the muscle which lies on the afore^

259 said muscle and beside the radius. From this muscle* a double tendon comes off and is attached to the metacarpals of the index and middle fingers [extensores carpi radiales lon^us et hrevis treated as one]. You will find the top of this muscle at the highest part of the outer condyle, reaching a point on the humerus above it.

Consider now the muscle above this [i.e. above the ahductor pollicis lon^us] and [above] the radius itself, the muscle peculiar to the radius, which turns the palm upward [supinator]. It has an origin above this [i.e. the radius] and continuous and united with the origin of which we have just spoken [i.e. with the origin of the extensores carpi radiales]. But here especially the dissection may become confused, since the end of this muscle, becoming membranous, insinuates itself into the muscles of the upper arm. Therefore let it alone [now] and do not search for * Text here reads 'I said that', a scribal insertion.

ORIGINS OF WRIST MUSCLES

21

it while dissecting the lower arm. When you come to the upper arm, you will first lay bare the muscle in front [biceps hrachii]. It is then that you will find the origin of this muscle inserted 260 into the humerus by a narrow ligament. The greatest part of it rests on and lies alongside the muscles of the arm there.

Such are the heads of the muscles on the outside of the fore/ arm. Of the muscles on the inside, that by the little finger that flexes the wrist starts from the inner condyle of the humerus having some connexion with the ulna too [flexor carpi ulnaris]; while that by the thumb has its origin in the same condyle [flexor carpi radialis]. Between the two heads lies the origin of the muscle that runs down into the skin of the hand [palmaris lon^us]. Under it again lie the heads of two muscles that move the fingers [flexores digitorum suhlimis et profundus] filling the entire space between radius and ulna. The smaller [flexor digi^ torum suhlimis] is exacdy in the middle and springs from the inner condyle* of the humerus; being connected for a short space with the ulna also. The other [flexor digitorum profundus] is under this and occupies throughout its depth the whole space between radius and ulna. Moreover, it is attached to both bones [in the ape]. To the ulna it is attached at its forward outgrowth 261 [coronoid process] in the elbow region, and this part branches out in the wrist in line with its attachment into the litde finger. Another part of it with the same origin moves the four [other] digits and is placed in line with the index. And there is a third part of it which pertains to its own [special] fingers [i.e. I, II, and III]. This part, the belly, occupies the space between radius and ulna.

Chapter 8

[Insertions of Interna?^ and External Muscles of Forearm]

When you have dissected this muscle, it is time for our exposi/ 261 tion of the transverse muscle [pronator quadratus] which I post/ poned. All the muscles so far discussed having been removed, * Text reads kephale for kondyle.

22

BOOK I

those peculiar to the forearm become visible. By these the whole hand is supinated or the reverse. There are four: two are seen to reach the upper part of the forearm and two are close to the wrist [Fig. 15].

Of the two at the wrist, one is the transverse* muscle. It lies between radius and ulna [pronator quadratus] and issues from the 262 ulna, while the end reaches the radius, to move which is its function. Thus if you place the hand palm upward and stretch the origin of the muscle, grasping it with your fingers, as I told you always to do, you will see the whole hand being turned palm downwards. (Similarly if you stretch from its head the muscle that lies at the top of the forearm, the head of which reaches the humerus [supinator]^ you will make the hand turn palm upward. Thus to these two muscles opposite functions are assigned, though both move the lower end of the fore/ arm.) The yet longer and more fleshy muscle [extensores carpi radiates longus et hrevis], which lies altogether above this, also moves the hand to the supine position and we therefore reckon it among the outer muscles. The other [pronator quadratus], which turns the radius inwards, initiates the prone position [Figs. 14, 15].

The two muscles remaining move the upper part of the radius and are also opposed, their position being oblique. The one comes from the inner parts, issuing from the [inner] con/ 26^ dyle of the humerus [pronator radii teres]. It is there closely united with the head of the muscle on the thumb side which moves the wrist [fexor carpi radialis] but starts higher on the condyle. The other [supinator] is on the outside, and is smaller. Because of this, its fibres have a more slanting position. And it has a more sinewy insertion on the radius than the muscle on the inside [pronator radii teres] which we mentioned earlier, of which the attachment to the radius is continuous with it.f

I have now explained all the muscles that surround the ulna and the radius.

* Reading lechrion for loxon, oblique.

f Two lines here unintelligible, followed by four of repetition.

23

Chapter 9

[Small Muscles of Hand]

You now proceed to the small muscles of the hand. Remove all 26^ tendons of muscles on the outside, as far as their terminations in each finger, but not those of the muscles inside.

Examine the small muscles beside the tendons which flex the 264 third joint [lumhricales] before you cut them away. These muscles take their rise from the four sheaths surrounding the tendons [of the flexor digitorum profundus] and reach the sides of the fingers, producing very slender tendons. If, beginning from the fleshy part of the muscle which lies beside the first tendon, you dissect carefully, freeing it from the neighbouring parts, you will find the small tendon extending along the whole finger. Like the tendons from which they arise these muscles are four in number, namely, for the fifth, fourth, third, and second digits [Fig 14].

The thumb is moved by two other muscles, one drawing it away as from the other fingers [abductor pollicis brevis], the other drawing it towards the index [adductor pollicis]. That which draws it away to the utmost [abductor pollicis brevis] must necessarily be longer, wherefore its head issues from the first bone at the wrist [navicular but also from the radial sesamoid]. That which draws it towards the index is naturally shorter and broader and has transverse fibres [adductor pollicis]. This latter 26$ rests on the other muscles that I am about to mention. Its head is attached to the third metacarpal [but also to the second].

As the thumb is drawn away from the other fingers by the muscle [abductor pollicis brevis] that arises from the first of the bones in the carpus [navicular], so is the little finger drawn away by a muscle of like kind [abductor minimi digiti], which has its origin in the bone of the carpus corresponding to it [pisiform], in which is also inserted the tendon which bends the whole wrist [flexor carpi ulnaris] [Fig. 14].*

* Here there must have dropped out from the text a passage describing the cotttrahentes digitorum.

24

BOOK I

These seven muscles [four lumhricales and three contrahentes] have, of course, not escaped the notice of the anatomists, for there is no tissue lying over them which needs skilful removal for their display. For not only are the muscles that abduct thumb and Htde finger bare of covering by muscle or tendon, but they actually come to light before the tendons which flex the fingers, if that method of dissection be followed in which we remove the membranous tendon which lies under the palm. Each of the other [four muscles] [lumhricales] Hes along the four deep/set [flexor] tendons. 266 However, as I have said, it is not surprising that the tendons lying deep at the metacarpus were unknown to them, as they were to me for long. For unless you remove the large flexor tendons and the seven muscles which I have just discussed, none of those small muscles of which I am about to speak can be seen. If, however, these be removed, there becomes visible a continuous fleshy sheet formed from them all. This needs care/ ful dissection so that you may distinguish the separate muscles [Fig- 15].

There are two for each finger [palmar inferos set]. They reach the first articulation on the inner side and are attached to the sides [o{ iht phalanx]. For this reason they make no rigid and unwavering curve, but incline a little to the side, so that each, when contracted, bends the first joint slightly, but the two com/ bined produce a straight and rigid position in each finger.

All the others [dorsal interossei] issue from the ligament at the wrist and metacarpus at roughly the same articulation of the bones [as the palmar interossei]. Those belonging to the thumb [fexores pollicis hreves described as two muscles] have 26] their attachment higher than these. They issue not from the aforesaid bones but from the ligament that confines the two ten/ dons of the muscles which flex the fingers [fiexor retinaculum]. This ligament issues from the bones of the wrist on either side, without being attached to the ends of the ulna, or to the base of the metacarpals. [Fig. 15].

If you remove these muscles also, there will be no others left

SMALL MUSCLES OF HAND

2$

in the wrist or lower arm. You can then proceed in your investigation of the combination of the bones — their numbers, relations to each other, and their union. Of these enough has been said in my De ossihus.^^

Chapter lo

[Ligaments of Wrist and Hand]

Try to dissect with a sharp lancet all the ligaments [syndes^ 267 MO I, ^bonds'] which remain when the muscles are removed. Remember that such structures of their nature have a threefold function. First, that to which they owe their name, as binding [li£o, I bind, hence ^ligaments'] bone to bone. Second, they 268 protect underlying structures, as I have said, for the tendons at the wrist [fexor and extensor retinacula]. Third, they may cover these same tendons, forming an integument [tendon sheaths]. A fourth use is not peculiar to them. It is that when muscles end ligamentously they may act as ligaments as we have men^ tioned, but not so as to bind bone to bone, for in their midst they conduct (synaptousi) the muscles under them to the bones into which they are inserted.

None of the muscles hitherto discussed has ligaments of this last type, though others have. Of such, as for example the muscle in front of the upper arm [biceps and its lacertus fihrosus], I shall speak later. And yet some of the muscles of which I have spoken have some general Hgamentous character to the eyes of those who can trace the beginnings of things.* Such is the muscle which abducts the thumb [ahductor pollicis 269 hreuis]. This, though small, has something much like a liga^ ment in its attachment to the first of the bones at the wrist [navicular but also the radial sesamoid].

Among the muscles previously described some have a ten/ dinous structure according to the thirdf use [as tendon sheaths]. There are five of these in the wrist, one on the inside which * Literally 'See the great in the small'. f Text says 'second'.

26

BOOK I

rests on the two big muscles which bend the fingers [carpal tunnel], and four on the outside. Of the latter the middle belongs to the tendons which move the fingers [extensor digi^ torum compartment],^^ two are at the radius [extensores pollicis longus et hrevis compartment],^^ and the fourth is in the ulna [extensor digiti quinti compartment].

Different from these [and in the fourth class] are certain membranous ligaments round all the joints in the fingers and wrist. Others are firm and coarse, such as those which bind together the carpal and metacarpal bones of which I must speak presendy. If all the muscles are removed, these are clearly seen; in fact, while the bones still hold together you can observe

2J0 the movement of the ligaments of the metacarpus at their union with the carpus. When these ligaments are detached, what seemed a united mass is at once clearly seen to be separated and severed. Because of the shortness of the bones [of the carpus] and the closeness of the joints, their movement is not quite obvious. (Many people think that all these bones* of the wrist are one.) You must separate them at their meeting points by cutting the ligaments. Their junction will be apparent if the tendons are moved before they are dried up, for there is between them a litde articular give which indicates clearly to the close observer the places for their severance. If you extend and flex the wrist the junction of the bones is visible. If you make an incision there you will separate them all from one another and see that their appearance is varied.

27^ While laying bare these spreading ligaments you will notice another [medial ligament^ which is round and set opposite the tendon which flexes the wrist on the little finger side [flexor carpi ulnaris]. In Book I of my De usu partium I have explained how it retains the cartilaginous bone [pisiform] which lies there upon the articulation of the wrist. In laying bare the liga^ ments you will see the tendon of another muscle, that which flexes the wrist by the great [i.e. middle] finger [flexor carpi radialis]. This tendon appears to unite with the nearest bone * Text irrelevantly inserts kai poly mallon = 'and still more'.

LIGAMENTS OF WRIST AND HAND 27

of the carpus at that point lying by its side [trapezium], but passes through the ligament to the base of the second* bone in the metacarpus. Extreme care is needed not to sever the tendon in baring it, nor to assume that it stops at the point on the first bone of the wrist where it seems to do so to those who cut carelessly.

Observe here also the stylus/like process given off by the ulna in a line with the little finger. Anatomists call it styloeides. 272 If you move round the whole articulation to the side, you will see how it is adapted for movements of the wrist in turning round the whole hand. Observe exacdy also the movements of the radius on the ulna which we make when we turn the hand.

Chapter ii

[Extensors and Flexors of Forearm]

You cannot observe accurately the movements of forearm on 272 upper arm in flexion or extension until you strip the upper arm of all surrounding muscles. Let this then be done, remember^ ing that we said that the muscle resting on the radius [hrachio^ radialis] reaches up to the humerus and that the muscle under it [extensores carpi radiales longus et hrevis], that is, the muscle attached to the metacarpals of the index and middle finger, also comes up a short way. It is better to preserve the heads of these muscles, or at least that of the muscle resting on the radius [hrachioradialis], for you will first see it clearly when you lay 275 bare the anterior muscle of the upper arm [biceps]. You will expose it, paying attention firstly to the vein running along the whole upper arm [cephalic] called *shoulder vein , and secondly to the muscle which occupies, or rather forms, the highest part of the shoulder [deltoeides], for it is the only muscle that lies there.

The incision along the vein should be downward (the skin here being, of course, removed as well as the membranes * Text says 'first'.

28

BOOK I

[fasciae] round the muscles). The incision from the highest point of the shoulder should be made with attention to the like/ nesses and differences of the fibres, from which you will see that the outline of the muscle [deltoid] runs to an apex, like a triangle, inserted into the humerus.

This muscle pertains to the shoulder^joint and, alone of

[Reconstruction of Galen's diagram of deltoid.]

those that move it, must now be removed to render visible the double head of the anterior muscle of the upper arm [biceps]. [In the figure] let AB be the collar-bone, BC the spine of the scapula; suppose that the fibres* arise between the first and third of these points and extend at the one end to B, at the other to D, B being the top of the shoulder and D the farthest point of the insertion [of the fibres] into the humerus; and that BD be the whole [length of the] insertion. Of this muscle we must speak again, when we go through the muscles which move the shoulder joint. For the present, having noted it, remove it and follow what I have to say next.

The anterior muscle of the arm [hiceps]^ which is clearly visible beside the 'shoulder vein' [cephalic] even without dis/

* Text reads 'muscles'.

EXTENSORS AND FLEXORS OF FOREARM 29

section, in all, and especially in athletes, has two heads. One [caput Ionium] is attached to the ridge on the neck of the shoulder blade, the other [caput hreve] to the process which 275 some call *like an anchor' (ankyroeides), others *like a crow's beak' (korakoeides). The ligament of each head is strong and nearly round. Follow these heads as they run down through the upper arm. By their union they form this muscle which, unlike them, neither hangs loosely nor is raised from the humerus, but is closely applied to it. It rests unattached as far as the elbow/joint upon the smaller muscle lying beneath [hrachialis]. There [the^/Vepy] gives rise to its aponeur5sis, a strong tendon attached to the radius. It has a share in the membranous ligament round the joint [by the lacertus fihrosus] by which it flexes the joint, bending it slighdy inwards.

If this muscle [hicepi\ be removed, you will find another beneath which also encircles the humerus. [It arises] from two fleshy heads, one at the back of the humerus, the other more to the front, the posterior being much higher [hrachialis]. You will see them joining to form a single muscle which, passing 2j6 into a tendon, is attached to the ulna. It flexes the joint and bends it slightly outwards. But if both muscles [biceps and hrachialis] perform their function correctly, the bend of the articulation is inclined neither to right nor left.

There are thus two anterior muscles which flex the elbow. Three others united extend it [triceps]. These you must treat as follows:

First dissect the muscle on the inside of the upper arm under the skin [dorso^epitrochlearis corresponding to part of latissi^ mus dorsi in man] which has its head near the limit of the muscle behind the armpit [latissimus dor si]. (On the nature of this I shall speak in explaining the muscles moving the shoulder.) Its end reaches the elbow/'joint at the inner condyle of the humerus. This termination is membranous and thin.

When it has been removed, observe the origin of the two other muscles which extend the forearm [corresponding to parts

triceps in man]. Of these one [caput longum] springs from 277

30

BOOK I

the lower side of the scapula, about half'way down the upper part. The other issues from the back of the upper humerus below its head [caput laterale]. These, as they run on, coalesce in the upper arm and, continuing, are inserted in the crook of the ulna [olecranon] by a flat tendon. If you follow the fibres from above longitudinally, this tendon will be seen to be twofold, deriving its outer part from the first [part] of the two muscles we mentioned and the inner from the second. And if you separate each [part] of the muscle from the other and try to stretch it, you will see that the whole forearm is extended by each but that a difference lies in the lateral inclination to the side, for the former inclines outward, the latter inward.

Another muscle lies under it, surrounding the bone of the upper arm obliquely [caput mediale]. This unites with the second muscle and is thought to be a part of it by the anatomists, as indeed it is, if you think of this muscle as single. But it is

278 possible actually to separate them along the fibres. If you do this you will find that this muscle remains fleshy throughout, and is attached to the posterior part of the elbow. If pulled, there seems to me to be a straight and direct tension at the elbow joint, deviate ing neither to right nor left, though sometimes a little inwards.

I have now mentioned all the muscles in the arm. Having heard them, remember what you ought to know about these and about all the phenomena that you observe in dissection. For some muscles or tendons or Hgaments you find vary a little, some in their course and some only at their end. Again, some fuse with their attachments or become attached to what fuses with them, or have other such slight differences. If ever, when you are dissecting a limb, you see something that contradicts what I have written, recognize that this happens infrequently. Do not prejudge my work until you yourself have seen, as I have, the phenomenon in many examples. Here ends my first book. In the second I shall describe ana^'

27^ tomical procedures on muscles and ligaments in the legs. I shall add also the disquisition on the nails, which has reference to both limbs.

BOOK II

[On Muscles and Ligaments of Lower Limh]

Chapter i

[Why the Ancients wrote no such Books]

I commend Marinus,^^ who has written on anatomical pro^ 280 cedure, without criticizing my other predecessors who have not. For them it was superfluous to compose memoranda for them/ selves or others since they practised dissection from childhood under parental instruction,^^ as they did reading and writing. And it was not only professional physicians among our prede/ cessors who studied anatomy, but also general philosophers.^^ One so instructed from his earliest years would no more forget what he had learned from experience than would others the alphabet.

In time, however, the art came to be customarily imparted not only to kinsmen but to those outside the family. Thus the habit of dissection from early years came to be discontinued. For when the Art was communicated to [any] favoured adult it followed that the instruction became the poorer.

How much training from childhood counts in everything has been made clear, I think, by our forefathers, when they called 'educated' (pep aideumenoi) not only those skilled in the arts and sciences, but all who had gained some reputa^ tion in life, just as they called their opposites 'uneducated' (apaideutoi). Hence the Art, being no longer exclusive to the Asclepiad family, was ever degenerating from one genera/ tion to the next. Thus, too, arose a demand for memoranda to 282 preserve knowledge.

Formerly, then, there was no demand for accounts of ana/ tomical procedure, nor for the sort of handbooks that were

32

BOOK II

first written, so far as I know, by Diodes [c. 360 B.c.]/^ Other early physicians followed him and not a few of the younger school whom I have mentioned.

In addition to their other deficiencies such treatises have not made clear the usefulness of their matter, but fling together in^* discriminately things that can be of the greatest service to the Art with others that contribute litde or nothing thereto. It is indeed to the good that anatomical theory should be included in books on diagnosis, prognosis, and treatment, as Hippocrates plainly does. But, since there is danger that such studies may perish, because of the litde regard that my contemporaries have for the arts and sciences, and further since they themselves no longer have practice from their earliest years, I feel justified in 2% writing these memoranda. Yet had it been possible to preserve the oral tradition, such writing would have been superfluous.

Accordingly I have [here] communicated everything I have learned from the beginning to those who find they need it. Would that it were possible for all to acquire that knowledge. Already I see some who have been taught by me grudging to share their knowledge with others. Should they die suddenly after me, these studies will die with them."^^ Wherefore I have nothing but praise for Marinus^^ for recording his anatomical experience, though I was myself compelled to write another work on the same theme, since I have found his both incom/ plete and obscure.*

Chapter 2

[The particular Uses of Dissections]

283 Almost all anatomists seem to have failed to treat clearly the most useful part of the science. What could be more useful to a physician for the treatment of war/wounds, for extraction of missiles, for excision of bones, for [treatment of] dislocations, fractures with ulcerations, &:c., than to know accurately all the * This last sentence is, in the text, the opening sentence of the next chapter.

USES OF DISSECTIONS

33

parts of the arms and legs, and all, not so much of the internal as of the external parts of the shoulders and back, breast and ribs, abdomen, neck, and head ; For it is from these that we have 284 to extract weapons, incising the contiguous areas, excising some parts, evacuating humours in putrid infections and abscesses, and treating ulcers. Again with bones we have to cut out some affected parts or open them up. If a man is ignorant of the position of a vital nerve, muscle, artery, or important vein, he is more likely to maim his patients or to destroy rather than save life.

Certain knowledge, as the number and appearance of the muscles of the tongue, would be additional, but not primary or essential. I say 'additional' since we must inquire closely into such things because of doctrinaire theorizers who, not satisfied with the useful side of natural knowledge, are ever demanding 28^ *For what is this part ?' * Why is it of this nature or size f An intelligent man may grasp the matter sufficiently by two or three careful dissections by which is revealed what is useful for medical practice and, secondarily, for the knowledge of nature. I of all men am entitled to say that such studies in anatomy are useless for the treatment, diagnosis, and prognosis of disease.

[A gap here in text.] . . . escaped the attacks of unscrupulous sophists who, neglecting to criticize the theory, turn their attack against its authors, professing that their opponents, being ignorant of such studies, bring the charge of uselessness against them. For their sake, so that ignorance on the part of their critics may not provide the sophists with an easy line of attack, I have laboured at the purely theoretical as well as the practically useful part of anatomy. I have given sufficient proof of this in my De usupartium, and now I shall describe anatomical procedures on all the parts of the body. But, while doing this, 286 I also distinguish the value of each of the studies [i.e. theoretical and practical] and demonstrate its usefulness.

Anatomical study has one application for the man of science [aner physikos] who loves knowledge for its own sake, another for him who values it only to demonstrate that Nature

B. 2353 D

34

BOOK II

does nought in vain, a third for one who provides himself from anatomy with data for investigating a function, physical or mental, and yet another for the practitioner who has to remove splinters and missiles efficiently, to excise parts properly, or to treat ulcers, fistulae, and abscesses. Now all this [last application of anatomy] is most necessary, and a really good physician must first of all have practice in it, and next in the actions of the inner organs, which are important for diagnosing diseases. For some functions are of greater moment to natural philosophers than 2^7 to physicians, both for pure knowledge and to show how the artifice of Nature is perfectly worked out in every part.

Chapter 3

[Why Anatomy is neglected or mistau^ht]

28J Yet the anatomists have not done this. They have obviously elaborated with care the part of anatomy that is completely useless to physicians or that which gives them little or only occasional help. But they have given far less care to the part that needs urgent attention and is most useful and necessary for all to know, to wit that concerned with the muscles, nerves, arteries, and veins — not just those round the heart or any of the internal organs, but those evident in legs, arms, and outer parts of the chest, by the spine, breast, ribs, shoulder-blades, abdo^ men, neck, or head.

I have daily seen those ignorant of such things fearing what was not to be feared, and confident where confidence was mis/ placed. Such, for example, was he who examined suspiciously the muscle inside the thigh [gracilis] as if it were of vital import tance, when it has neither a large tendon nor an artery nor a

288 vein, nor does it initiate any of the leg movements^'^ as do the muscles that extend or flex the knee. The most useful part of the science of anatomy lies in just that exact study neglected by the professed experts. It would have been better to be ignorant of how many valves there are at each orifice of the heart, or how

WHY ANATOMY IS NEGLECTED 35

many vessels minister to it, or how or whence they come, or how the paired cranial nerves reach the brain, than [not to know] what muscles extend and flex the upper and lower arm and wrist, or thigh, leg and foot, or what muscles turn each of these laterally, or how many tendons there are in each, from where they take their rise and how they are placed, or where a vein or a great artery and where a small underlie them.

These things are so necessary to physicians that not even the Empirics, who wrote whole books against anatomy, have dared to condemn such knowledge. Indeed they admit that ^Sg all such knowledge is most useful, though they maintain that enough of it can be learned from the wounds that occur from time to time. One might well wonder at their temerity, for since even those who have devoted much time to anatomy have failed to bring it to perfection, one could scarcely acquire it from the contemplation of wounds. Perched high on a pro/ fessorial chair a man can say these things to his pupils without being able to instruct them in the actual practice of the Art. For he begins by being ignorant of the parts of the animal organs, and even those [among the Empirics] thought to be highly expert are acquainted only with the parts clearly visible under the skin.

It is needless to enter into controversy with these men. Nor need we be over^zealous to prove that anatomy 'depending on cases' and on 'observation of wounds' — these are their own terms — is not only unable to teach the precise nature of the parts, but that it cannot do so even when carried out with careful atten^ tion, unless accompanied by constant practice on many bodies, aided by instructions which I repeat in the course of this work. One can then disregard those of the Empiric School since they 2^0 are evidently quibbling. Further censure is due to all the anato/ mists whose investigations into such matters have been supers ficial. Failing to recognize many tendons or even whole muscles, what must one suppose happens to them with nerves, some of the finest of which have the greatest power?

Therefore I call on the young to set aside for the present the

36

BOOK II

dissection of brain, heart, tongue, lungs, liver, spleen, kidneys, stomach, larynx, as well as embryos and pregnant wombs, and first to learn thoroughly how the humerus, scapula, and forearm bones are articulated, and to gain knowledge of each of the outer parts in the limbs, what muscles move them, and what nerves, arteries, and veins are in each part. I put anatomical practice on arm and leg before all others, thinking it right that 2gi the young should go first to what is pressing and of great advantage to the Art.

This was bound to entail the same arrangement in my exposi^ tion as that which I followed in my De usu partium, which is not only for physicians but also for philosophers. In that work, since my subject was the bodily organs, I put first the discourse on the hand, for that part is characteristic of man. Now I do it not only for that reason but even more to give the young prac/ tice first in what is most necessary. For I see that just the oppo/ site is being done by those who think themselves fit to deal with the subject of anatomy, though they are still ignorant of which of the elbow veins has a nerve, or muscle/head, or end of an artery under it. For this reason they make grave mistakes in venesection. Yet they dissect the heart or tongue of an ox with/ out realizing that these are utterly unlike those of a human being.

Chapter 4

[Muscles of the Thigh inserted on the Tihia]

2^2 In the previous book I explained the practical method in dis/ secting the arm muscles. I shall now give a similar account of the leg. Until one has learned to recognize these exacdy, it is impossible to dissect nerves or vessels or to teach others to do so.

The skin must be removed with great attention to the origin of the sole in the neighbourhood of the heel, lest there be torn with the skin that fascia under it [plantaris] by the expansion of which (as I pointed out for the hand) the hairless and inflexible

MUSCLES OF THE THIGH

37

part of the skin is moved.* Leave the skin there, as with the hand, having learned the same lesson [p. 7].

You had best dissect first the muscles in the thigh, and then either those round the leg, or those by the hip which move the head of the femur, and with it the whole thigh. But you may 2^5 desire to dissect either the leg muscles or those in the hip before those in the thigh. If you want to dissect the leg/muscles first, remove the ends of the muscles springing from the thigh that come down to the leg. If you [want to dissect] the hip/muscles first, then remove the heads that come up beyond the knee [to the femur]. You will find them without difficulty in the way I shall explain, if you start from such conspicuous and well recognized points as ham, knee, or shin. You should mark these well in starting to dissect, after the skin and underlying mem/ branes [fascia] have been removed, for thus the muscles prove most manageable, their outlines being distinguished by the dif/ ferences in the fibres.

First on the surface under the skin appears a flat tendon [sartoms]y somewhat fleshy, inserted in the tibia below the knee, where lies what is called the *shin' (ant ikne mi on). This tendon is attached there along the prominent part of the tibia, which is fleshless and uncovered, stretching down from above as a ridge. The upper end of this muscle (which they call 2^4 its *head') has a fleshy origin from the middle of the ridge [anterior superior spine] of the ilium which is extended length/ wise in the animal. In thin subjects its projection is quite visible before dissection. Moreover, it [i.e. the ridge] forms a boundary between back and front through its length till it ends in an acute projection comparable to that of the spine of the scapula at its summit [Figs. 5, 16]."^^

The muscle runs from the ilium to the inner region of the thigh, gradually turning askew. It then descends to the knee/ joint, passing round the inner condyle of the femur. Turning back thence, it is attached to the tibia slantways, at the part where it is fleshless and bare [Fig. 16].

* Text HYPOBEBLETAI DERMA TO KOl5.

38

BOOK II

Traction on this [sarforius] muscle from its origin brings the leg into the position that boys use in the palaestra in *changing

29s legs', when they throw the other leg on the thigh.'^^ This will be plain to you if a large part of the flesh on the leg be removed, and still more, if you cut off the foot at the joint. [For though] after death large muscles can, when pulled, exhibit their func^ tions without the flesh being cut away, this is impossible with small ones until most is removed.

If you attempt to dissect the [thigh] muscles first, it is best to remove the ends of any muscles associated with the leg. For thus you will see this [sartorius] muscle acting of itself, to move the femur and, in conjunction with the calf muscle, to draw up the leg as already mentioned. Beyond the point where this [sartorius] muscle becomes tendinous is another insertion [^raciliSj larger in ape than man] in the strict sense of a tendon passing into the tibia. If you follow this to its origin, dissecting away the overlying muscle, you pass through the surface parts of the

2g6 thigh on the inside as far as the pubic bone, where it has its head. The front of the [puhic] bone, extending vertically down/ wards, is gently rounded [in the ape]. The bones called *pubic* (hebes) here meet and fuse through cartilage. There these two muscles, one for each leg, are in contact at their origins. You can learn their action from their place of origin, from their course on the inside of the thigh, and from the area of insertion on the tibia. But, even apart from this evidence, you can find by the use of your hands how they move the leg, for if you pull in the direction of their origin, you will see the leg raised and rotated inward. You must recognize such distinct tions in the dead animal, having removed most of the parts that bend the joints and, if possible, leaving the bones bare of flesh. Beside the two muscles just mentioned [sartorius and ^raci^

297 lis] there is also engaged, in the same conjunction on the inner side of the tibia, a third attachment of a flat tendon [semimem^ hranosus proprius of the ape]. It slopes gently downward to the site of the oblique muscle [sartorius]. You will find it if you follow gradually, as with the two former, the part of the muscle

MUSCLES OF THE THIGH

39

that produces the tendon. At first it extends from the inner side of the tibia and knee, then, moving up slantwise along the ham through the back of the thigh, it reaches the outer and lower part of the ischium, at the hairless and fleshless part of the ape's rump [ischial tuherosity]. Springing from this, it passes obliquely through the thigh; then, within, it reaches the tendinous conjunction that we have mentioned, rolling the leg backward, as one might say, as dancers often do. (Note here this common characteristic of muscles, that if straight^set they cause a straight movement, and if oblique, an oblique movQy ment.) Among the thigh/muscles, none is more transverse since it starts from the outer side of the ischium and is attached to the inner side of the tibia. The tibia is thereby pulled back/ 2^8 ward and upward and rotated, a very complex motion. These three muscles [sartorius, gracilis, and semi^memhranosus proprius] are joined to the tibia by tendons, which you will have first to remove if you want to dissect the leg itself for it is impossible to see any of the underlying structures clearly while they are on them [Fig. 16].

There is another muscle [hiceps femoris, which in the ape has only one head], the fourth of those which descend to the tibia. Its insertion is not on the inside like the others, but only on the outside and plainly to be seen, being fleshy and broad and attached along the outer parts of the tibia. Traced upward, it becomes narrower* as it approaches its origin which lies at the farthest point outside the ischial bone. This origin is also out/ side that of the previous muscle. Attached there, its action is clear from its position, for it draws the whole leg outward with a simple motion. This is obvious by trial, for if you pull the 2gg muscle towards its head, the leg follows [Fig. 17].

In the case of a certain excellent runner, we saw this muscle \hiceps~\ ruptured about the middle while the man was racing. After that its place was empty and hollow, for the parts of the torn muscle had moved, the upper being pulled toward the origin, the lower toward the tibia. When pain and inflammation * Text says 'broader*.

40

BOOK II

had subsided, walking did him no harm and, taking heart, he began running again. Feeling none the worse for this, he actually restarted racing and was again victorious. This is not surprising, because in running we do not need the sideways turn of the [knee] joint, but it suffices to extend and flex it. Whence it follows that even the aforementioned three muscles in front of this [sartoms, gracilis, and semimemhranosus proprius] do not initiate motions in the leg that are essential for everyday use of the limb, even in running.

There is [in the hip region] a fifth muscle [semimemhranosus ^00 accessorius of the ape, unrepresented in man] in addition to the four I have mentioned. It does not reach to the tibia like the first three, but [goes] to the lower head of the femur and to the place of origin of the muscles of the leg on the inner side. It can be dissected not only from this point, but equally well from its attachment higher up. It is well to manipulate it at both points of contact. If you begin below, you will track it up to its head through the back parts of the thigh as far as the ischial bone, for the origin of the muscle is united with that of the third muscle [semimemhranosus proprius^ of my exposition, as is most clearly seen at that point. If you begin from above, you have as guide the head of the muscle dissected before [hiceps],

[Here has dropped from the text an account of the semi^ tendinosus. Its origin in the ape is associated with the hiceps on the ischial tuberosity. It descends, posterior to the semimemhranosus, to its insertion below the tuberosity of the tibia [Fig. 17].]

Four muscle heads in a row thus spring from the ischium. Outermost is that of the flat muscle torn by the runner [hiceps]. Second is that which rotates the leg outward [semimemhra^ nosus proprius]. Third is that now in question [semimemhrano^ joi sus accessorius J Fig. 16] which is [part of] the second and also turns the whole limb gently outward — a motion like to but less than the second.* And next to this is the fourth [semi^ tendinosus]. All these [four] heads issue in a row from the ischial tuberosity.

* Text reads 'third'.

MUSCLES OF THE THIGH

41

When you begin dissecting from above, seek to move down/ wsivd through the hinder and inner region of the thigh, that will bring you to its condyle, where issues a muscle of the calf on the inner side [medial head o[ ^astrocnemms]. You will see its head embracing and gripping part of the ligament round the joint. If you stretch this muscle at its head, the tibia is seen turning backward and somewhat inward on the thigh. This is because of the association of the head of this muscle with the inner and hinder part of the calf (gastroknemia) [Fig. 16].

Chapter 5

[Muscles moving the Knee-joint]

The thigh muscles are now under discussion. If you remove all 3^^ those I mentioned, you will find large muscles still remaining in front of, behind, and inside the part. Dissect those in front first. They all extend the knee but are variously placed and have dif/ ferent origins [Fig. 16].

There are four of them [making up the quadriceps femoris]. The highest [rectus femoris] springs from the ridge of the iUum in a line with the muscle first mentioned [sarforius]^ issuing from the parts underneath it. Next is one much larger, lower down, and on the outer part of the thigh toward the buttock [vastus lateralis]. From this head comes the biggest of the anterior muscles of the thigh. It is continuous and united with another which runs from about the middle of the thigh to its lower end [vastus intermedius].^ Another tendon [vastus mediae 3^3 lis] also reaches the same place as the muscle [rectus femoris] which was just said to spring from the ridge of the ilium. The two are seen to be united toward the knee/cap, the 'mill' (myle) as it is called. Here they are combined as a very strong flat tendon which covers the whole of it in front. This tendon * Greek text here inserts two irrelevant lines.

42

BOOK II

\ligamentum patellae] extends into the tibia, being itself very strong and inextricably attached to its front part beyond the articulation [Figs. i6, 17].

When you have severed these [attachments of the li^amen/ turn patellae'] three* muscle/heads will be clearly seen beneath. One [vastus lateralis] arises from the great trochanter, and the neck of the femur. The second {vastus intemedius], below the former, comes from the anterior region of the femur. It runs down straight through the front parts of the thigh as far as the 304 patella, remaining entirely fleshy. The third [vastus medialis] starts higher up, and ends by the inner side of the thigh, acquir/ ing a more membranous end. Their ends combine and make one, wherefore the anatomists pronounce them a single muscle, though it has three headsf which generate a very strong tendon. Why of all the muscles to the knee these should be the most powerful extenders is obvious. For unless they act vigorously it would be impossible to stand upright and, were all the others destroyed, these alone could suffice to maintain the tension.

Flexion of the thigh is to be classed as a less energetic action. That movement is comparable to what happens when we raise a leg, sustaining the whole body's weight on the other firmly planted on the ground. For this reason Nature did not assign this leg4ifting function to so many or to such large muscles. Of those already mentioned there is actually one only [semiten/ dinosus] in contact with the head of the calf muscle (which, I said, has come into being to bend the leg), and this does not so much bend it as turn it inward, for its bending action is both 30s slight and obscure [Fig. 17].

People think that the *large muscle' [adductor magnus] flexes the [knee] joint by itself That muscle, however, which occupies practically the whole postero^^medial part of the thigh, draws the leg after it little if at all, because its end only just reaches the parts round the knee-joint, while the ligament [of the joint]

* Text says 'two'.

f Text here adds 'just like those on the surface, of which I have spoken', the meaning of which is not clear.

MUSCLES MOVING THE KNEE-JOINT 43

lies all round it. It is not in the least degree inserted in the tibia, but they were driven to represent this muscle as the cause of the bend at the knee because they were ignorant of another muscle [popUteus], concealed in the joint, which could effect the flexion itself or had more power to do so than any other. It cannot be seen until you remove the muscles that move the calf Therefore I do not speak of it now, but in the due order of dissection I will explain its nature when it is laid bare.

Chapter 6

[Muscles of the Hip]

When the muscles round the thigh have been cut away, except 306 only the large one [adductor mass], you may dissect both those that move the hip/joint itself and those round the leg. Suppose that we deal first with those that move the hip^joint. Among them, we said, is the great muscle of the thigh [adductor ma^nus]. (Some think, mistakenly as I explained [p. 42], that it moves the knee/joint.)

Starting from this muscle, examine [a] the fibres which come from the back of the femur [at the Unea aspera] and pass up toward the ischium [adductor magnus, posterior division]; and [h] the fibres on the inner side [adductor lon^us] which reach the inner part of the pubic bone [i.e. the inner part of the pubic angle], for the muscle arising from that whole region is thus attached to the innominate bone by its union with the lowest part of the pubic bone. By the vertical fibres behind, it bends the hip/joint. (If it move the knee/joint at all it will do so by these and by no others, whereas those [fibres] which you will see carried up from the side parts to the pubic bone adduct 3'^7 the thigh.) Sometimes this muscle [adductor ma^nus in the ape] seems to present two or three different divisions, forming, as it were, two or three muscles, and sometimes only one or two. At all events, it has a certain contour attached to the inner part of the femur in its middle and upper middle region [Fig. 16].

44

BOOK II

Sever this muscle [adductor mass] from the pubic bone with care, leaving intact the underlying muscle which occupies the great foramen [obturator externus]. This [latter] muscle passes into a tendon, of which I shall speak later. In separating the great muscle from the pubic bone, spare not only that muscle which occupies the foramen but also that set low down which in these animals is throughout of dark colour [pec^ tineus]. It issues from the deeper parts of the pubic bone and is united to the lower part of the small trochanter by a tendon strong in proportion to the size of the muscle. The tendon is ^08 implanted in the inner part of the trochanter; it is fleshy throughout and not merely sinewy.

Another muscle [iliopsoas] produces a yet stronger tendon of attachment. This runs down, continuous with the muscle just mentioned [pectineus] to the remaining part of the small tro/ chanter which it embraces. It comes from the parts above, aris^ ing both from the ilium and from both loin/muscles. Obviously this muscle cannot be examined without cutting through all the muscles in the region of the body/wall (epigastrion) and removing everything that lies on the loins. You will [then] see clearly that it is the only muscle in the loin region that is threefold. In its inside portion [psoas minor] , by a strong liga/ mentous tendon, it reaches down to that part where the pubic bone ends next the ilium. In the outer part [iliacus], by another short, and much lighter aponeurosis, it arises from the ilium. The other [and third] part [psoas major] moves downwards between the aponeuroses, amalgamating with the muscle that 3'^9 attaches to the whole ilium within [iliacus] and producing the aforesaid tendon which unites with the small trochanter. From its position you realize that it flexes the thigh and rotates it inwards. If you put actual tension on it, you will see it pro/' ducing this effect, the opposite to that of the back part of the big muscle [quadriceps] that we spoke of before [p. 41].

It is obvious that the small, livid muscle [pectineus] initiates oblique motion towards the inside in the thigh.

In this region you will find no other muscle attached to the

MUSCLES OF THE HIP

45

femur, but proceeding to the external muscles, you will find them all attached round the head of the bone near the great trochanter. The first among these is set on the surface under the skin [tensor fasciae latae\ springing from the whole straight ridge of the ilium. This part [of the muscle] is entirely fleshy, but it becomes membranous and soon a membrane in the strict sense and of a ligamentous nature [tractus ilioHihialis of ape]. It is placed upon the higher parts of the ilium which tend to slope backward, being continuous with the end of the spinal muscles. 310

Where this membranous part [of the tensor] ends, there is a second fleshy process, opposite the one first mentioned, namely, that from the ilium. This process issues from the side parts of the coccyx, embracing also the back parts [gluteal fascia']. You must remove it, tracing the fibres downwards and stripping it off from all the underlying tissues, with a blunt lancet. These tissues lying between coccyx and inside* edge of the ischium are membranous and resistant, rather than fleshy. But all which passes toward the hip/joint [gluteus maximus] and is continue ous with it is fleshy, and fuses with the [membranous] head that issues from the coccyx. For a short way, then, strip off these tissues, too, from the underlying structures, together with those that correspond to them that issue from the ilium, and also their membranous centre [i.e. from the dorsal fascia over pi the sacrum]. Thus you will lay bare the top of the femur and find the twofold termination of the muscle, one [part] uniting with the back parts of the femur set roughly in a line with the fibres from the ischium to the coccyx [i.e. the tract known as gluteal fascia in man], the other [part] passing into a flat mem^ branous tendon which embraces the front muscles of the thigh [tractus ilio4ihialis of ape] coalescing with the fascia which we said before ran down to the knee [fascia lata, traceable to patella and leg in apes] [Fig. I7].f

When this muscle has been removed, there remains another [gluteus medius, larger than gluteus maximus in Macaca though * Text reads 'outside*.

t Here follow seven lines devoid of clear anatomical meaning.

46

BOOK II

less marked in Semnopithecus]. It is strong and fleshy throughout and issues from roughly the whole back of the iUum and em/ braces to some extent also the neighbouring bones [namely those of the sacrum]. Its tendon is attached to the apex of the 512 great trochanter, extending even in front.

In dissecting this muscle you must pay attention to a certain small muscle [gluteus minimus] which arises from the outer and lower parts of the ilium. You may think this to be part of the *large muscle' [gluteus medius] unless you examine its outline carefully. Not only has it an origin continuous with it [i.e. with gluteus medius], but it is also continuous with it as far as its insertion into the great trochanter. Further, its continuity is rather more in the inner parts than elsewhere. It also extends the thigh with a slight inclination outward.*

Another muscle [piriformis], dark in colour [and very robust in Macaco], is hidden there under the *large muscle' [gluteus medius], having itself a like position. It is more easily discerned than the muscle mentioned before [gluteus minimus], because of its hue. This muscle arises from the inner lateral parts of the sacrum [i.e. from the transverse processes of the last two sacral vertebrae, being somewhat different in man], and it is clear that it can rotate the head of the thigh to those parts. It is inserted in the great trochanter lower than the 'large muscle' [gluteus medius]. These three muscles [gluteus medius, gluteus minimus, and 3^3 piriformis] are thus all attached to the great trochanter.

Next there are two others [ohturatores externus et internus] that are completely hidden, which rotate the head of the femur out/ wards,f being attached by strong tendons in the hollow [digital fossa] by the large trochanter. Both arise from the pubic bone and occupy the [obturator] foramen, the one inside, the other outside. They pass out by the neck of the femur and both alike approach the trochanter at the aforesaid hollow. The posterior muscle [obturator internus] is attached higher than the anterior [obturator externus]. When you cut the latter from the pubis, try

* Text says 'inward' but the actions of the glutei are very complex, f Reading exo for es6.

MUSCLES OF THE HIP 47

to preserve the common [ohturator] membrane which underlies both. It occupies the whole foramen. Many muscles arise [in the bone] here, which pass to the bones lying beside the fora/ men on either side.

You will loosen the outer muscle [ohturator externus] with/' out difficulty. But if you wish to observe clearly the inner [ohturator internus], you must sever the symphysis puhis with a 314 strong lancet. You will do this easily, for a cartilage lies between, drawing and binding the pubic bones together. If you cut along this, the incision will not be difficult and, the bones once severed, the muscle comes plainly to view. This is easier if, having separated the bones, you grasp the ilia and forcibly bend them outward. Thus they are loosened and parted from the sacrum, so that the whole is everted and the inner portion of the pubic bone displayed.

For the present it suffices to remove the attachment of the [ohturator internus] muscle here. Later you will hear, in the anatomy of the rectum, how first to lay bare the covering membrane [ ? pelvic fascia, ? levator ant] which looks like a kind of wrapping. Yet it is not a wrapping of this muscle but is a sort of thin elastic membrane* running down to the anus on either side. Like the previous muscles [ohturatores\ it was quite unknown to all the anatomists, but when we come to the ana^ 5^5 tomy of the rectal region these muscles will be more fully dis^ cussed.

The muscle that is now under discussion, that within the pubic bone [ohturator internus], produces at the great tro^ chanter a motion opposite, but like in result, to that of its anterior fellow [ohturator externus]. Both turn the head of the thigh outwards,"!" the one through the front parts of the articula/ tion, the other through the back parts. Such then is the anatomy of the muscles moving the hip/joint.

* Literally 'membranous muscle', f Reading exo for eso.

48

Chapter 7

[Muscles of the Le£\

^16 It is now time to pass to the muscles in the leg. These can be dissected, as I have said, after those in the hip, but also before, if you remove the muscles in the thigh that run down into the leg. When they are gone, two muscle^heads [ gastrocnemius] are clearly visible. They arise from the back of the femur at the roots of the condyles. Thus their heads encircle these condyles. For this reason, each attaching tendon contains a rounded cartilage [sesamoid in apes]^^ which it shares with the most con/ vex part of the condyle. Passing through the ham to the calf, the heads join and become one.

At this point a considerable strand splits off from the outer head. This becomes a muscle [plantaris, larger in apes than in man] ending gradually in a flat aponeurosis under the sole, as I explained for the hand in Book I. Lay this muscle bare in two different ways, as I said [p. 7], and you will see that it is like in form [to that in the hand] and is united to the muscle at present under discussion [i.e. to gastrocnemius].

From the two muscular heads in the calf, there springs a tendon [tendo calcaneus] which lies beneath and adjoins the aforementioned muscle [plantaris]. It is inserted into the end of the heel at the back and can pull the heel that way.

517 Continuous with this muscle you will find an attachment higher up, belonging to another muscle [soleus\ mostly of dark colour, which springs from the fibula* at its highest part. These muscles at the back of the calf, whether you choose to count them as three [the triceps surae] or four [including plantaris], all reach the heel [tuher calcanei] and underside of the foot.

There are other muscles continuous with them, not exactly at the back, but rather to the side and within the leg, which reach to the underside of the foot [fiexores di^itorum fhularis et tibialis]. At the point where they yield tendons, a ligament * Text says 'tibia'.

MUSCLES OF THE LEG

49

[flexor retinaculum] is laid over them which passes out of the tibia into the calcaneum. If you divide this with a straight cut, as in the hand, and follow the tendons, you will find them all inserted into the digits. Yet it is not, as in the hand, that one moves the middle joint and the other the first and third, but both move all three. The hallux is excepted, for the tendon that moves it reaches the second and third joints as with the hand.

The divisions of the heads of the two muscles that I have 5^5 spoken of [flexores digitorum tibialis et fbularis] are not always dis/ tributed in the same way, for often the one moves the toe corre/ sponding to the index and the litde toe, the other moves the middle and the fourth toes, while both, united in a common tendon, move the big toe. Sometimes again it is their fusion that varies. Thus the heads of these tendons are between cal/ caneum and tibia and they differ only in that one [flexor dipy torum fihularis] is placed at the lower end of the talus where it lies beside the calcaneum. This head has a ligament of its own apart from the common [flexor retinaculum] ligament."^^

A third tendon [tibialis posterior] arises at the very end of the tibia and is fixed firmly on it, while it is bound by a ligament [of the retinaculum] which again is peculiar to it. This tendon itself bends the whole foot backwards, as do those inserted in the heel. The end of it fuses with the first bone of the tarsus on the inner side [navicular].

When each of these muscles has been dissected, turn to those on the outer side of the leg, of which there are three, so far as 319 origins go, but in respect of tendons of insertion and motions induced — to which above all you must attend — there are many more. When you have removed the membranes there under the skin, you will see a ligament like that on the outside of the hand, under which passed all the tendons which extend the fingers [extensor retinaculum]. This ligament is much longer and stronger* than that [in the hand], particularly if you consider the difference in the limbs. For the ligaments in the foot, as Nature has made them more numerous, so are they stronger, * Text says 'more slender'.

B. 2353 E

50

BOOK II

being meant for more energetic functions. This ligament is slightly aslant and not at right/angles, like that in the wrist. It is attached to the end of the tibia and to that of the calcaneum. You must cut it, too, along the axis of the Hmb and, stretching the parts to their origins and baring the underlying tendons, begin the demonstration of the muscles as entities. They lead po you down to the tarsus and up to the leg.

First you will see a muscle [ peroneus longus] extending along the fibula to its upper head. The end [of this muscle] is secured by ligaments and inserted in the tarsus in the line of the big toe, reaching out a litde beyond to the inner and lower region [of the foot]. You will see a second muscle [fexor digitorum fihu^ laris or fexor hallucis lon^us] lying beside this and thought to be part of it, as it has a common head above and lies along it on the outside throughout the leg, but its tendon is inserted into the head of the first phalanx of the big toe [and into digits III and IV]. So, if you recall the dissection of the hand, the parallel is clear between this twofold muscle and that in the hands that is common to wrist and thumb [flexor di^itorum profundus and flexor pollicis longus].

Continuous with this is another thin muscle [tihialis anterior] set in the region between fibula and tibia. It is inserted into the side part of the big toe as a whole, being exactly parallel to the small muscle in the hand which is thought to be a part of the muscle that gives the three bigger fingers their 321 oblique motion on the outside. But this tendon in the foot, when it approaches the hallux, passes through a ligament hav/ ing the same function as the small rings on chariots.*"^^

After these muscles, consider the tendon/head lying under the [transverse] ligament assigned to it [on the dorsum, i.e. extensor digitorum lon£us], like these aforementioned heads [on the inner side]. They are plain enough to an attentive observer. If you start from it in a downward direction you find four ten/ dons which extend the four toes, comparable to those on the dorsa of the hands. Over this muscle you will see another * See p. 52. The insertion is inaccurately given.

MUSCLES OF THE LEG

51

[extensor hallucis lon^us] of which the origin is on the fibula and the insertion at the end of the tarsus in the great toe a Httle above the inner side. You may see the head of this muscle bound by a certain ligament that arises on the inner* side of the tibia and inserted into the neighbouring fibula [corresponding to a part of the anterior talo^fihular ligament in man] which is like many another slender ligament which retains muscle insertions.

Chapter 8t

[Muscles arising from the Fibula]

The muscles [just described] lie toward the front of the leg. 322 Other three from a single head are in the outer part. They have a ligament in line with them which runs down from the fibula to the heel [superficial peroneal retinaculum]. When it is loosened, you will see that there are three tendons of the muscles. One, of a considerable size [peroneus longus] passes gradually to the outer region of the tarsus and from there, passing aslant across the sole, reaches the head of the first bone [metatarsal] of the big toe. It obviously bends it at the articulation. Where it makes the turn, as it were, round the tarsus, travelling down from the upper parts to the lower, you will find a [sesamoid] cartilage [os Vesalianum] coalescing with the tendon. . . .ij:

The foot of an ape differs from that of man because this animal has toes different in nature. For human toes are much smaller than the fingers, while the toes of apes are larger, like the toes of creeping animals, and are deeply cleft and separated. It is by these the ape climbs so easily, as do weasels, mice, 525 martens, Sec,

. . .§ As I said, you will not find this tendon [of the quadratus * Text says *outer'.

f The text of this chapter is much disturbed.

X Here should come descriptions of the peroneus hrevis and the peroneus minimi digiti, but they are missing from the text. § Here a hiatus in the text.

$2

BOOK II

plantae] in the human foot [which is very different from that of the ape] but the thin tendon lying alongside it which springs from the small muscle, drawing the little toe outwards \ahducy tor di^iti minimi]^ you will find in human beings, as you will the next which bends back and turns upwards the whole foot [tibialis posterior] in that part. The latter has a close parallel with that in the lower arm in line with the litde finger [fexor carpi ulmris]. Its tendon sometimes becomes cloven on the side of its origin and the tendon that draws the little toe outward [ahductor digiti minimi'] passes through the parts of it. If it chance not to be split, the membranous ligament that surrounds it receives, between itself and the tendon, the other which passes to the little toe, performing the same service for it as the small rings on chariots through which they thread the reins. Of like nature is another ring formed by a ligament in the big toe which serves as an outlet for the tendon. . .

These three muscles have a united origin. The first/ mentioned in the tarsus forms a connexion with the lower parts of the foot from the upper parts of the heel, being set under the skin near the surface, having originated from delicate ligaments attached to portions of fiesh. The second has its beginning where the head of the above-mentioned muscle ends, and not far from its beginning this second muscle ends in a round tendon, being itself thin throughout. The third turns the whole foot upwards and springs from the remaining part of the heel.f This muscle stretches up the foot with an inclination towards the inside, whereas the muscle that coalesces with the big toe bends it outwards, and when both are stretched at once, they extend the foot straight backwards.^ ^ * There is a small hiatus here.

f Reading pterne for perone. Here three lines of repetition.

53

Chapter 9

[Muscles of Foot unknown to Galen s Predecessors^

These muscles were dissected by our predecessors, if not with 3^4 complete thoroughness and accuracy, at least fairly well. Those I shall now discuss were almost entirely unknown. 5^5

The first of notable thickness and strength, if not length, is hidden in the joint behind the knee [popliteus]. You will find it after removing the muscles at the back that run down to the calf [gastrocnemius] which were earlier subjects of dissection in my treatise [pp. 40-41]. This [popliteus] muscle lies between the heads of the other, occupying almost the whole breadth of the leg there.

Its origin is a very strong ligament arising from the outer condyle of the femur. You will find it if you dissect the liga^' ment of the articulation which, springing from the outer parts of femur and fibula, fastens them together and binds the whole joint [arcuate popliteal and lateral ligaments]. The muscle is [partly] hidden under the ligament and ascends obliquely from the fleshy substance of the calf across the back of the knee to the condyle where its head is.

Its head is formed at the condyle within and in front of the [capsular] ligament that binds together the whole articulation. ^26 If you pull on its head you will see the leg bend. As this muscle is itself short the tibia — surrounded by much flesh — is attached short. If you remove the f^esh [of the leg] and lay the foot bare, you will readily see the tibia drawn back, with a slight outward swerve, by the ligament and muscle in question.

It is not remarkable that this [popliteus] muscle remained un/ known, for its head is hidden. But for the muscles in the foot, I cannot say why they were overlooked, particularly by those who examined the seven intrinsic muscles of the hand. For in that too they missed the muscles lying deep down on the bones [interossei], as I have already said, though not the conspicuous seven.

In the foot there are four kinds of muscle (not two as in the

54

BOOK II

hand), three in the sole, and one in the upper parts upon the tarsus.

The latter [kind, on the dorsum] involves two muscles [ex^ tensor digitorum hrevis and extensor hallucis hreuis]. They produce

527 oblique movements in the toes, analogous to those produced in the fingers by the muscles on the outside [i.e. dorsum] of the hand.

Those underneath the foot, which are seven, as with the hand, give an oblique movement to each toe. Of these [seven], as in the hand two emerge from the first bones at the wrist, so in the foot two from the first bones in the tarsus draw away [digits I and V] from the other toes [ahductor hallucis and ahductor digiti minimi]. The other five [muscles] will be mentioned later.

The others in the lower parts are small muscles [lumhri^ cales\ springing from the flexor tendons [of the jlexores digi^ torum fihularis et tihialis] before they are cleft in each of the toes. The function of these muscles is to bend the middle joint of each toe. Other smaller muscles [contrahentes] are attached to the tendons already split. They have an exact parallel with the muscles in the hand that initiate an oblique movement in each finger. They, too, are four in number.^^ When two muscles are added that I have already mentioned, which draw back the ends of the toes as far as possible, their total becomes seven.

32S A third kind is that of the muscles in the feet [interossei] beneath those attached to the bones, analogous to those in the hand that remained completely unknown. These of course you will see if you remove all the tendons, as with the hand. Their whole arrangement, number, and function corresponds to those of the muscles in the hand that I have previously men/ tioned. Two, set in front of the first articulation, bend the toes to some degree, together making a balanced movement, but each separately swerving* slightly toward the side. Sometimes they are so continuous with one another that there seems but one muscle in each toe. When these muscles have been dissected, there is no other left in the limb.

* AMBLYNON.

55

Chapter lo

[Some Ligaments of Leg and Foot]

As with the arm you examined the ligaments of the bones, so 5^^ now examine those of all the exposed joints and first of the hip. This has one Hgament embracing it [capsular ligament], as with all joints. A second, hidden in the depths of the joint [liga^ 3^9 mentum teres], ties the head of the femur to the hollow in the hip/bone [acetabulum]. It is so tough that it could be called a 'cartilaginous sinew'.

Examine the Hgament that encircles the articulation, to find whether all parts of it are equally thick and strong, or whether some exceed others. Do likewise with the knee-joint and further with those in the foot, keeping even tension on the ligaments, for if you let one part shrink while you stretch and distend another, the latter will appear weaker. In these articulations you will find no great projection of the parts in the embracing liga/ ment though some will be seen in the foot, as I shall indicate.

The knee/joint, however, has several other ligaments [besides the capsular]. One is deep down [cruciate] comparable to that hidden in the hip/joint but twofold in the knee.* There 550 are two others at the sides [collateral ligaments]. The outer [of these] — which I mentioned in describing the muscle behind the knee overlooked by the anatomists [popliteus, p. 53] — Hnks femur and fibula. The lower end of it towards the fibula is placed under the insertion of the muscle [peroneus longus] the tendons of which, passing round the outer side of the tarsus, reach, I said, the first joint of the big toe. This [fibular coU lateral] ligament is carried rather to the front of the fibula than to the side. The inner [tibial collateral] ligament is thinner and weaker than the outer. It arises likewise from the condyle of the femur and likewise is not attached exacdy at the side of the tibia, but somewhat anteriorly.

In the knee/joint are other cartilaginous Hgaments [menisci] encircling each condyle of the tibia. They meet where the * Text reads 'thigh'.

56

BOOK II

hollows of the tibia adjoin. They produce a single strong carti/

331 laginous tendon in that region, inserted into the part between the condyles of the femur {anterior cruciate ligament']. Dividing the joint — for it lies between the cavities [at the head] of the tibia and the condyles of the femur — it slips away in course of time and the space between the cavities at the head of the tibia appears as empty, though it was higher up when the animal was alive.

I shall examine in their turn the remaining ligaments in the foot, first mentioning those you removed to observe the tendons. Some of them do no service to the articulations themselves. [Such are] those in one portion of the bone, Hke that [flexor retinaculum] which embraces the tendon/head at the back which flexes the toes, and that which is attached at the end of the tibia and grasps the tendon that dorsiflexes the whole foot [extensor retinaculum]. Moreover, the bones, into which these tendons are inserted, have ligaments which* extend from one [bone] to

332 another, as does the ligament on the surface from the end of the tibia to the calcaneum [deltoid ligament], which both holds together the tendons beneath it and at the same time clamps the bones. Thus the ligaments in front which fasten the tibia to the fibula [superior extensor retinaculum] both bind these together and serve as a shield for the tendons lying beneath, just as the anterolateral ligaments [superior peroneal retinaculum], guarding the tendons there, not only protect and clamp them securely but also fasten and bind fibula to calcaneum. Thus such ligaments are shared between the bones themselves, which they unite and the muscles beneath them.f

You will find other ligaments which are peculiar to the articulations as such and are more fibrous. You will recognize these [as mostly] hidden in the depths, though some are ex/ tended on the outside like those that guard the tendons. Thus there is a longish ligament [anterior taloflhular] not strong like the others — which springs from the same root as the ligament

333 in front [anterior inferior tihiofhular ligament]. The latter is

* It has been necessary to remove a negative here and to make some other adjustments in the text to obtain sense. f Here three lines of repetition.

LIGAMENTS OF LEG AND FOOT 57

attached to the fibula. The former does not, like the latter, itself bind tibia to fibula, but at a lower level it passes towards the outer region and down through the frontal projection of the talus almost hidden by it. Its end reaches the bone of the heel [calcaneofhular ligament]. Under the origin of this ligament, there is another [lateral talocalcaneal ligament] issuing from the end of the fibula* continuous with the [capsular] ligament encircling the whole articulation. Its end is not much behind the [malleoy lar] process, immediately crossing the joint towards the fibula.

Next that ligament, at the bottom of the tibia, is a more fibro^cartilaginous ligament [deltoid] through which the tibia is united to the inside surface of the talus, just where the tibia receives it. In the same way another on the outside joins fibula to talus [posterior talofibular ligament]. A third, issuing at the very foot of the neck in the talus [portion of posterior talo^ fibular ligament], passes into the calcaneum. And a fourth, in the front parts, binds the head of the talus to the navicular 55^ [talonavicular ligament].

All these four ligaments connect the navicular to the sur/ rounding bones and are fairly fibro^cartilaginous, as are those that bind deep down the joints at hip and knee. Thus in the foot the talus, being articulated with four bones, its fibro^ cartilaginous ligament passes down to each in the depths, out/ side to the fibula, inside to the tibia, below to the calcaneum, in front to the navicular.

As all the bones of the carpus are embraced by a strong liga/ ment, so, but to a greater degree, a strong ligament embraces all the bones of the tarsus. Some of them are united with each other by certain other natural junctions, small but firm.

Chapter ii

[On the Nails]

It remains to give an exposition on the nature of the nails. 334 This [exposition] has two parts, one applies to all bodies made * Text reads 'tibia'.

58

BOOK II

335 of homogeneous particles (homoiomeri a),^^ the other to the nails alone. Some think that they come into being as a mingling of bone, sinew, and skin, [all HOMOiOMERiA],to which some add flesh. That the nails partake of the nature of all these is clear, but it is impossible to see that their substance has come into being out of them, for every homoiomerious body is formed so by nature from the matter that is the substrate of the animal. The lower arm is not generated from the upper as are nerves from brain, nor is the wrist [generated] from the lower arm, nor are the bones of the fingers [generated] from it [the wrist]. For there is no small difference between joining with a thing [as bone to bone] and growing out of a thing, as branches from trunks and twigs from branches, or as arteries and veins are divided off [from their trunks]. For what grows from a thing must have its nature, as an offshoot of its substance. Nerves are offshoots from brain/substance, but a nail is no such offshoot

jj6 from the tip of finger or toe, but is of another kind of substance,

as are the stone and tiles and bricks of a house.

The manner of construction of the living creature is like

that of the external objects that men fabricate, putting together

different substances into one [whole]. They fasten them together,

making that which they form out of them. Yet a brick does not

spring from a tile or a stone. Rather there are certain substances

invented for combining them, as clay and glue and nails and

bolts and ropes. Sometimes the method is one of mere juxta/

position, as with things nailed in or fitted in. So with the

works of Nature; some things she fixes in, as teeth in gums;

some she puts together as with a buckle (gigglymoeides),

as the bones at the cranial sutures; some she attaches as with

glue, as those joined by a cartilage; some as with clay, as those

joined by flesh; and some as with rope, as those joined by a ligament. ^4

The nails she has united to the ends of the last internodes by 337 a ligament and by a natural junction with flesh and skin, lay/ ing the former underneath throughout and making the latter grow round the whole root outside. Not only a nerve, but also

ON THE NAILS

59

an artery and vein reach the very root [of the nail]. From these the nail derives sustenance, life, and sensation — as do the other parts — but none of them [the parts] comes from the conjunct tion of these three tissues, still less from their mingling together, as Erasistratus conceived. He advanced an opinion which v^as clearly at variance with the observed facts, for the sub/ stance of the organs is obviously different from the essence of these three, as I showed in the third book of my work on the anatomy of Hippocrates.^^

Stomach, bladder, and uterus are each so made by Nature. Each has its nerve for sensation, with vein and artery for sus/ tenance and life, all demonstrably distributed through them, like irrigation channels through a garden. But this is not so 55^ with the nails, for they grow up from below, Hke the hair. Like hair, it is well that they be continually renewed and growth never cease, for they are worn away.

The nails, being a different kind of substance, were joined to an artery and vein and nerve at their root to ensure life, nourish/ ment and sensation. And they were fastened to the bone and the skin so as not to hang loose, for they, too, had to be a part naturally united to the whole organism, like the others. But if, on the ground that they are harder than sinew and skin and softer than bone, it be urged that they are compounded from the substance of these, then it must be said that everything else has come into being so; cartilage from bone and Hgament mixed; ligament from cartilage and nerve; nerve again from brain and ligament. For nerve is intermediate between these two combinations, not that it was made what it is by the mixing of the brain with ligament, but by compression alone.^^ For ice too is produced from water when congealed by cold. Let them say then that ice too comes from water and stone, 339 completely mixed with one another, if they think that every/ thing that is intermediate between two bodies, not having their function or structure, is produced by a ^mixture' of these two.^^

BOOK III

[NerveSj VeinSj and Arteries of Hand and Foot]

Chapter i

[Need for Anatomy of surgically accessible Parts]

^40 Those who neglect practice in the Art and rather regard sophism tical theories, concern themselves little with the exact nature of the limbs. But how can they treat dislocations, whether simple or compound, or fractures and sphacelus of the bones; how can they even open abscesses (aposkemmata),^^ or excise

341 gangrenes, or remove a missile or splinter properly if they have not learnt enough to open a vein correctly ; I expect beginners to practise all such methods [of study] first because I see their necessity, and second because, if the time needed to learn them is but short, as they think, then the shame of ignorance is so much the greater.

The limbs then are made up of bones, ligaments, muscles, arteries, veins, nerves, and the wrapping of them all, to wit the skin. As to the nature of the latter the professed experts in anatomy were mistaken about certain parts, notably as to the palm and the sole. Because of such ignorance a certain surgeon of repute, excising a sphacelation in the wrist, rendered the palm insensitive. Not long ago, being present with another practitioner who was treating this part, I showed him the region where the tendon attached under the hairless part of the hand

342 begins to widen [into palmar fascia], and suggested that he take care not to sever it. Thus the patient retained his power of feel^ ing. For should the tendon mortify and you have predicted the consequent loss of sensation [from injury to the median nerve], you will escape reproach. So too if the tendon be severed by some sharp missile as happened in one case, the physician will escape blame if he foretell the event.^^

It is thus proper to know these facts about the palm of the

NEED FOR ANATOMY

61

hand, and the sole of the foot, and many other things as to arteries, veins, and nerves. First, sensation and movement in all the fingers or toes do not depend on the same nerve. Secondly, of all the nerves that run down into them, in the upper Hmb through arm and forearm, and in the lower through thigh and leg [a small hiatus here] . . . and when sometimes they cut a nerve in the thigh, they make some of the fingers and toes in^ sensitive or immovable. This happens to them because of their ignorance of the nerves.

There are thousands of other mishaps because some practi/ 343 tioners do not know the veins and arteries well enough to avoid injury in operating. So, when they are excising bones or open/ ing abscesses, they cut through important veins and sometimes, by severing large arteries, they are confronted by uncontrollable haemorrhage. Again some, in opening a vein, may cut an artery, being ignorant as to which of the veins in the limbs have companion arteries.^^

The case of my patient deprived of sensation in the Htde fingers [digits IV and V] and half of the middle finger [i.e. parts supplied by C.7 and 8] is known to all because of his celebrity as a sophist. Doctors of the third [Methodist]^^ School were treating him and making a fuss over the fingers, as if they alone were affected, while the condition had origin at the point where the nerve first emerges from the spinal marrow. The Methodists were putting applications on the fingers, using [pre/ parations of] a kind first 'relaxing' and then 'constrictive' — as they were pleased to call them — without bothering about the 344 antecedent cause. They recognized only that a state of insensi/ bility and numbness had arisen in the fingers — as by mere chance — and that it was worsening little by little.

The patient, failing to improve with drugs, communicated the nature of the treatment to me. I asked him if he had had any blow on the upper or lower arm. When he denied this, I asked him the same of the upper part of his spine. He replied that he fell out of a carriage three or four months before and, in being thrown to the ground, was struck in that part of his back

62

BOOK III

by a projecting stone. He suffered severely, but in six days the pain left him, though on the fifteenth day he had a slight sensa^ tion as of insensibility and numbness of the fingers. This went on increasing up to the present, unrelieved by drugs. I reasoned that the consequent inflammation in the root of the nerve to the affected fingers had as sequela an induration which, though itself 545 painless, had produced insensibility in the fingers to which the nerve was distributed. Accordingly I transferred the treatment from the fingers to the site of the original blow and thus cured the trouble.^^

A whole day would not suffice me to describe all the condi^ tions of this kind that I have seen in the feet and hands, in wounded soldiers, in gladiators, and in many civilians — acci/ dents in the many changing circumstances of life — in which those ignorant of anatomy always cut a poor figure. For, on the one hand, in their operative procedures, they may sever some nerve, small indeed but with no small power, thereby destroy^" ing in some underlying part the power of sensation, or motion, or both, or, on the other, failing to foretell the result of wounds, they are held responsible for the injury.

I perceived that the knowledge of the limbs and of other outer parts is most necessary and is utterly neglected. I resolved 346 therefore to add successively to the anatomy of the muscles in the limbs (which was my first task) that of the arteries, veins, and nerves, and so to encourage the young, engaged in dissect tion, to practise primarily on those [outer] parts. For they daily see practitioners, learned as to the number and nature of the cardiac valves, of the lingual muscles, and the like, yet ignorant of the anatomy of accessible parts, making the gravest errors in prognosis and local treatment, whereas those familiar with this branch of anatomy, yet ignorant of what the others know, are as constantly successful.

63

Chapter 2

[Precautions in removing the Skin]

Let us now set out the proper way to dissect the vessels and 34^ nerves in the limbs; but first as to the arm as a whole. We may begin with the saying of Hippocrates that *The human foot is composed of many small bones, like the "end of the arm" (CHEIR akre)'.^4 He *foot' without qualifications, but 347 to CHE I R he added akre, since the limbs are not like in their nomenclature, though of similar construction, for as femur is to lower limb, so is humerus to upper, and as foot is to the lower limb, so is hand to upper. The part starting at the joint by the wrists and split into fingers, is called cheir akre, just as the end of the lower limb with which we walk is the Toot'. I shall use this nomenclature, calling the whole limb cheir with^ out qualification, and when I want to designate the end of the CHEIR from the wrist [downwards], speak of the cheir

AKRE.

This limb begins, of course, at the shoulder/joint. The neck of the scapula is articulated there with the head of the humerus, so that if you cut off the whole arm there, you can conveniently dis^ 34S sect it separately. You have often seen me demonstrating its parts.

The first step in the procedure is to remove the skin from the underlying tissues. This is not to be done anyhow, as do curriers who, along with the skin, take away the membrane [fascia] beneath through which the nutrient veins reach it. You must leave the membrane and sever the skin from it, using a sharp lancet from the first. Taking a selected part of the limb in your hand, remove the hair so that sufficient skin is bared for the first cut, for you will thus incise the better. It is natural at the first attempt either to leave part of the skin uncut, or to sever the underlying membrane with it. By trying a second or third time, increasing or tailing off the depth of the cut, you will soon 349 learn the right measure.

[Here follow two displaced pages of a trivial discussion of terms, a translation of which would be purposeless.]

64

BOOK III

351 You must incline the lancet toward the skin when separating it from the membrane. If you turned it towards the membrane, you would injure it, while to pierce the skin does no harm. This operation is rather tedious, so, if you are demonstrating the parts of the arm to another, remove the skin before he arrives. If your colleague, who participates in the dissection, wants to show it to others, do the operation in his presence. For the work needs great precision and calls for one who really wants to know and does not mind taking trouble. Many a time I have left the task to a colleague, only to find the membrane

352 torn in some places and in others adhering to the skin. Where that happens, none of the veins and small nerves under the skin can be found, and this especially in the ape. It is true that in such large beasts as horses, donkeys, mules, and catde they do not wholly disappear, yet if the membrane be torn from the continuous tissue beneath, clear apprehension is no longer pos/ sible. In small animals, however, [the superficial veins and nerves] are completely destroyed if one of these accidents hap/ pens to the membrane [fascia].

Therefore when the whole arm has been bared of skin, leave the membrane still entire upon the underlying tissues. In this membrane, before it has time to dry, examine the surface veins and nerves. These do not show equally in all cases, either because they are naturally so small in some apes, as in some human beings, or again because the adiposity varies. In thin animals the nerves are more clearly visible; in the fat they are

353 concealed. When the ape is full-blooded, the superficial veins can be clearly seen; when bloodless, they are indistinct. Never/ theless, in all cases try to observe and remember the *roots'^^ of the nerves on the surface and their course, so that in making an incision you cut along them. Thus the nerves severed will be few or none, but if you apply the lancet transversely you may divide many. Try especially to avoid 'roots', realizing that, as with a tree, in cutting a branch or twig, you harm the plant but little, while if you sever the crown of the root, you ruin the whole plant. So with the nerves. If you divide a *root'the region

PRECAUTIONS IN REMOVING THE SKIN 65

which derived sensation from that nerve will be rendered insensitive.

If you remember the anatomy of the muscles as expounded in Book I, you will learn here, too, to find without difficulty the origins of the nerves distributed through the skin. But if you have forgotten, leave this present book for the nonce and return to Book I. As soon as you have a clear realization of the posi/ 354 tion of the muscles, turn to what follows. Assuming that you will do this, I shall proceed.^^

Chapter 3

[Nerves in Upper Arm]

In Book I the nature of the muscle that embraces the top of the 354 shoulder [deltoid] was explained to you. Of it Hippocrates wrote: *As for the upper arm, were one to strip the shoulder of flesh, he would strip the area over which this muscle extends.'^^ I expect you to keep this muscle in mind with reference to the part, for there the shape of a [Greek letter] delta is produced, and some have called the muscle *deltoid*. The part in question encircles the head of the humerus and this is the starting/point of the arm itself The deltoid muscle, triangular in form, has its attachment at its apex to the humerus.

When you see clearly the apex of the triangle in the outer side of the arm, by raising your eyes you will see a number of little nerves, fine as hairs, springing from the depths [upper lateral 355 cutaneous branches* of the axillary (circumfex)]. They are like twigs of a little bush, springing from one stem but at various angles. As some grow straight and others oblique, so is the course of such nerves from their origin, some passing along the limb, others to the sides. They reach beyond the middle of the upper arm. [These include brachiocutaneous branches of the radial.] The outer parts below are enmeshed with little nerves from another root which also rises up from the depths and is spread

B. 2353

F

66

BOOK III

abroad, embracing the outer and lower nerves of the regions round the elbow^joint [lower lateral cutaneous and posterior lateral cutaneous branches of the radial].

For the most part, you must take for granted such sub^ cutaneous nerves and small veins as I shall describe, because their continuity is not preserved. Further, their position, num/ ber, or calibre is not always exacdy determinate as they are for

356 the larger vessels and nerves. Their origins, however, are always from the same vessels and nerve [trunks] as the two just described as *like little bushes' [p. 65].

One of these [large] nerves [axillary] comes from that which is intertwined with the deltoid, the other [radial] from the largest of those that go to the upper arm. This [latter] twines round the muscles at the back [of the humerus] and passes to the outer side of the limb and reaches the lower arm by the higher of the processes of the humerus called kondyle [lateral epicondyle].

Of the [former] nerve [axillary] a small portion penetrates to the spot mentioned [i.e. outer side of upper arm], while the remainder of that which is distributed to the deltoid comes through entirely to the skin [as the upper lateral cutaneous]. These then [i.e. axillary and radial] are the two sources of the cutaneous nerves in the upper arm on the outer side.

The skin in front receives small nerves [lower lateral cutaneous] in its upper region from the first branch (epibasis) of the second nerve [radial] that enters the upper arm from the spine, and, in the region below, in front of the elbow/joint, from

357 another nerve [musculocutaneous] of those from the spine which is alone from the beginning, of which more anon. But the skin of the upper arm within and behind, up to the ends of the shoulder/blade, is enmeshed with another nerve [intercosto^ brachial (intercostohumeral)] which emerges from the second inters costal space. This nerve also reaches the upper arm, like all the others, through the armpit. Whoever wishes to examine them exactly must first cut away the small muscle that was over^

NERVES IN UPPER ARM

67

looked by anatomists [pectoralis minors see pp. 122-3], for under it pass all the nerves assigned to that region [Fig. 23].

First on the surface, but under this muscle, lies the nerve [intercostohrachial] which I said emerges from the second inters costal space. It divides completely into branches to the skin of the upper arm on the posterior and inner sides.

Next, deeper down, when glands, membranes, and vessels are removed, lies a succession of large nerves. A cutaneous nerve [cutaneus hrachii medialis] descends on the upper arm to the spot where the head of the small muscle [pectoralis minor] lies in apes. It starts from the very large muscle there, 358 which moves the outer part of the armpit [latissimus dorsi], and it ends in the back region of the elbow, at the inner parts. Where it passes into the arm it is immediately divided into three; its higher branch twines round certain parts in the inside of the upper arm as far as the articulation behind; the next part round the whole back region of the skin; the third round all the continuous tissues up to the shoulder/blade. The skin of the upper arm then contains the starting-points of the nerve of which we have spoken. That of the lower arm I shall deal with shortly. If you first examine the nature of all the nerves in the upper arm, it will be much easier for you to dissect and learn about those in the forearm, not only on the surface but in the depths.

[Deep nerves of upper arm, Fig. 23.]

As the upper arm starts from the shoulder/joint, it is as well to sever it [there] and dissect it separately. Begin the operation at the humeral [cephalic] vein and the front muscle with two heads [hiceps]. The latter, as you have learned [p. 28], arises from strong tendons and is inserted by an aponeurosis into the 359 beginning of the radius. Where the two heads are just uniting you will find the first nerve [musculocutaneous] passing along the humerus. At that spot the large muscle in the armpit at the back [latissimus dorsi] is attached to the humerus by a strong flat tendon. Next [to this tendon] there is attached to it [i.e. to the humerus] the tendon of the largest of the muscles from the

68

BOOK III

breast [pectoralis major], being fleshier than the aforesaid muscle. Next to it again is the attachment of the muscle of the top of the shoulder, called deltoeides.

[i. Musculocutaneous nerve.] The first nerve, then, that comes from the spine through the armpit to the upper arm, enters it at the attachment of the tendons of the posterior muscle of the axilla, the largest of those that move the shoulder/joint \latissu mus dorsi]. Then at its entrance it passes under the anterior ^60 muscle [biceps] of which the heads are here still separate. Pass^ ing under the inner head it gives a branch to each head. Thence it goes straight down, in contact with the fibres of the inner and more slender head which arises in a ligament from the anchor-' shaped process [coracoid]. The heads coalesce and make a single united anterior muscle which, as you learned in Book I [p. 28], flexes the elbow/joint. You will see this tendon clearly if you cut both tendinous heads above and separate them to the straight part where they unite. With that part the nerve, too, travels down.

As you do this another muscle [hrachialis] is exposed. It is much lower than the former [hiceps] and rises only a short way on the humerus which is hidden by it. It hides also, as I said, the tendon of the first muscle [deltoid].

In their course the two tendons [of the hiceps] send forth sometimes from one of them, sometimes from both, aponeu/ ROSE IS [sometimes a lacertus fhrosus] into the heads of the 361 smaller anterior muscles of the forearm. . . .

[2. Axillary (circumflex) nerve.] [The passage on this nerve is missing. Ten lines are substituted on the Median and Ulnar nerves, irrelevant here.] So now, leaving these nerves, go back to the beginning of the arm.

[3. Kadial nerve.] After the two nerves I have spoken of there is a third, near the second. It makes a deeper penetration into the upper arm along with the great vessels, artery, and vein, which pass through the axilla. This nerve is split up along with the vessels to enter the large muscles of the upper arm [triceps, differently divided in ape and man] which extend the elbows

NERVES IN UPPER ARM

69

joint, and it gives branches to both, making its way slantwise to the outer region.

This [radial nerve] is the largest of the nerves entering the 362 upper arm. (You hear anatomists habitually designating as *large' a nerve, artery, or vein without indicating differences in length but only in circumference [misleadingly] as though they had used the term 'thickest'.) Where this nerve passes out round the humerus and through the region at the back and pushes beyond a little above the elbow^joint, a branch [is seen] to make its way out to the skin. Of this I have spoken already in the section on the cutaneous nerves of the arm [p. 66]. How the remainder of the third nerve [radial] reaches the forearm and how it there divides, you will learn later in the section on that part.

[4. Ulnar nerve.] Most parts of the upper arm having now been laid bare, examine [one of] two nerves remaining on the inner side, where the aforementioned three entered [the armpit], a little deep to the third. This other is seen first of them all, even without the dissection of the muscles in the upper arm, being on the surface under the skin. I have already mentioned it in the 565 anatomy of the superficial nerves [p. 65], and postponed ex/ plaining its complete distribution till I came to the anatomy of the lower arm. Yet this nerve begins its division in the upper arm above the elbow/joint [in the ape, with branch to m. epitrochleoanconeus] and is carried through practically the whole bend, already divided into many branches, for only the higher parts of the bend lack a branch from it, while the anterior superficial parts of the upper arm, above the elbow, receive their branches from this nerve. [Either the text is confused or Galen here describes an abnormality in which the medial cutaneous nerve arises from the trunk of the ulnar.]

[5. Median nerve.] There remains a fifth nerve of those that come from the spine to the upper arm. Like the others, it passes through the inner side. This nerve gives no portion of itself to any part in the upper arm, either superficial or deep. In thickness it resembles the second [axillary] just as the first

70

BOOK III

[musculocutaneous] resembles the fourth [ulnar]. You will esti/ mate the second and fifth [axillary and median] as about three 364 times as thick as the first and fourth [musculocutaneous and ulnar]. Thickest of all is the third [radial].

You remember that I said another nerve [intercostohrachial, p. 66] enters the skin of the upper arm, emerging through the second intercostal muscle. So that among the nerves from the spine to the arms there are two that divide as cutaneous branches only [the second being cutaneus hrachii et antihrachii medialis], and five* distributed deep down to all the muscles of the limb, with a few delicate branches to the skin.

Chapter 4

[Nerves to Forearm and Hand]

364 Leaving the upper arm, pass now to the forearm. If you sepa/ rate the skin from the membranous tissue, as I have said, you will see the first beginning of a nerve [ulnar] — fourth of those mentioned in the upper arm — which supplies most of the inner side of the forearm, extending to the lower part, and to much of the outer part [medial cutaneous, sometimes in the ape a branch of the ulnar]. That part of the forearm on the radial

565 side, both back and front, receives the branches from other nerves, anteriorly from that first mentioned [musculocutaneous], posteriorly from the third [radial]. (An account of the cutanea ous nerves in the hand will be added to the anatomy of the big muscles [of the forearm].)

You saw five nerves (i.e. i, 3, 4, and 5, pp. 68-69 and cutaneus hrachii et antihrachii medialis], in dissecting the upper arm, passing through the bend of the elbow into the forearm, but only one [the last named] is dispersed into the skin, being split above the bend at the elbow.

Four then remain. The first, of which I gave an account be^ fore in the anatomy of the upper arm, reaches the middle of the * Text says Tour*.

NERVES TO FOREARM AND HAND 7I

articulation at the elbow [musculocutaneous]. A second, which is lower, reaches the inner and lower condyle [medial epicondyle] t of the humerus where it is at its flattest and least convex [median]. A third nerve [radial] which, I said, is above those that go to the whole arm, reaches the forearm touching the radius in association with the outer and upper condyle [lateral epicondyle] of the humerus. The remaining nerve [ulnar]^ the fourth of those that reach the forearm deep down, has its place between the point of the elbow and the inner and lower head ^66 [medial epicondyle] of the humerus.

If you trace the natural attachments and positions of the muscles and dissect them as you learned in Book I, you will observe the distribution of them all [i.e. the nerves]. You may start from any of them, though it is perhaps best to keep the same order as was employed for the upper arm.

The nerve to the forearm through the middle of the bend at the elbow [median] produces there a very delicate branch [ramus anastomoticus]. This runs by the side of the vein [v. medialis antihrachialis] which extends along the approximate middle of the surface throughout the forearm, and meets at the wrist the artery with plainly visible pulsation [a. radialis]. And yet this nerve, which is the highest of all those mentioned, gives another very delicate branch to the head of the large muscle peculiar to the radius [flexor carpi radialis], and next to this branch another, carried along the remainder of the forearm* by the radius, very like a spider's web [n. interosseus anterior]. After passing under^ neath the vein — which is spHt off from the humeral [cephalic] and across which we cut — what is left of the nerve I am de^ 567 scribing passes aslantf to the large muscle pecuHar to the radius [flexor carpi radialis] and is carried out of the upper parts between the four already mentioned slender muscles [flexores digitorum]. . .

* Text says 'shoulder'.

f Text adds 'gradually on the surface'.

X Here are eighteen lines, most of which fit neither human nor simian anatomy. They are, in any event, out of place.

72 BOOK III

^68 Let us now speak of the outer nerve [radial] first, so as not to interrupt the exposition of the two remaining nerves, distri/ buted through the anterior parts of the forearm and fingers. This nerve, after it has given off the branches in the upper arm [to the triceps] of which I spoke earlier, is carried down to/ wards the elbow^'joint between the smaller of the anterior muscles in the upper arm [caput medialis tricipitis] and the head of the large muscle peculiar to the radius [fexor carpi radialis]. It sends its first branch into the outer parts of the forearm, and it is distributed on the surface under the skin there [n. cutaneus antihrachii dorsalis] and in the wrist. And it yields other branches as it passes through the articulation at the wrist, and yet others again where it enters at its head the muscle that extends the wrist by the bifurcate tendon [i.e. the tendons of the extensores carpi radiales longus et hreuis]. One of these is split into the head

3^9 of this muscle, the other goes forward undivided. . . .* Its end passes through to the wrist in line with the bigger fingers, being split up on the dorsum to enter them under the skin. It spreads through two fingers and half of the middle finger, sometimes uniting at the end of the radius with a small branch of the above/mentioned nerve which extends to it.

The rest of the third nerve [radial] inclines towards the outer region of the forearm. It is carried aslant through the depths, first to the bifurcate muscle of the wrist [i.e. the tendons of the two extensores carpi tadiales] into which, I said, it enters at its origin, before producing the aforesaid branch. It is then through the muscles of the radius verging on the outside of the elbow [hrachioradialis and the two extensores carpi radiales]. It gives cer/ tain fine branches to both and to the muscle extending the four

570 fingers [extensor digitorum communis] and after that to the muscle that initiates the oblique motion in the lesser fingers [extensores digitorum proprii], and then in its turn to the muscle that bends back the wrist at the little finger [extensor carpi ulnaris]. It pro/ duces all these branches at the origin of the aforesaid muscles, not far from the [elbow] joint. Thence it is carried along the * Six lines here are anatomically unintelligible and are omitted.

NERVES TO FOREARM AND HAND 73

bipartite muscle which moves the thumb and the wrist [i.e. the two extensores carpi radiales] and gives manifest branches to it also. In the course of this journey, the tendon of the muscle that gives the thumb its lateral motion [abductor pollicis longus] Hes very close to it for some distance as far as the wrist. Next it has for neighbour the muscle that moves index and middle fingers in the same fashion. What remains of this nerve is distributed to the articulation without reaching the fingers. The largest of the terminal branches enters the depths of that region where lies, I said, the ligament that hides the origin of the tendons extending the four fingers.

This then is the mode of dispersal of the nerve by the outer 571 condyle [lateral epicondyle] that reaches the forearm from above. It was, we remember, the third of the nerves from the axilla to the arm.

The remaining two nerves [ulnar and median] are distri^ buted to all the muscles on the front of the forearm. In dissect^' ing these [muscles], as you learned in Book I, you will follow up the course of all the nerves that enter them, starting at the elbow/joint. You will find branches going from both nerves into the flexors of the fingers, and indeed into all the other muscles except that which was said to be the second to go to the upper arm [axillary]. The fourth of the nerves which, I said, runs between the point of the elbow and the lower con^ dyle [medial epicondyle] of the upper arm into the lower arm [ulnar], gives a certain portion of itself to the muscle that bends the wrist at the little finger [flexor carpi ulnaris]. You will find the remaining nerve [median] giving a portion of itself to the muscle that moves the radius there [pronator teres] and then, as it advances, a part also to the higher of the muscles flexing the wrist [flexor carpi radialis] and to that which passes into the 37^ palmar fascia [palmaris longus], and a delicate part deep down to the small muscle in the radius there [pronator quadratus.]

The two large nerves [median and ulnar] fake their course through the forearm between the muscles that flex the fingers [flexor es digitorum suhlimis et profundus], resting on one and lying

74

BOOK III

under the other, and they give of their substance to both [untrue of ulnar]. When these muscles end in the tendons, the remainder of each of the nerves reaches the wrist and meta^ carpus, being dispersed through the tissues there and the inside parts of the fingers, the higher [median] to the two big fingers and the half of the middle finger on the side next the index, the rest to the middle finger and the remaining litde finger. 57J The higher of the nerves is expended there. The lower [ulnar] sends a considerable part into the outside of the hand on the surface under the skin, reaching the finger-tips of the inner two and a half fingers. The remaining half of it with the thumb receives the whole end of the nerve I mentioned [radial]. There is no muscle on the dorsal aspect of the hand as there is on the palmar side.

Chapter 5

[ Veins of Axilla and Arm]

J7J A single artery but two veins enter the arm. One of these veins is obvious even before dissection, for it lies on the surface, between the skin and the underlying muscles. Of these [muscles] one arises from the acromion, becoming triangular there [deU toid]. The other forms the fleshy part of the breast [pectoralis major]. Both are inserted by strong aponeuroses along the front of the humerus, not far from the shoulder/joint [Fig. 9].

The 'shoulder vein' [cephalic] then lies on the surface between these two [muscles], along the inside edge of the deltoid, and reaches the end [of the muscle]. Thence it is carried down in

374 the outer region of the upper arm, in contact with the larger of the anterior muscles [biceps] along the line that bounds it laterally. When near the elbow it separates from this muscle and mounts on the large muscle at the bend of the radius [hrachioy radialis]. There it splits into three parts, roughly equal. One plunges into the depths: observe the position and course of this

VEINS OF AXILLA AND ARM

75

in examining the surface veins. The second [median basilic] reaches the bend of the joint uniting to a part of another vein [basilic] that is carried into the forearm. The third and last in/ cHnes towards the outer region of the forearm and divides there.^^ Before it splits into three at the elbow, the large 'shoulder/ vein' [cephalic] can be clearly seen next the skin throughout the upper arm., nowhere sinking in the depths but outstanding and conspicuous, particularly in athletes who are naturally thin 375 and muscular. Throughout the upper arm it distributes delicate branches into the skin and superficial muscles. This you will see in dissecting large, fuU/blooded apes, and other creatures of the six different kinds of four/footed creatures of which you learned [p. 97].^^ When it mounts on the muscle of the radius [brachioradialis] at the elbow/joint, the three divisions into which it is split are sometimes equal, sometimes unequal; sometimes one is larger, sometimes another, but none ever greatly exceed/ ing the others.

The branch [of the cephalic vein] to the outer region of the forearm gives off branches that are more clearly visible than those in the upper arm, and it is entirely consumed [in the fore/ arm in] anastomosing with other veins to be described. Whence they come, you will now learn.

The vein which i verses the axilla [axillary], which is much larger than the *shi ilder vein' [cephalic], together with the corresponding artery divides into branches all along the arm.

These two vessels [vein and artery] are in contact through 37^ the armpit into the upper arm, and the nerves and the branches into each muscle are united with them by a single natural out/ growth [axillary sheath]. When they have passed through the upper arm, coursing along the larger of the anterior muscles [biceps], the artery goes on to the muscles in the forearm, passing now into the depths as it was at the start. The vein, however, divides into two near the joint. One branch goes deep with the artery and divides [into venae comitantes] throughout with the artery. The other [basilic] runs obliquely down sub/ cutaneously. It is plainly seen in thin people and those with

76

BOOK III

large veins. You will see it more clearly if you constrict the arm with a bandage.

The first branch of this vein [hasilk] is seen running down aslant to the bone [ulna] of the forearm. It courses between the inner condyle [medial epicondyle] of the humerus and the bend

377 at the elbow but, mounting on the forearm [below], it goes forward with it to its end. The second branch arising with it runs above the forearm for a little but at once divides. Of the branches the lower reaches the [cephalic] vein, which I said runs along the bone of the lower arm. The higher, often passing outside, sometimes comes to the same vein in the forearm and, reaching it, is consumed by final division into branches. The vessel stretched along the forearm reaches its end with certain branches extending to the lower region of the wrist, sometimes visibly, sometimes indistincdy.

[Here follow five pages of very elaborate description of the veins of the forearm and hand. Since these are, in fact, highly variable, and since their variations are without significance, the translation of these pages would be unprofitable.]'^^

38^ All these veins [in the lower arm] can be seen clearly even before dissection in many men who are both thin and full/ blooded, and have large veins, but the surrounding air should

384 be warm or the man have just had a bath. You must compress the part with your hand where you wish the full veins to be clearly seen. You should do this often and in many subjects. Its usefulness is considerable, and that for two reasons: first, for the knowledge of the vessels themselves, for no phenomenon is accurately and quickly recognized unless often seen.'^° (This is proved by [identical] twins for they are indistinguishable to strangers but are easily distinguished by intimates.) And secondly, to convince yourselves of the close similarity of the bodily parts of men to those of apes.'^^

All these veins that you see in man without dissection, you will see in the ape during dissection. Clearly then these animals are like men in respect of the deep veins as well. I want you

385 to have frequent practice on them, so that if you have the

VEINS OF AXILLA AND ARM 77

luck to dissect a human body, you will be able readily to lay bare each of the parts."^^ This is not everybody's luck, and it cannot be achieved at short notice by one unskilled in the work. Even the greatest experts in anatomy among the physicians, and even when examining the parts of the body at leisure, have obviously made many mistakes. For such a reason even those who sought to dissect the body of a German enemy, who had been killed in the war against Marcus Antoninus, could learn no more than the position of the viscera. But one who has prac^' tised beforehand on animals, and especially on apes, lays bare with the utmost ease each of the parts for dissection. It is easier for a careful man, previously practised in dissections, to gather some/ thing quickly from examination of a human body, than it is for one who is inexpert to discover the obvious even at his leisure.^^ For men have often rapidly observed whatever they wished in bodies of men condemned to death and thrown to wild beasts, or in brigands lying unburied on a hillside. Again, extensive j86 wounds and ulcers, reaching deep down, have exposed many parts which were recognized by the experienced as having the same structure as in the bodies of apes, and yet they were of no service to the inexperienced [see p. 4]. By constantly dissect/ ing bodies of exposed infants,* they were persuaded that man has the same bodily structure as an ape. In the course of various surgical operations that we perform, sometimes remov/ ing mortified flesh, sometimes cutting out bones, the likeness becomes apparent to the practised eye. But some are so careless of the highest standards that they will not learn, even what can be ascertained precisely, before dissection.

Chapter 6

[ Venesection]

What I have just said [in Chapter 5] as to the veins in the 386 lower arm and hand can all be ascertained in man before dissec/

* Literally 'By frequently dissecting many bodies of exposed children'.

78

BOOK III

tion* in many cases. Thus, for example, after the dichotomy of the vein through the axilla to the front of the elbow/joint, the [branch] vein that reaches the bend has an artery lying under

5^7 it for some distance. This, in thin subjects with strong pulses, you can recognize by touch and by its movement. If therefore you let blood in one in whom this vein is clearly visible, you must keep well away from the artery. And where only the part resting on the artery is visible and the rest is out of sight, you must be particularly careful.'^^

First [observe that] when you bind the arm, the place round the artery swells into a sizable lump; secondly, cut one of the other veins which I shall mention and never this one when this area is distended, knowing that so broad and strong an artery underlies it. When it is swollen to the fullest extent, raise and stretch round it the vein that rests on it. Thus the artery becomes emptier, where the vein is stretched round, so that if one apply the lancet with the usual degree of force employed in pressing it down and lifting it [as in venesection], it would quickly pass through [the vein] and pierce the underlying artery. Therefore

388 it is best to discard this [vessel] and pass to a neighbouring vein, particularly one of those running down towards the ulna.

If none of these be visible, then pass to the vessel [median hasilic] that arises from the venous junction in the bend of the elbow which, I said, extends to the top of the radius. If not even that is visible, [pass] to the vein [median cephalic] which comes to the bend at the elbow from the *shoulder vein', and if it be not visible and if blood needs to be let from it, the vein that comes to the bend from it must necessarily be cut instead. If not even that be visible, [choose] the vein that stretches up aslant to the radius; if not even that, the vein from the armpit

38^ running into the bend at the elbow [hasilic]. This last vein is most useful for disease of the parts below the collar/bone, the 'shoulder^vein' [cephalic] for parts above.'^^ gut they have the second and third place after those I mentioned. Since the vein that runs up to the top of the radius [median] is common to

* PRO TES ANATOMES.

VENESECTION

79

both, I give it the third place in both limbs. The first and second places are taken by the right and left median.* I have now said 389 all that is to be said about the superficial veins throughout the lower arm to the fingers.

Chapter 7

[Deep Veins of Forearm]

Now investigate the deep veins, after removing the superficial 38^ veins at the bend [of the elbow]. When these are gone and the muscles dissected, as you learned, you will see the deep veins conjoining like the superficial. Moreover, after their meeting they separate again and run as a pair through the lower arm to 39<^ the wrist, parallel with one another. The lower one runs along the ulna, the higher along the radius, accompanied by the arteries supplying branches to the muscles.

A certain portion of the lower [ulnar] vein, when it reaches the small muscle of the radius [pronator quadratus] emerges on the innerf side where, dividing, it unites with the superficial veins there. Moreover, the part of it which remains deep joins deep branches of the superficial veins on the inner side of the ulna.:}:

I said that two [superficial] veins run into the arm, one through the armpit, considerable enough in size [hasilic]^ and the one much smaller, yet itself large, which they call 'shoulder vein' [cephalic].

Chapter 8§

[Deep Arteries and Veins of Arm]

A single artery [axillary] reaches the arm with the vein that 391 goes through the armpit [hasilic]. Both emerge from the chest

* Ten repetitive lines here follow. f Text says ' outer'.

\ Here a brief repetition is omitted.

§ It would seem that Chapters 7 and 8 should be united. The first sentence of Chapter 8 repeats the last of 7.

80

BOOK III

along with the ninth pair of nerves from the spine [T.i contributing to lower trunk of brachial plexus, Fig. 23]. They enter the upper arm where they are reached by the third nerve [radial]. From there, giving important branches to all the muscles of the upper arm, they [i.e. brachial artery and vein] are carried straight down to the bend of the elbow. The vein, however, at the end of the upper arm, divides in two. One part goes to the skin but the deep part is carried to the bend with the artery, taking with it in addition a third part of the *shoulder^ vein'. Then, dividing in two with the artery which is similarly divided [into radial and ulnar], it is carried along and distri^ buted, thus divided, to all the muscles up to the beginning of the fingers.

In feehng the pulse by the wrist joint, we touch the higher 5^2 artery by the radius. In thin people the artery between index and thumb [arteria mefacarpalis dorsalis], which has its origin from that [in which the pulse is felt], can be seen moving too. The movement of the lower artery [ulnar] which runs along the bone of the forearm towards the litde finger, cannot be distinguished clearly unless the man is quite thin and has a strong pulse. For Nature keeps the arteries down, nowhere bringing a branch conspicuously to the surface, which, as I indicated earlier, is the case with veins and nerves. Thus it is not remarkable that you cannot find any artery on the back of the finger/ends, for there is none at all there. But the front [of the hand] since it has many muscles, has also many arteries, [some] reaching each of the fingers.

You will see all the arteries at the wrist, with their companion veins that come from the inside parts, when you have cut away the broad tendon [palmar fascia]. For their position is between this tendon and the tendons bending the fingers, along with the 393 delicate nerve that I mentioned before. . . .*

I have now described all the [vascular] structures of the arm. * Here five lines of obscure meaning and construction.

8i

Chapter 9

[On the Care needed in investigating Nerves and Vessels']

You must not read of each of the phenomena that you observe 393 as you would read the Historiae of Herodotus, for mere enjoys ment's sake, but you must store them in your memory so that you may know precisely the nature of all the parts of the arm.

Some parts have neither artery nor nerve, nor large vein, while some have one, two, or all three. Potency in arteries and veins is proportionate to size, but not so for the nerves, for in some parts a small nerve has great power, for example, those dispersed through the muscles that move the thumb and, next to them, those that move the index. For if they alone were preserved in their natural state, while the others [in the hand] were paralysed or quite destroyed, the man would not be maimed in the full sense, or his hand entirely useless. If the middle finger be added to these, there will be little wanting to the functions of the hand, even though the small fingers be destroyed. But if, while the four remain in a healthy state, some/ thing were to happen to the muscles that either flex or extend the thumb, all functions of the hand would go, for the activi/ ties of muscular opponents are always vitiated together. When the muscles that extend the thumb are detached, the muscle the natural function of which is to flex it, having done its job for the nonce, flexes it [for good]. Later it will not be able to do so, for it is impossible again to contract a muscle that remains contracted, unless it be first extended.

Therefore make yourself thoroughly acquainted with the nerve of each muscle and especially of those having an impor/ tant function. Thus if it be necessary to remove a missile or splinter by cutting through or round a structure, or again, if we are to excise some putrified part or gangrenous bone, let us spare the important vessels and nerves. 39s

I know of a slapdash practitioner who in one case excised a large part of the muscle in the outer region of the upper arm, without greatly harming the limb. But he later applied the

B. 2353 G

82

BOOK III

lancet freely to that region inside the anterior muscle where the fifth* nerve [median] mounts on it. In the phrase of Hippos crates, he was ^expert with a foolish facility'.^^ With one swift circular cut, he not only severed the third nerve [radial] but the two in the front of it [ulnar and median] and, in addition, the [brachial] artery and vein, for all these lie there together. Dis/ mayed for the moment by the haemorrhage, he attended only to that, putting ligatures round the severed vessels. A little later, however, the patient was unable to move any part of his hand and had no sense of touch over most of the limb. He shouted at the physician, these very words, *You have cut my poor nerves'.

396 This healer had indeed made the whole limb useless with one incision. Others have done the same to other parts of the arm and leg from ignorance of the nerves. I pass by, for the present, all the mischief they have done in blood-letting, by [their] failing to understand the parts to be watched in each of the veins at the elbow, of which I have spoken also in my book De mortuorum dissectioneJ

For all these reasons you should dissect the arm of an ape frequently. If you observe something unusual in it, this too may be of use to you. Thus in dissecting an ape I once observed a little nerve [cutaneus antihrachii medialis] resting on the vein at the elbow. The observation of these things has proved useful in the case of certain well-known physicians who were blamed for having severed a vein, since immediately after the incision a numbness along the hand was sensed and this affection ever after remained. But I made clear to these critics that such an idiosyncrasy in the bodily frame was sometimes found, and

397 thus freed the physicians from censure. I persuaded those who were accusing the physicians not only by calling on others as witnesses for their testimony, but also by pointing to a record of the phenomenon in the vein I have just described, in the anatomical notes I had taken of each subject dissected. . . .f

* Text reads 'third'.

f Here ten irrelevant lines on the superficial nerves of the arm.

83

Chapter lo

[Nerves in the Thigh, Fig. 2^*]

The dissections that I have explained having been successfully 397 performed on the arm [we turn to the leg]. Four cutaneous 39^ nerves will be seen at the beginning of the thigh. They are equal in number to the large nerves to the muscles, for they descend from them.

[a\ One runs down from above, from the anterior muscles to the whole skin surrounding them and is distributed there [cutaneus femoris lateralis (L.3 and L.4)].

Medial to it lies a nerve that passes through the groin [n. femoraliSy rami cutanei anteriores] on to the large, narrow muscle [sartorius].

[c] The third [cutaneus femoris posterior] near the kokkyx, as it is called, is more difficult to examine than the afore^ mentioned.

[d] The fourth [genitofemoral], which is even harder to examine than the third, is at the perforation of the pubic bone by the groin.

There are very small nerves like spiders' webs passing out to the skin, some stouter than these and some like strong hairs, and yet others thicker with the *roots'^^ quite clearly visible. Those stretched on the anterior muscles [group a above] with a strong membrane over them are seen to arise at the mid^front region when the surrounding skin is scraped off. Those that pass through the groin [group h above] on to the delicate and narrow muscle [gracilis] cohere and twine round the inner 399 region of the thigh and leg. They run along with the [saphe^ nous] vein as far as the inside attachment of the astragalus [n. saphenus]. From the nerve which passes out near the coccyx [group c above] almost the whole of the back and outside part of the thigh receive the branches. The end [of the thigh] at the knee is excepted, for there another nerve [cutaneus surae lateralis]

* The nerves (Fig. 24) of the lumbo/sacral plexus are different in ape and man.

84

BOOK III

passes out by the broad muscle [hkeps femoris]. So at its end a single small part, as I have said, of the nerve, passing out through the perforation of the pubic bone [group d above], twines round the rest of the inner region of the thigh.* Addi/ tional nerves twine round the outside parts of the thigh \cutaneus surae lateralis], because the inside receives branches from the nerve [saphenous] that runs along the [femoral] vein.

The remaining part of the back of the leg has a nerve of its own [a branch o{ cutaneus surae lateralis], split off from that which twines round the calf The front part receives a portion of the nerve that twines round the anterior muscles of the leg.

When you have examined the small cutaneous nerves, dis/ sect all the muscles round the hip, as you learned in Book II [p. 43]. When they are separated from one another, the branches of the large nerves are seen clearly. They run, as all these nerves do, between the muscles, giving their branches to them. You will see four origins, as you did for the cutaneous nerves which are branches from the deep nerves and, being so soon observed, will lead you to discern the larger nerves. But, even apart from the surface nerves [acting as guides to them], the origins of the large nerves are readily discovered when the muscles are being dissected.

There are three origins of [large] nerves of comparable size which I shall mention first, and there is yet a fourth, the largest, which is bifurcate, of which I shall speak later."^^

Of the three nerve/stems [of comparable size], one [n.femoralis] is divided up for the anterior [flexor] muscles only.

The second [nn. fie xores femoris peculiar to ape and innervate ing hamstrings] runs along the large vessels, giving fine web/ like branches to them and to the adjoining muscle. It is in contact beneath with the largest muscle of the thigh [adductor magnus] and above with the delicate narrow muscle [sartorius] which we dissect first among the muscles of the thigh. '''^

The third and last nerve stem [obturator] passes out through the large perforation of the pubic bone and through the two

* I have rectified some disarrangement of the text in the above paragraph.

NERVES IN THE THIGH

85

small muscles that occupy it, one outside and the other inside [ohturatores externus et internus]. These [last] among the muscles moving the hip/joint have been overlooked by the anatomists, as you learned. This nerve is divided in two before it traverses the muscles. One of its parts, running up higher, is dispersed through the muscle that springs from the pubic bone [gracilis] which was the second that you learned to dissect. The larger and lower, passing out through the perforation and the small muscles beside it, splits up to enter the biggest muscle of the thigh [adductor mass] and sends out some very delicate off/ shoots from itself to the small muscles lying beside it [gracilis].

When you have examined these three nerve origins, pass to the fourth [sciatic], which belongs to two large nerves [tibialis and peroneus communis] running down to the leg and dividing into branches to the tips of the toes. This will be in plain view 4^^ when the buttock muscles have been dissected. With these you were made familiar in Book II in the anatomy of the muscles of the hip/joint.

Along with these let there be dissected the heads of the three* muscles round the hip which I described as arising from the ilium [the glutei, pp. 45-46]. The large nerves [ischiadic] are visible lying under them, passing out from the inner parts of the sacrum, along with the delicate little nerves that spring from it. These [latter] are dispersed through all the muscles round the articulation on the outside [piriformis, gemelli, ilia^ cus, psoas major, and psoas minor] and the first muscle of all on the surface which draws the articulation backwards [gluteus maximus], the yet larger fleshy muscle beneath it [gluteus mediusY^ and the small ones underneath that. One of these springs from the bone of the ilium [gluteus minimus]; another [piriformis], which is always of a dark colour, from the sacrum; and a third goes from the pubic bone to the large trochanter of the femur [obturator internus].

The delicate nerves are used up in entering these muscles, and sometimes give branches to heads of the aforementioned 403 * Text says Tour*.

86

BOOK III

muscles. But after that, only the largest nerves are seen coursing through the back of the thigh, giving a very large branch to the broad muscle [gluteus maximus] and one, plainly visible, to the other three [glutei medius et minimus Sivid piriformis] and sometimes to the largest muscle at the thigh [adductor mass, wrongly]. The broad muscle [gluteus maximus] receives a nerve above at the head like the others, and also another after that, but the great nerve [ischiadus = tibialis plus peroneus communis] pursues its course [unbranched] through the middle of the thigh. From this [united] nerve issue those that pass through to the skin as I said earlier [p. 84]. Such are the nerves in the thigh.

Chapter 11

[Nerves of Leg and Foot]

40^ Consider now the nerves in the leg. Only two large nerves enter the leg. These are plainly visible at the back of the thigh, as I have said, when the broad muscle [gluteus maximus] was dissected [p. 85]. One enters it; the other [ischiadus] is pro^ longed very far. The latter nerve* comes in close contact with the knee-joint and passes back to the inner side of the leg.

404 It reaches the beginning of the leg, and there the nerves [tibialis and peroneus communis] first separate, the smaller [peroneus communis] to the outer muscles, the larger [tibialis] to the inner. The outer and smaller nerve passes to the leg under the very head of the fibula. The inner and larger nerve plunges at the top of the calf between the heads of the twin muscles [gastro^ cnemius] which, as you learned in Book II [pp. 40-41], spring from the femur. A large remainder of this nerve passes to the under parts of the foot. Delicate ends belonging to the other nerve [peroneus] are distributed to the upper parts of the tarsus. A certain portion of it [ramus anastomoticus, absent in man] reaches the other nerve that runs through the calf [tibialis posticus] near the lower end of the tibia.

* Text reads 'muscle'.

NERVES OF LEG AND FOOT 87

A single large nerve [plantaris, double in man] reaches the underside of the foot and is distributed through its parts. This is a remnant of the large nerve which is distributed to the back muscles of the leg [tihialis]. It descends to the underside of 40s the foot along with the tendons flexing the toes. It was remarked that a part of the anterior [peroneus] nerve is fused with this nerve, for small nerves from it reach the upper parts of the foot.

The remains of three small nerves [reach the foot]. One runs alongside the vein at the inside parts of the leg [n. saphems]. The second \suYalis\ runs on the surface at the back of the calf, which I just mentioned as entering the calf between the [paired] muscle from the femur [cutaneus surae medialis], A third small nerve [cutaneus femoralis posterior] springs from the large main nerve [ischiadus, wrongly] itself, which, running down the calf by the muscle along the fibula, reaches ultimately to the foot, being distributed to the outer tarsus by the lesser toes, just as the aforesaid nerve, which I said runs along with the vein through the whole limb, stretches out its ends to the greater toes.

Between these are other remains of each of two big nerves [ramus superfcialis of n. peroneus and ramus plantaris of n. tihialis] which, I said, twine round the anterior muscles of the leg. These reach the middle parts of the tarsus. One is on the surface just under the skin, on the ligament at the tarsal joint, 406 dispersed through the parts by the skin of the tarsus alone. That set deep under the ligament [medial and lateral plantar branches of n. tihialis] is distributed to all the muscles on the tarsus the tendons of which, as you learned, initiate the oblique movement of the toes [p. 49].

Chapter 12

[The Two Veins of the Leg]

A small vein from the pubes reaches the leg, nourishing a small 406 part of it. I shall speak of it later. Another vein, a very large one, is distributed through the entire limb, running from the

88

BOOK III

inner part of the groin. Certain irregular branches from it pass to the skin. Such veins some physicians call sporadikai. Those distributed through the muscles have a [more] fixed origin and position, but as in the arm they are not always of equal size.

I shall now mention all the branches usually visible of the

407 large vein, which is the main source of all those in the limb. At its origin a branch on the surface under the skin runs into the front and inner surface of the thigh, dispersed in various pat/ terns. Next, three or four other delicate sporadic branches are distributed through the skin. At the middle of the thigh another important one, like the first, shows itself beside the narrow muscle [sartorius] wherein a vein is rooted. There are two or three other small sporadic branches. Next there is a branch of considerable size on the inner side of the knee, and next another which is bifurcate, and after it several others of like nature. All these are superficial but certain others correspond to them in the depths.

The first [deep] vein after the groin is distributed to the two anterior muscles [vastus lateralis and vastus intemedius]. After it is another deeper and rather large branch, between the largest muscle of all [adductor ma^nus] and the inner of the anterior muscles [vastus medialis]. From it many veins go to almost all

408 the muscles round the thigh. Next comes the vein that I said is dispersed under the skin and after it another, also from the great one to the anterior muscles [quadriceps], passing through the depths to the outer region of the thigh. After it comes another considerable branch, which passes rather deeper down to the largest muscle [adductor mass] and those lying beside it semimembranosus and semitendinosus]. After these there is that mentioned before in the enumeration of the superficial branches, which passes by the inner side of the knee to the end of the leg, being divided freely in the skin [internal saphenous]. Near this branch you will see others from the large vein dividing up into the lower parts of the largest muscle [adductor ma^nus] and through the whole articulation to some depth.

VEINS OF THE LEG

89

Sometimes the large vein [femoral] divides at once, sometimes division does not take place until the beginning of the calf, when a vein [short saphenous] passes round through the under parts of the joint to the outer region. There beside the fibula it becomes bifurcate. One part of it divides up on the surface in the inner parts of the fibula to the ankle. The other part, carried 4^9 through the depths of the outside muscle [companion vein of peroneal artery], gives branches to each, and passes through be^' tween tibia and fibula near the lower end, so that the convex end of the tibia* is embraced by the end of this and by the end of the superficial vein.

Sometimes when the large vein divides in the ham, this vein arises from the other one of the parts. But however it divides and whatever its condition, the large vein is divided at the ham and with one part passing through the calf reaches the end of the tibia at the ankle, and thence passes to the sole between tibia and fibula there. The other part passes to the shin and divides into several veins, all running in the front part between tibia and fibula, their ends going as far as the tarsus, the foot, and the 4^^ toes, joining with one another and the veins lying beside. . . .f

Chapter 13

[Arteries of Lower Limb]

The largest artery [femoral] coming through the groin passes 410 into the thigh at the same spot as the large vein. In thin sub/ jects with a strong pulse you will find its movement percept tible to the touch there. Both vessels run through the inner region of the thigh, covered bylj: the narrow muscle along the thigh [sartorius]. Into it, as into all the others round the thigh, pass branches of the artery proportionate in size [Fig. 18]. * Text says 'fibula'.

f Here for two and a half pages Galen sets forth an elaborate plan of the superficial veins, which hardly accords with anatomical facts and is devoid of interest for the modern reader. I omit them.

ij: Text says 'lying on'.

90

BOOK III

As in the upper limb, so in the lower, veins go along with the arteries that pass into the muscle. Yet arteries do not accom/ pany the superficial veins, but always come through the depths to the muscles. Every vein in the thigh and along the leg, that

413 I said divides deep down to enter a muscle, has an artery lying beside it, but not so any of the superficial veins. This is clear from the fact that in well/covered persons the pulse is never perceptible in the leg unless at the tarsus in a line with the second toe. We often feel the artery lying there, when we cannot feel that in the wrist.

There are other arteries in tarsus and foot, which often show the pulse in thin subjects, when one is swollen to its full extent. At the wrist on the outside [that is on the dorsum] I said that no artery is found, because there is no muscle there. It is for the small muscles on the dorsum of the tarsus [extensor digitoYum hrevis] that the artery I mentioned just now is dis^ tributed there, just as it is for the muscles under the foot that a small artery [plan f arts lateralis] accompanies the afore men^- tioned vein, and reaches this spot. They move down into it through the space between fibula and calcaneum.

As to the artery [a. ohturatoria] passing into the thigh through

414 the perforation in the pubic bone which they call thy^ ROEiDES [thyra, hole, door, gate], you may assume that all I said a litde earlier about the vein is said of it, for it is dis/' buted to the same three muscles as the vein.

BOOK IV

[Muscles of FacCy Headj Neck and Shoulders]

Chapter i

[Function and Order of Anatomical Works]

In the De usu partium my aim was to explain the structure of all 4t$ the human organs, so far as it concerns the Art. I followed this principle with the best of the older physicians and philo/ sophers. Therefore I began with the hands because these are possessed only by human beings. The legs naturally came next, 416 since in them also man has something that animals lack, for he alone walks quite upright on them."^^ It was shown that the ape is a ridiculous imitation of man, walking like one, and yet defectively in most important ways and falling short of straight^ ness in the structure of the legs. So, too, the thumb, which controls the action of the human hand, is incomplete in the paw of the ape.

In the present work, my aim is twofold; first that each bodily part, the actions of which I explained in the former work, may be accurately observed; and second to promote the proper end of the Art. For since I see contemporary Physicians, reputed serious students of anatomy, making little of the more useful part of it and cultivating the more pretentious, I sought first to demonstrate this to the young and to encourage them to pursue the more useful. This I have done in the beginning of Books II and III. The recapitulation there of the [contents of the] treatise 417 [De usu partium] included practically all the customary dissec/ tions of the limbs and superficial parts of the body, as to muscles, vessels, and nerves. For it is from them, and not from liver, heart, or lung, that we extract missiles and splinters and it is in

92

BOOK IV

them that we treat fistulous ulcers, derangements of the humours, suppurations, and septic infections.

I wished both my works to be arranged alike throughout, as [they are] in the first two books. But I observe that the enthusiasm for the less valuable part of anatomy daily increases, while almost everyone neglects the more useful part. Therefore I decided to encourage the young to study what is more urgently necessary and that not by argument only, but by the scheme of instruction. What I want them to learn first, I set down first in this discourse. Therefore, after the account of the limbs in the previous [three] books, in the two that follow I set down the superficial anatomy of the whole body, in so far as it refers to muscles, beginning from the face and head.

418 Among those muscles that are united with the surrounding skin of which the anatomists overlooked the most important element, are the two broad and delicate muscles ending in the jaws and lips and arising from the cervical spinous processes [plafysma myoides]. From these there springs a membranous ligament with the fibrous strands common to all muscles but which links the substance of the two muscles [of the two sides]. Many fibrous strands also pass up from the spine of the scapula as they do from the clavicles, and end in the face [Figs. 11, 12].

These muscles must be severed in due course in accordance with the nature of their fibres. Those ignorant of them, when they cut at large across them, dividing the fibres, cause the mouth to be drawn to the opposite side. These cases have been overlooked by all, and I shall say a litde about them later, but those interested in practical anatomy have recognized the mus/ cular substance under the skin of the forehead [occipitoyfrony

419 talis] and its action. They state that the brow region is drawn up by it, and that the skin on the forehead derives its motion from it. Yet most surgeons do not know this, and ignorantly incise the forehead transversely rather than vertically. The result is that they make too large an incision there, particularly near the eybrows, and the skin continuous with them is drawn down to the eyelids and weighs down the eyes by resting on them so

ORDER OF ANATOMICAL WORKS 93

that they do not open properly, and their activity is thus im^ paired. As the direction of the fibres is downwards from above, so is it with the muscles moving the jaws.

Is it not then disgraceful that people ignorant of many such facts should [idly] inquire if there be not some cartilaginous or bony element in the pineal gland J or if it be possible to find a cartilage or bone in every heart or only in a large one ? Such ques/ 420 tions I see engage the attention of present/day physicians more than do useful problems. For these reasons I resolved to add other two books to the anatomy of the limbs — thus making a quarter of the whole work — and then a fifth [book] after that. When the whole anatomy of the muscles has been fully dis^ cussed in them, I shall return to the order followed in the De usu partium}^ That is I shall speak first of the organs of assimilation, then of those of respiration, then of the parts in the brain and spinal marrow, then of the reproductive organs, and lastly of investigation on the foetus.

Book XVI in the De usu partium is on arteries, veins, and nerves. I explained there what is common to all and useful to be known about these, whereas what is the nature of each is expounded in this present work De anatomicis administrationihus. For this reason I must now treat of them very exacdy, for many details were omitted in my earlier work De anatomicis administra^ 421 tionihus lihri duo J Why it seems to me better to give an account of arteries, veins, and nerves at the end of each treatise I shall explain in that book where I describe the procedures by the good use of which one may gain experience.

Chapter 2

[The Five Kinds of Muscles of the Mouth]

Now we must proceed to the anatomy of the muscles. First as 421 to those that move the mouth (gnat hoi) with the lips, the jaw being unmoved. It is possible to clench the teeth and draw the corner of the mouth towards either side of the neck. In this

94

BOOK IV

action the skin is stretched toward the junction of acromion and clavicle. These muscles [platysma] can open the mouth on either side towards the neck, just as other muscles called MASSE TERES (*masticators'), attached on the flat surface of the lower jaw [ramus], move it round either way. The tem/

422 poral muscles [on the other hand] do not swing the jaw. Their natural function is to draw it up in biting on anything or in nibbling or in shutting the mouth. It is these muscles that Hippocrates calls mas setere s^° but I shall always call them 'temporal* (krotaphi tai) to avoid two meanings of one word. I shall call masseteres those lying on the jaw and moving it either way [Fig. 13].

All known living creatures except the crocodile move their under jaw, while the upper remains unmoved.^^ The actions [of the lower jaw] are three, chewing, shutting, and opening the mouth. The movement of the mouth first mentioned is dis^' tinct from these, since it can take place when the lower jaw is at rest. It is distinct also from the movement of the lips which is affected by yet other muscles. Thus there are five activities connected with the mouth, and five kinds of muscle, all of which I shall describe in turn, beginning from those dis^ covered by myself

In all the types of animal that physicians dissect, as being not

423 very unlike man in nature, there are muscles, both broad and thin, which are intended by Nature to draw the jaws sideways. The types of animal that do not differ greatly in their nature from man are, roughly speaking, six in number, of which I have already spoken [p. 97].^^ Here I treat of apes because of all animals they are most like man.

Apes [for dissection] should be drowned, that no organs in the neck be damaged as they are by strangling. A straight incision must be made with a sharp lancet along the neck from chin to breast, the lancet being pressed so evenly on the skin that nothing else is severed. You will easily accustom yourself to do this, not only here, but throughout the body, by shaving the part you intend to cut.

MUSCLES OF THE MOUTH

95

Practically all the skin on the body has a membrane [dermis] lying under it which is removed with it in skinning. Here is a broad and delicate muscle [platysma] with many fibres which have a [general] direction corresponding to the associated vessels.^^ These fibres end at the lips and their origins are mani/ 424 fold, for they arise from all the neck vertebrae, from the scapulae and from the clavicles. Those that come from the cervical vertebrae run rather more transversely. Those that run up from the clavicles are nearly vertical. Most of them reach the point of the chin and are inserted into the lips, alternating with one another, as purses are drawn up [by their strings], some passing from left to right of the lips, others the reverse way [Figs. 11, 12].

The membrane from which the fibres originate is not like that of others in thickness or strength but proportionately stronger, for it is formed of the substance and has the nature of ligaments which spring from bones, being hard and insensitive. 42^ Hence this membrane and all those like it should be called 'ligaments', since such they truly are, and 'membranous' for clarity as having the delicacy of membranes. This ligament springs from the ends of the spines of the cervical vertebrae and binds them all to the muscle.

Naturally, when the animal is skinned, this muscle [platysma] disappears, stripped off with the ligament like a membrane. You can make a double test on one animal by shaving off the skin from the muscle on one side and removing skin with muscle and ligament to the vertebrae on the other. If you keep the mem^ brane* stretched, you can examine in the delicate ligament the numerous fibres in a row, one after the other, like the fibrous cords. They are best seen in either old or newborn animals.

Both [old and newborn] lack fat, which accumulates on membranes, ligaments, tendons, and sinews, and indeed on all avascular and cold tissues. In the newborn the fibres are small, the ligaments powerless, and the muscular substance soft, and so perhaps such subjects are better avoided in the present inquiry. * Text says 'skin'.

96

BOOK IV

Those thin from age are the most suitable, for their flesh is scanty and dry and the fibrous element even more dry and yet well developed. But if it be a choice of unsuitable animals, select the newborn rather than the large and fat, for nothing so obscures dissection of fibres as fat.

In this muscle [platysma] examine the position of the fibrous strands which run up, from the regions I have mentioned, to jaws and chin, for they guide you to the origins of strands that come from many regions. Those in the front and side of the head rise up from the underlying muscles; others coming from the back, springing from the spinous process, have their

427 origin as you may see along with the delicate and flat ligament there [Figs. 11, 12].

It is well to insert a threaded needle to put a loop round each strand close to the lower jaw, then, stretching out the strand by means of the thread, remove the fibrous strands on either side of it. Do this to each strand, so that, when the muscle is cut out, the fibres are left intact, so that their origin may be seen when you remove the thick muscles underlying them. It suffices to do this on one side. On each [side] cut away the ends of the fibrous strands running down to scapula, clavicle, and spine, strip the muscle from the underlying tissues and draw each portion of it towards the end so as to see the animal's jaws following the portions of the muscles pulled on by them. Either the animal must be still warm and lately dead, or else the surrounding air must be summer4ike, or you must throw warm water on it, for if the parts round the jaws have time to cool they become

428 difficult to move, growing stiff as hide.

This muscle arises behind from the spine continuously. Thence it runs to the base of the bone of the occiput, then passes under the ear, touching its attachment, and thence it passes to cover the masseter muscle, uniting ligamentously with the upper jaw bone. Thus the two sides, so to speak, of this part of the muscle [platysmafaciei] are completely defined. The three remain/ ing divisions are not thus separable, since for the most part the spine of the scapula bounds the part of the muscle there

MUSCLES OF THE MOUTH

97

[nuchal part of platysma], but sometimes a small part of the fibrous strands passes from this, too, into the lower regions. The same may be said of the clavicular [portion], but none of the fibrous strands are so sharply defined as the aforementioned boundaries.

Most of the anterior parts of these muscles in apes so conjoin that they appear one. In some animals the straight sides of these muscles are separate from one another; in some they are 42^ in contact through a few oblique fibres, particularly in the region of the larynx. These muscles are separate from one another in proportion as the animals are long in the neck. If you remove these muscles, you can demonstrate either those from the nucha or those in the face.

Chapter 3

[The Six Kinds of Quadrupeds, The Lips and their Movements]

I stated earlier that the parts round the mouth have five dif/ 4^9 ferent movements. I think I had better go over them all. Let us start with the lips into which, I said, pass certain interlocking fibrous strands of the thin flat muscles [plafysma]. In apes the interweaving of these strands is plain to view, while in animals longer in the neck it is less plain in the degree that the neck is longer. Those with the longest neck retain little trace of 430 interchange of these fibres, for in them antero/posterior fibres disappear and the oblique or transverse perform the whole function without their help.

In these animals the lower jaw is also longer than in the ape. Of all animals man has the shortest jaw in proportion to his whole body. After man, the ape, then the lynx,^^ then the tailed ape, and then the dog/faced baboon. Their neck, too, is as long and they all have a coUar/bone like man. Some of them stand more erect than others. All [can] walk with their weight on two legs, some worse, some better. No other known

B. 2353 H

98

BOOK IV

animal walks thus. After these comes the bear class, then pigs, then what are called the jagged/toothed' (karcharo/ DO NT A, roughly the carnivora) then two other classes of 4P animal, namely the horned cloven^footed ruminants and the hornless, with uncleft feet and undivided hooves. As for the other classes of animal, biped and quadruped, omitted from these six classes, there is no difficulty in finding to what to liken them.

The lips have a special character of their own, for in addi/ tion to the variety of their motion, for which they came into existence, it is not possible to conceive a more perfect bodily substance. You can turn them out and aside, draw them in, stretch them lengthways, tighten them or slacken them at need in eating, drinking, speaking, or performing any other activity. Since they are attached to the skin and the flat muscles [parts of the platysma] that we have discussed [p. 7], you may place their origin wherever they will no longer follow the skin, as you strip it off. Further, the lips are joined with the bone of the jaw as well, for they have a third ingredient in their composi^ tion, a porous substance [presumably mucous membrane]. Thus their nature is composed from this substance, from the skin and from the flat muscle — three ingredients mingled. 43^ They derive their sideways movements from the flat muscles through their transverse fibres. The movement downwards and upwards comes from their whole substance and, for the sake of these movements. Nature has penetrated the mandible with small [mental] foramina and given them nerves [inferior dental].^"^ These holes are near the end^^ of the jaw on either side of the junction [of the rami]. Through them emerge what is left of the nerves to the sockets of the teeth, from which the gums and the teeth and the surrounding membranes derive sensation [Figs. 11, 12].

While stripping the lips from the under jaw, be careful not to cut the nerves. They run upward from beneath in accord with the nature of the lips. By the action of these nerves the Hps are drawn down.^^ They are brought together by

THE LIPS

99

Strands passing into them out of the thin flat muscles by the fibres coming up from the clavicles. Acting like a purse, pulled either way by the muscles at the side, the lips increase in thick-' ness as they lose in length [and vice versa]. It is as if you were to put a finger on either side, pressing them and reducing their 433 width or, again, increasing their height and thickness as you diminished their width. So the tension of the muscles, pulled opposite ways at the same time, draws the ends towards the middle, their spongy nature contributing greatly to this result. For all substance of this nature is both emptied and filled easily, contracting when emptied and expanding when filled. More is said of it in my work De motihus duhiis?'^

Just as nerves are supplied to these [i.e. lower lips] from the lower jaw [from mental branch o{ mandihular division of V],^^ so are they to the upper lips from the upper jaw [from the injraorhital branch of maxillary division of V],^^ also passing through fine foramina in all animals. If these foramina are not visible, you will find them in a larger specimen of like kind. (I call a horse like in kind (HOMOEiDEs)toa horse, an ape to an ape, a dog to a dog. Call them homogenes instead of homoeides, if you will.89)

These [upper lips] are moved in the same way as the lower. 434 They are drawn up by the afore^mentioned nerves which move certain delicate muscles peculiar to the upper lips.^^ They are pulled sideways by the fibrous strands of the flat muscles that come down to them. They are drawn together by the inters woven fibrous strands. In large animals you will see clearly some of them reaching the origin of the lips and stopping there, and some intertwined with each other [Fig. 12].

In exposing the lips, mark by means of ligatures the nerves below that traverse the masseter [zygomatic^ buccal, and mandiy hular branches of VII] advancing to the side parts of each lip, so that you may examine their origin again. And examine closely whether certain anatomists have been right or wrong in saying that each of the lips is moved by two muscles, each mn^ ning obliquely to the lips, into the upper from above and into

100

BOOK IV

the lower from below, or whether rather each muscle is of somewhat cuticular nature reinforced by muscle fibres.

Chapter 4

[Masticatory Muscles]

435 It must be shown clearly that the muscles moving the alae of the nose [nasolahiales] are of a like nature to that of the flat muscle [platysma] that was discovered by me. Here, too, there lie under the skin naturally united fibrous strands by which they are moved and fibres of such a nature are even more charac/ teristic of the skin of the forehead [frontalis]. But the alae of the nose are conjoined and fused with the upper lip [through the leuatores lahii], without being provided with any special muscle for this purpose [Fig. 11].

Move upwards gradually to the cheek, stripping off the skin from the tissue there. If you do this, you will see clearly the masseter muscles with the nerves [branches of VII] extending over them and ending at the mouth. Before dissecting the masseters, raise these nerves with hooks and free them from underlying tissues up to their end behind the ears, and leave them there. Remember to examine round the foramina of the skull whence they spring [stylomastoid foramina].

But first proceed [a] to the masseters, [h] to the muscles within the jaw in the mouth, and [c] to the temporal muscles,

436 for these three pairs of muscles move the under jaw. The tem-' poral muscles, along with the muscles inside, draw it up, while the masseters turn it to the side. You must dissect each of them thus. Cut the strands of the masseters extending from upper to lower jaw, consecutively so as to observe how they fit into one another. Divide those on the surface, drawing them up with hooks, stripping and dissecting them to the upper jaw, whence they spring, until you come to the underlying [fibres]. These have a different direction, for they fit into each other and do not run straight down. Wherefore it is necessary for the

MASTICATORY MUSCLES

lOI

lower jaw not only to be extended and brought to the upper, when animals are chewing, but also for it to run slighdy aslant, sometimes forward and sometimes backward, for such is the action we need in chewing [Fig. 13].

Each masseter forms two muscles, coming each from its own head to a common end. The insertion is in the lower jaw which is to be moved. One of the heads you will see in the cheek, 437 strong and sinewy, embracing the substance of the fleshy part with a powerful ligament; the other lies along the whole jugal bone and is not at all sinewy. The former draws up the jaw slighdy to the front, the latter is for the opposite movement, and its nature is to draw the jaw backwards to the degree that the former draws it forwards. If you stretch the heads in turn you will see the movement plainly.

As to how you are to do this, give me your attention now. The principles I am going to state apply to all operations for examining the movement of a part in a dead animal. We must remove all the flesh from those bones on which the investiga^ tion is being made, keeping intact only the muscles that move them. Dissect these muscles also right up to their heads. Cut these away from the bones from which they issue and draw 43^ them towards you, laying hold on them with your fingers, pulling them to the site from which they arose. If you do this aright, you will see the movements of the bones that have antagonistic muscles inserted into them.

Thus you must remove all tissues round the lower jaw and, laying it perfecdy bare, observe the movements of each mas/ seter. You will see them even more plainly if you not only strip everything else from the lower jaw, and particularly all that issues from below, but also the temporal muscles them^ selves which you can dissect either after the masseters or before. Either way it is necessary to excise what is called the zygoma. When it is away, the whole temporal muscle is clearly seen inserted into the process of the mandible called korone [coronoid] by a broad tendon.

Moreover, now that the zygoma is removed you will see

102

BOOK IV

the relations to each other of three muscles, to wit, the masse/ ter, the temporal, and the muscle hidden within the mouth [pterygoid], which is contiguous to them.

439 The masseter is in contact with the temporal in several places, and more extensively with that [muscle] which is hidden within the mouth [pterygoid]. Thus if one were to say that it [the pterygoid] were part of the temporal, one would hardly err, for the temporal, being attached all round the [coronoid] process of the lower jaw, is in union with this third muscle [pterygoid]. The latter has its origin by the wing/like (pTERYGOEiDEs) outgrowth of the skull [lamina ptery^ goidea lateralis], and is below attached to the flat parts of the lower jaw where there is a place made slighdy hollow to afford access to the muscle. At its origin there is a great hollow round the wing4ike outgrowth of the skull [pterygo^maxillary fossa]^^

It is not possible to examine this muscle till you have loosened the lower jaw, either removing it from the skull at the joint, or by severing the end where lies the junction of its two parts. The temporal muscle is visible enough if you but excise the

ZYGOMA.

Hippocrates says that the lower jaw is compounded of two

440 bones joined together at the end.^^ This has been said by all others who have expounded the nature of the bones with accuracy, yet it is not possible to demonstrate the junction in all apes, for in most of them it will look to you as if the lower jaw were a single bone. In dogs the junction is seen clearly, and in them it is easiest to divide the jaw at this point. Dogs have the three muscles of which I have just spoken, and all the kinds of animal mentioned above [p. 97] have them, and they produce the same movements, the masseters being double, but the others being single [p. loi].

You must find by trial in what animals the lower jaw is easily cleft, and so proceed to the apes.^^ If you want to practise on them from the start, you will divide the jaw at the point with an excision knife. Paying attention to this lower end of the 44^ jaw/bone and to the junction of the front teeth called *incisors',

MASTICATORY MUSCLES

103

Split the jaw with a scalpel at the mid/point. When you have drawn the parts asunder, examine from within the third muscle attached to the flat part of the lower jaw [huccinator]. You will see it clearly when you have stripped off the membrane that covers all the parts round the mouth [buccal mucous mem/ brane]. Following up its fibrous strands you will get a clear view of the [pterygoid] muscle arising from the hollows of the skull produced by the pterygoid (wing/like) outgrowths.

As for the masseters, when they have been prepared before^ hand, as I have described [p. loi], after you have laid bare and cut away the temporal muscles so that at no point is the lower jaw moved up or retracted, you can observe clearly how they move it. But if you wish to dissect the temporal muscles first, you must remove both [masseters] and, having bared the muscle of both skin and membranes, examine the fibrous strands to see how, starting from many regions, they all con^ verge on the tendon. Then cut away all the origins [of the temporal] and stretch them out vigorously. You will then see 442 the lower jaw following and the mouth closing. So open it with your own hands and then draw the temporal muscle upwards to see the lower jaw following it once more and the mouth closing again.

When you have observed these [reactions], cut away [the temporal] till you can see the muscle [pterygoid] inside the mouth, fusing with it at many points. Before you cut it, you will see the masseter adhering to it here and there. This also should now be cut out so that you can see the inner [muscle, i.e. pteryy goid] before the separation of the lower jaw. Detach this either at the articulation or at the junction — so that when it is turned back the inner muscle is visible. If you divide it at both places, you will make accurate examination yet easier. It is clear that in the case of this muscle, too, its origin lies by the skull and its insertion at the lower jaw, where it is attached at the flattest point 443 on the inner side where it is somewhat hoUow.^^ It emerges from the skull at the hollows beside the pterygoid bones. Once you have cut out the whole of this muscle together with

104

BOOK IV

the half of the lower jaw, you will be able to examine all the parts at the mouth, first the gums round the sockets of the teeth and then the sockets and the teeth themselves.

Chapter 5

[Discussion of EyeyMuscles postponed]

443 Since my intention was to examine the muscles first, let us pro^ ceed to them. We should begin with those round the eye, but I put off treating those in the eyelids even in my De usu partium^^ till after the discussion De motihus duhiis}'^

Dissect the inner muscles in the eye region, either excising first with a circular cut what lies around them, or cutting out

444 the eye as a whole. It is not, however, necessary to dissect the eye of a an ape when you have ample opportunity for such an operation on the larger animals. Therefore let us postpone dis/ cussion of the globe of the eye, also, to that part of the present work in which I shall describe a dissection* of such parts as can be examined separate from the rest of the animal. (For we can remove from the body the brain, eye, tongue, larynx, lung, heart, liver, spleen, kidneys, womb, bladder, testicles, bowels, or stomach.) Meanwhile, as we planned from the start, let us rather consider in detail the larger muscles that fasten part to part, yet are not themselves included in any one part, for it is not possible to conceive even the nature of such muscles apart from the animal as a whole.^""^

Chapter 6

[Muscles of Forehead and Neck, and Movers of the Head]

444 Let us now think of ourselves as stripping off the muscle4ike skin on the forehead. I have said before that a flat muscle is set under the skin here and naturally united with it. If you dissect

* ANATEMNEIN TO LOGO = to dissect in discoursc.

MUSCLES OF HEAD, ETC.

105

it to its origin you will see it becoming progressively thinner. 445 As you strip off the whole skin from the head, you will trace certain outlines of muscles round the ear which, in other animals, you will see not as mere outlines but as complete muscles.^^ Since as you do this the skin round the head is removed, while that round the neck was removed when you exposed the thin and flat muscles [platysma], it is time to dissect those muscles that are connected with the head and then those in the neck. As there is some dispute about the origin of these muscles I shall mention their junc^ tion with each bone as it comes up for consideration, sometimes saying that they

join with a bone (symphysis), some, pi^gram of cervical part times that they arise from It (ekphys is), of trapezius muscle of or grow into it (kataphysis), or Macacca] are inserted into it (emphysis).

First of all a flat muscle is seen on the surface, nearly trian/ gular, such as what geometers call trapezoid. You will grasp my meaning more clearly if you cut a right/angled triangle with a straight line parallel to the lowest side (basis). Of the lines that join these two, one is at right angles to both, the other is oblique. The line at right angles to both springs from the spine (akantha) at the neck. The base of the figure is the whole spine of the scapula. Parallel to this is a small line on the skull at the nape, near the first vertebra. That which unites it and the end of the base is the fourth side of the muscle, the oblique one, which runs towards the so/called akromion and joins for a short distance the end of the clavicle there.^^ In dissecting this muscle, begin from the highest line of origin which starts from the middle of the skull at the nape and extends transversely towards the root of the ear at the side [Fig. 10.]

It is clear that here is a single muscle running on either side of the spine yet neither division [of the muscle] reaches the ear, but each falls short of the ear by the distance that it proceeds

106

BOOK IV

from the nape. Make a transverse incision by the first origin, freeing it from the skull. Then thrust a hook through it and dis^

447 sect it from the underlying tissues. Proceed downward along the boundaries indicated, namely, the spinous processes of the cervical vertebrae and the slanting side of the trapezius, reach/ ing the clavicle near the akromion.

Suppose that this is done: the muscle is now visible, inserted into the sharp ridge on the scapula. The question which I had previously postponed now arises, namely, as to the muscles that fasten together parts which are [both] movable [that is, which is origin and which insertion]. The shoulder/blade makes extensive movements, and the head as great. If, in a freshly killed animal, you remove the flesh from them that the response may be ready, and if you try to pull on both in turn, by this muscle, either end will equally follow the other.

It is best, however, to hold that this muscle [trapezius] is produced by Nature for the shoulder-blade and not for the head, for these reasons. First because when it [the muscle] is severed in the neck, the scapula drops down and can never again be raised. (This should be done in the live animal.)

448 Secondly, because there are other muscles that move the head laterally, while only this one draws up the shoulder to the head. Thus, if we deprive the shoulder of this, it will want such motion altogether. Yet it obviously has this motion and since some muscle causes such [motion], it must be this. Third, in long/necked animals this muscle does not reach the head but is exactly triangular, for the line that joins the lines that bound the right angle begins at the lower parts of the neck and ends before it reaches the skull at the nape. For Nature, that does nought in vain,^*^ would have been active to no purpose in bringing up to the head a muscle which could have raised the scapula even if it had ended lower down, by movement of the neighbouring spine in such animals, and the extension to the neck would be unnecessary. Fourthly, evidence that the

449 scapula is moved is that a nerve comes down to this muscle from the brain [a branch of XI]. If one cut it, the movement of

MUSCLES OF HEAD, ETC.

107

the scapula is paralysed but not that of the head. Yet the book of Lycus^^ maintained that the head is drawn down to the shoulder by it, for he was ignorant both of the nerve and of all else of which we have spoken.

But it is not my intention to criticize Lycus or any of my predecessors unless incidentally.^^ For I know that any diligent reader anxious to discover the truth will find the books of other writers crammed with errors. For truly Lycus overlooked one pair of the muscles moving the lower jaw, namely, the pair inside the mouth [ptery^oids]^ just as he ignored the flat muscles in the neck [platysma], along with those just mentioned [cony cerning the trapezius]. He is ignorant of many more of the facts to be stated next. Sometimes he is alone in this, sometimes the others share his ignorance. I therefore invite all who meet with these books to judge of the points in question, making themselves eye-'witnesses of anatomical operations. For it is my express purpose in writing this work to enable diligent readers 45<^ to teach themselves, if they lack instructors, since the friends who urged me to write it as memoranda can, even without it, recall what they learned from me, unless they slip into indo^ lence. Hence I shall forbear to criticize my predecessors so that the argument may proceed the faster while I state only actual facts.

The second pair of muscles [rhomhoideuSt pars capitis, not present in man] is comparable in length to those already men/ tioned [i.e. to occipito/scapular part o[ trapezius] for, starting from the same region of the bone of the skull at the nape, they are inserted into the upper angle of the base of the scapula. Their breadth is considerably less. For these muscles are narrow and weak compared to those which appear so large even before dissection that in athletes they raise a swelling in the neck [sternomastoid]^^ [Fig. 10].

Begin to dissect the delicate muscle that we are discussing [rhomhoideus, pars capitis] in the same way as the first, that is, from the middle region of the skull at the inion [external occipital protuberance]. For lying under those mentioned before

io8

BOOK IV

and like them, they have a transverse origin there and like them

451 they extend along the spinous processes through the neck and are easily stripped off from the underlying tissues. But the former [fibres of trapezius] run thus throughout the neck and to the scapula; whereas the latter, when they approach the scapula, cohere with the muscles lying beside it on either side, and where they reach the scapula produce a round tendon which runs along the inner parts of the base [vertebral border] as far as the middle. They too draw up the base of the scapula towards the inion.^^

The muscles dealt with before draw up not only the base but the whole scapula. When they are removed, if your examination be as careless as that of Lycus, you will think you see the so/ called *spinal muscles' extending [evenly] over the whole neck, but if you look closely you will see many other pairs of muscles there, not only in apes but in all other animals, differing as plainly as could be from the spinal muscles.

They [the spinal muscles] arise from each of the upper cer/ vical vertebrae through powerful ligaments. They are attached to neighbouring vertebrae, their strands running a rather short course. On the other hand, those pairs mentioned before [tra^

452 pezius and rhomhoideus, pars capitis] extend the head by fleshy projections throughout the neck, being of no mean length in most animals. The sinews run up from below along these, as if they ended in the head instead of having their starting/ point from it.

The first of these muscles [splenius] is a flat pair arising from the skull at the i n i o n transversely like those first mentioned. (It makes no difference whether we call it a kataphysis (a growing to) or an ekphysis (a growing out of).) They are triangular: one side is the line mentioned on the inion; the second line is that of the cervical vertebrae; the third line unites these. Their fibres are oblique, slanting from the inion to the spine [a very different and much stronger muscle in apes than in man].

In the contrary direction to these, the fibres of the muscles

MUSCLES OF HEAD, ETC.

109

under them run slanting forward towards the transverse pro^ cesses of the vertebrae. Since they all tend towards this region 453 [of the INI on], they form a single sheet on each side. Their outlines — usually treble, sometimes double — will make you think that it is not a single muscle but three or two. Yet when three seem clearly visible, you will see one extends to the spines of the vertebrae, a second to their transverse processes, and a third in between* [This seems to describe the triangle formed by ohliquus capitis superior ^ ohL cap. inferior, and rectus cap. post, major. ^

As to the actions of these muscles, one can, of course, infer them from their fibres, but it is possible to strip all the surround/ ing tissues from the skull and to draw it backwards by these muscles. It is obviously stretched up and bent backwards by all of them, but by each of those just mentioned with an incHna/' tion to the side. On the other hand, the combined oblique actions of the muscles give a direct resultant. When a pair, whether of those lying above or those below, is stretched simul/ 4S4 taneously, you will see the head in equipoise, by moderate ten/' sion brought to a settled condition of erectness, while more violent tension imparts a backwards flexure to the animal's spine. It has been made clear that you should attempt such observation of the movement after all the flesh has been removed with the skin of the head and face.

You will begin the dissection I have described of the three pairs of these muscles from the bone of the skull at the in ion into which they grow, for they are easier to dissect from there. Continue to their lower end, which may be rightly called either 'origin' or 'insertion'.

Chapter 7

[Four Small Muscles behind the Skull and on the First Two Vertebrae^

When these [muscles] around the articulation of the head are 454 removed, three other pairs of small muscles become apparent.

no

BOOK IV

I shall speak of those when I dissect the muscles lying under the pharynx.*

In reality the muscles behind are not three but four (apart from the small ones hidden by the articulation at the side of the first

455 vertebra, on which account they escape notice). The fourth pair of the small muscles behind was overlooked by anatomists for the following reasons. The first vertebra does not have the structures at the back which produce the spinal process, and, moreover, it is the most slender of all the vertebrae. On this account it has surrounded itself with the second [vertebra] so as to form a close association. For these reasons and because the muscle that fastens the first vertebra to the head is so small [rectus capitis posterior minor], another [and larger] muscle is laid outside fastening the second vertebra to the head [rectus capitis posterior major]. Thus the small muscle is hidden. The muscle lying on it behind begins from the vertebra below [axis] and ends in the skull at the inion near its middle. [The muscle is relatively much larger in the ape than in man and has a wide insertion on the occiput.] For that reason also the two [larger] muscles which are straight are in contact with each other and cover the whole articulation. Until they are re^ moved, the small muscles cannot be seen, though they are just as straight and spring Hkewise from the skull and are in contact

456 with others in the same way as those on them. They are inserted in the back part of the first vertebra just as those above them are inserted in the back part of the second.

The reason that the first vertebra does not have a posterior process is certainly because the skull had to be attached to the second vertebra so that the head could be thrown back. Thus no process could have been set underneath among the muscles there, such as the other vertebrae have, for they would have been pierced or crushed by it. In dissecting the two pairs of muscles you must handle them in two ways. Either sever the muscles from the second vertebra, then pull on them and follow their course with the lancet to the head. This is the easier method. * I have transposed this and the next sentence.

MUSCLES BEHIND THE SKULL III

Or Start from the head and work to the vertebra. If you do not touch the strands of small underlying muscles, you will see them with their own outline, but if you touch and cut them anywhere, you will think that they coalesce with the muscles on 457 them. However, the attachment to the first vertebra will be clearly visible in either operation.

These two pairs of muscles merely draw the head back. The third [ohliquus capitis superior] fastens it to the transverse process of the first vertebra. It is oblique, having its origin from the skull continuous with the former but retreating to the sides. Thus the smaller pair along with the whole first vertebra has been overlooked by anatomists, for the first two give the false impression of arising from a single vertebra, since the spine of the second lies in a Hne with the transverse processes of the first.

And just as the middle parts of the first vertebra are hidden, because it lacks a spine, because it is feeble at that point, and because four muscles are superimposed on it, so the lateral parts of the second vertebra have been almost obscured because the first surrounds it there with robust transverse processes.

The third pair [of muscles] initiates sideways movement of the head along the Hne of its fibres, for the nature of all the muscles is, by contracting, to approximate the structures to which their ends are attached. I have discussed all such points at greater length in my book De motu musculorum^^^ with which I advise all who would gain anything from it to make them^ selves thoroughly familiar.

There remains [for consideration] a fourth pair of muscles {ohliquus capitis inferior]. They He at an angle to the third. They fasten the first vertebra to the second and their ends reach the transverse processes of the first and the spinous process of the second. These three muscles [ohliquus capitis superior, ohl. cap. inferior y and rectus cap. post, major] form an equilateral triangle, the first, third, and fourth under discussion. The second is invisible until the first is removed, but the other three are plainly visible.

I used to wonder how this Lycus,^^ whose book has just been

112

BOOK IV

459 published after his death, recognized in his anatomy of the muscles only one of the pairs which fasten head to first vertebra. What I have just said proves plainly that all overlooked the first vertebra, and when we dissect the nerves this will be pointed out again. But it is strange that, when they had a precise view of the first pair of muscles, they did not observe the third and fourth, for all are equally visible to one dissecting the muscles common to the neck and head. But as they actually write their view that the muscles of the neck are parts of the spinal muscles, I think that they cannot have attempted to dis^ sect them. Having decided that there were certain muscles peculiar to the articulation of the skull, they put full trust in reasoning apart from dissection. And so they wrote their notes as if from actual observation, for it is not possible for anyone who had seen the muscles common to the second vertebra and the head to be ignorant of the others. Not only did they ignore

460 observation, but the movements of the head on the first two vertebrae they regarded as insignificant.

Chapter 8

[Movements of First and Second Vertebrae]

460 The nature of these movements and their relationship with each other and with the joints in the head I have described in my treatise De ossihus.^^^ Anyone who approaches the present work before gaining experience in that is building on sand. Assuming that my readers are acquainted with that subject, I shall now discuss the movements that involve the first and second vertebrae.

The first and second pair of the four muscles I have spoken of simply extend the head backwards on the neck. When they act, the condyles (korone) of the skull are clamped on the facets of the first vertebra and the occipital bone is fixed firmly on them, but none the less touches also the second vertex bra, which is itself the utmost limit to the backward flexure of the head.

FIRST AND SECOND VERTEBRAE I13

When the head nods forward again, it moves to the front and rests upon the anterior arch (apophysis) of the first vertebra, and the condyles float free in the facets, separate from the back parts [of the adas]. Should the head get forward beyond the 461 first vertebra. Nature provides no active aid. Not only are the muscles that pull it down capable of bringing such danger in bending it, but its weight also sinks it down. Nevertheless, there is a safeguard since the anterior arch of the first vertebra pre^ vents the head from slipping too far forward, fixing and raising the head just before it goes too far. So much for Nature's lesser security. But she has a much greater defence in the second vertebra. Coming from it is an upright conical process [odontoid]. For Nature here fixes the lower [vertebra] by means of the front parts, carving out a small hollow in the first vertebra [odontoid facet] where lies its anterior arch. Behind this the end 4^2 of the rising process [odontoid] of the second vertebra is mounted. From it issues a strong apical ligament which is in/ serted into the skull. Another ligament, transverse to this, is produced from the first vertebra itself This binds to a nicety the conical end of the second vertebra.

If you want to observe these phenomena, it will be easier if the small muscles are removed. If you excise the posterior arch of the first vertebra you will see clearly the said two ligaments performing the service for the skull that I have described. The one ligament holds it back, that which springs from the apex of the tooth or peg (pyre N or whatsoever else it may be called) on the second vertebra. The transverse ligament holds and fixes this tooth, keeping it inflexible.

Lateral bends of the head are made by the oblique muscles. They incline it to one or the other of the condyles, to whichever the muscle stretching it leads. There the head is firmly fixed in the facet [of the atlas] , pressing the condyle into it, and floats on the other and higher condyle mounted in the opposite facet. 4^3 In this movement the head turns the second vertebra with itself in the direction it moves by means of the ligament. So that Nature with good reason attached it [the axis] to the first

B. 2353 I

114

BOOK IV

vertebra by another pair of oblique muscles that have the func/ tion of righting its turns and bringing it back to its original position [ohliqui capitis inferiores].

Chapter 9

[Muscles uniting the Skull with Sternum and Clavicle^

46^ Enough has been said on the muscles of the head [attached] to I N I o N and neck. Next must be discussed those that bind the head to sternum and clavicle. All the muscles discussed having been removed, we can deal with these and also with the muscles binding scapulae to spine. But since I have spoken of the dis^ section of many of the muscles springing from the head, it would be better to add those that move the head anteriorly.

It is clear, I think, to all that, reaching down to the sternum and the first parts of the clavicle from two starting/points, one lying behind the ear, the other under it, these muscles [stemoy

464 mastoid and cleidomastoid which are separate in the ape] either move sternum or clavicle with thorax towards the side of the head, or advance the head. It is not less clear that it is impossible for them to impart this motion to the thorax. So it is the head that is advanced by them.

You must recognize that general principle applying to all muscles. Those that have a straight position initiate a simple motion, those that do not, a composite motion. All the afore^ said muscles that spring from the head have a straight position and [produce] a simple motion. Those running down into the scapulae draw them up; of those that run into the neck, some bend it back straight, some move it slightly obliquely. The muscle springing from the back parts of the ear and coming down to the end of the collar-bone at the sternum [cleido/ mastoid^ does not lie in a straight line and as its position so is the motion that it yields. So with the muscle following it, that

46s is attached to the sternum [sternomastoid]. You will find their attachments in the region of which I spoke, that of the one

UNITING SKULL WITH STERNUM II5

[stemomastoid] continuous with the first muscle common to the neck and head [splemus]^ reaching the ear along a trans/ verse line, that of the other [cleidomastoid] at the root of the ear. This tendon is narrow, hard, and fairly round; the other is fleshy like all the rest I have described as springing from the bone of the skull at the inion [Fig. 13].

The attachments of these muscles to the aforesaid parts are with double ends. The muscle under the root of the ear, hav^ ing become twofold as it moves forward, is inserted in the sternum with one of its ends, with the other in the part of the clavicle articulating with it. The end of the muscle is fleshy, that which enters the sternum more bloodless, harder, and liga^ mentous. The other fleshy muscle makes a similar attachment with the clavicle to that with the skull. It is united and con/ tinuous with the aforesaid fleshy attachment. Yet it is not at/ 466 tached to the whole collar bone as some have thought but stops near the middle. This I have observed continually but not the three attachments each with its own outline in all cases, though in one case their termination was seen to be twofold. Perhaps it is better to call their ends at the clavicle bone not 'insertions' but 'origins' or 'heads', and their ends in the skull 'termina/ tions', if they really move the skull. But for the sake of system I give the name of 'origins' [ekphyseis] to the attachments above on the head and 'insertions' [kataphyseis] to those below by the clavicle, like my predecessors in anatomy [Fig. 13.].

Chapter 10

[Muscles which move the Scapula]

These muscles having been removed, we pass to those of the 4^6 scapula. There are two by the spine [rhomhoidei] which alone, I hold, draw the scapula backwards — Lycus made little of its other movements — and a third [atlantoscapulariSy absent in man], having its origin from the first vertebra and terminating 467 in the end at the acromion, and a fourth, long and thin, which

116

BOOK IV

fastens the scapula to the bone called hyoid at the beginning of the larynx [omohyoid^ with no central tendon in apes] [Fig. lo].

When handling these muscles proceed thus. Behind the head of the animal, when you have examined the spinous processes, pass from the second vertebra to the third. Examine the attach/ ment of a muscle from the side parts of it, for if you detect it you will find it easy to follow the attachments as they spring from all the succeeding vertebrae [longissimus capitis].

When you have examined the five [vertebrae] of the neck, as I have indicated, you will find a superficial muscle near the thoracic inlet. This hides the rest of the muscle that arose from the five vertebrae of the neck and arises also from the seven of the thorax [lon^issimus capitis and cervicis]. So that you must first remove the muscle on the surface, which is placed lower, to observe that which comes down from the neck. Cut away from the low^set muscle first the attachments to the twelve thoracic

468 vertebrae and then strip it off as far as its insertion into the scapula and then treat the other in the same way. [This can only mean the trapezius, which below its origin in the cervical vertebrae, is treated as a separate muscle.] When the low^set muscle [rhomhoideus minor] on the surface is visible, inserted into the root of the process at the shoulder-blade, and another [rhomhoideus major], growing into the whole base, draw each to its own origin along the line of its fibres to learn their functions. You will see the scapula drawn towards the spine by both, the higher [rh. minor] inclining it towards the neck, the other [rh. major] to the lower parts of the spine. If both are pulled on, the scapula moves back, without deviation, to the first seven vertex brae of the thorax, to which they are attached.

After these, pass to the muscles arising from the first vertebra. To this [atlas] there are two transverse processes from which a number of muscles issue. Two of these we have already dis^ sected [ohliquus capitis superior and ohl. cap. inferior], one going up into the skull, the second moving to the second vertebra, set

4^9 transversely to each other. Next to these, at the end of the trans/ verse process are two other large muscles, the one extending to

MUSCLES WHICH MOVE SCAPULA II7

the shoulder/blade [atlantoscapularis anterior, unrepresented in man], high through the neck, not fixed quite fast or mounted on the other, but bounding the large flat muscle, first mentioned [trapezius], which I said is attached to the spine of the scapula. The other muscle, with origin from the transverse process of the first vertebra, will be treated of in Book V.^°^

When you have cut it [atlantoscap. anterior] from the first vertebra as far as the shoulder-blade, dissect it till you find its insertion into the end of the ridge of the scapula at the acro^ mion. Pull on its insertion in the line of its fibres to see the high part of the shoulder/blade drawn forward and upward to the side of the neck. This muscle is fleshy and roundish. It is in^ serted into the third part of the ridge of the scapula at the highest part near the acromion.

The authors of treatises on the dissection of the muscles were mistaken about this [atlantoscap. anterior] muscle, as about many 470 others. So it was with Lycus,^^ some of whose anatomical works have now reached us. I did not see him while he was living, though I was familiar with the pupils of Quintus and was not deterred [in seeking him] by the length of a journey either by land or sea. Lycus had no reputation among the Greeks while alive but, now that he is dead, some of his books in circular tion are greatly admired. I have nothing to say about the others. I have not met with them. But the anatomical books, at least those I have so far read, I found to contain many errors. How^ ever, as I said, my aim is not to criticize my predecessors unless incidentally, but to record only anatomical observations, on which Marinus has compiled one large work. This is obscure in interpretation and faulty in observation.^^ Let us then proceed to the task before us without bothering about the errors of our predecessors.

A long thin muscle stretches out from the parts at the larynx to the scapula [omohyoid], pulling it towards the front of the neck. It goes to that part of the bone which at its upper side 47^ approaches the root of the anchor/like process [coracoid], but the attachment varies in different species of ape. Its upper attach/

II8

BOOK IV

ment, being a little above the larynx, I shall describe in the account of the dissection of that part. As you cut away this muscle, realize that you are still leaving one that moves the scapula which cannot yet be observed [serrafus anterior].

Leave it then for the moment. But we would say only that, of the muscles ranged round the scapula, that move it, some are peculiar to itself, some shared with other parts. The six muscles mentioned before belong to it alone; two of them are beside the spine [rhomhoideus and trapezius]; two others ex/ tend to the head [splenitis and upper trapezius], as does a fifth which springs from the first vertebra [atlantoscapularis anterior]; then a sixth is fastened to the hyoid bone [omohyoid]; and yet another, shared with the articulation of the shoulder, dragging the scapula downwards [serratus anterior]. Of this I shall speak in its proper place.

Chapter ii

[ The Twin Muscles that open the Mouth]

472 Since our task is to explain how the parts of the animal should be laid bare, let us return to the structures continuous with those previously described, for the sequence of the parts in the course of dissection controls the order of teaching.

After the removal of the muscles discussed, those opening the jaw would be seen [digastric]. They take their origin from the stonelike [petrous] bone of the skull and extend up to the very end of the jaw [i.e. the chin], so that the muscles of the two sides meet. They have a special character in that in mid/course the fleshy element vanishes and each becomes avascular, as though

473 interwoven of the subtlest fleshy fibres. If you sever their origin and dissect their body to the chin, preserving the junc/ tion to the jaw, and then draw them towards their origin, the jaw will follow and the mouth will open.

Of course all such operations should be carried out after the skin has been removed, and while not only the ligaments

MUSCLES THAT OPEN MOUTH II9

round the articulations but also the muscles are still fresh and therefore soft. The most accurate scrutiny of each muscle is possible when all the others have been removed and only those muscles remain, the movements of which are opposed to those that you are examining. Flesh forms the largest part of the substance of muscles. When tendons and nerves are mingled with the flesh, we have a muscle. I have spoken of this in my De motu musculorum. '^^^ Those who intend to follow this present work must read it all.

The function and use of the muscles of which I have spoken being made clear, I must state that it is not necessary to look for another pair opening the mouth. Nature is content with that pair which I have just mentioned, for she has opposed it alone 474 to the three that shut the mouth. ^^'^ The cause of these and of all the other [muscular] phenomena has been set forth in my De usu parttum,^^^

BOOK V

[Muscles of Thorax, Ahdomen, Loins, and Spine]

Chapter i

[Muscles uniting Thorax to Humerus and Scapula^

4y^ Our next task is the separation of the scapulae from the thorax to reveal the muscles of respiration. My account will be of the one side only, for the two correspond in all ways.

Remove the skin round the chest from the underlying tissues. Examine first a muscle of the surface above the others [thoracic

4^6 portion of panniculus carnosus]. It starts from the region of the nipple, extending obliquely upward to the shoulder^joint. This muscle is freed from the underlying tissues by 'excoriation' (d arsis). People use this term when tissues are linked by numerous delicate, web^ike connexions. These, if separated in the living animal, keep each its own even and smooth appear/ ance, nowhere torn or lacerated. In tissues naturally united, however, and especially in muscles, division produces a rent in the sundered parts and moreover a lancet is always needed for their separation. Those held together by web^'like fibres, on the other hand, are parted well enough by the fingers. For you, however, it is better to use a lancet on them too, for thus you will see clearly what you do; since the fingers obstruct scrutiny of the tissues. Blades shaped like myrtle leaves (myrsinai)

477 are the handiest.

You must separate this muscle, running up from the false ribs, by stretching its fibres with a hook and then dissecting it gently. Its origin is more closely attached to the underlying tissues than are other muscles. When loosened, you can pull on it with con/ fidence. Dissect it to the shoulder^joint, observing whether the muscle hangs loose or lies upon the tissues at the articulation.* * There is probably here a gap in the Greek text. See p. 130, line 6, and note 109.

MUSCLES UNITING THORAX TO SHOULDER I2T

Now pass to another and much larger muscle [pectoralis major, pars sternalis]. It runs to the same joint but springs from the whole sternum and has the nipple lying on it. This muscle is twofold, its fibres crossing each other like the letter X. Some run up from the lower parts of the sternum to the higher part of the joint. Others run from the higher parts of the sternum to the lower part of the joint. They cross at the fleshy part of the 47^ armpit. The hollow there is produced by two muscles, namely this and another which is stretched along the ribs [pectoralis abdominis generally minimal in man]. Of it I shall speak presently.

Because of the crossing of the fibres and consequent difference in their activity, it is possible to say that the muscle springing from the whole sternum [pars sternalis^ is really two muscles united, for the fibres from the higher part of the sternum bring the humerus to the thorax without pulling it downward, while the other fibres give it an oblique downward movement.

Think of four consecutive movements that you have often seen me demonstrate. First and foremost is a [simple] adduction of humerus to thorax by the muscle of which we speak. Second is bringing humerus to thorax along with the surrounding flesh and inclining it gradually downwards. The first is the act of the 479 higher [pectoralis major, pars clavicularis], the second of the lower, fibres of this muscle [pectoralis major, pars sternalis]. The third movement is the action of the first muscle [panniculus carnosus] which began by the nipple. The fourth movement is the drawing of the humerus over the ribs. This also is twofold, for [a] it continues the movement of the first muscle and par^ takes of the nature of the second, being a combination of adduction of the humerus and of laying it on the ribs, while [h] it pulls the humerus vertically up and down across the [Fig. 9].

One muscle initiates each of these movements [a and h\. One of the movements [a] is initiated by the small surface muscle that I discovered [part of iht panniculus]. It will be dealt with presendy. The other [h] is initiated by the biggest muscle [deep part pectoralis major] which I have said produces, along with

122

BOOK V

480 the muscle at the sternum [pars sternalis] the hollow at the armpit. These two muscles are very well developed, particularly in athletes, and clearly visible in them.

In due course I shall speak of the muscle running up from below [pectoralis ahdominis]. At the moment, however, I shall revert to those that pass from the nipples to the head of the upper arm. Of these the first, I said,* starts from the false ribs near the hypochondria not far from the nipple, and causes the downward movement of the upper arm [thoracic portion of panniculus]. Next it is a muscle of considerable size with fibres overlapping each other as though it were twofold, so that one might reasonably think there were two continuous muscles [superficial and deep layers of sternal part o( pectoralis major]. In succeeding chapters this muscle is to be called *the largest of the chest muscles'.

A third muscle remains, which becomes visible when this [pectoralis major] is removed. It, too, springs from the sternum, [but] at its junction with ribs 2 to 6 [pectoralis minor]. It is the

481 highest that adducts the humerus. After it comes the muscle that visibly draws the humerus to the upper ridge [spine] of the scapula [spinodeltoid portion o[ deltoid].

If you choose to separate the scapula from the thorax, as first proposed, you must first dissect the muscle running up from the false ribs to the shoulder/joint [thoracic portion o{ pan^ niculus\ then the large one [pectoralis major] which arises from the whole sternum, a part of which was the fleshy piece by the armpit [caudal portion pectoralis major], then the third which, I ex/ plained, was hidden under the second [pectoralis minor]. While the second itself issues from the whole sternum, the third issues from its articulations with all the ribs except the first and seventh.

The third muscle [pectoralis minor]'f extends over the length of the clavicle, forming a triangle. This, the highest of its sides,

* Here a line perhaps displaced, which may be rendered: 'to make the hollow of the armpit along with the muscle at the sternum'.

■f Text says 'second, which is also the largest', and confuses the pectoralis minor with the capsular part o( pectoralis major.

MUSCLES UNITING THORAX TO SHOULDER 123

lies at right angles to the sternal origin which is the upright line 482 of the triangle, while the third side joins these. The high muscle over* this is far stronger than the thirdf muscle and is itself a triangle, but obtuse not right-angled [pectoralis major].^^^

These three muscles all terminate in flat tendons inserted into the humerus. But the tendon belonging to the large muscle [pectoralis major] has its insertion lower, in the same line along the humerus, below its head, and is double, like the muscle itself. For the first part, from the lower portion of the muscle, is inserted on the humerus on the inside, and the second, which starts from the higher part, on the outside. A tendon from the more sinewy muscle first mentioned \_panniculus\, becoming membranous and delicate, reaches the articulation, where lie the ridges of the hollow {sulcus hicipitalis] occupied by the inner head of the anterior muscle of the upper arm [hiceps]. The tendon of the third [pectoralis minor] moves up to the highest part of the head of the upper arm, inserted into the membranous 48^ ligament encircling the joint [in the ape but only exceptionally in man].

If you cut away these three muscles from the joint, the scapula will have been loosened from the chest. It is [still] bound, how/ ever, to the sides of the thorax by two muscles coming up from below.

One, on the surface, is thin. It is produced from membranes attached to the fascia in the iliac region. These arise primarily from the lumbar vertebrae. Thence the muscle [latissimus dorsi] takes its rise, and the fibres, moving round, become gradually fleshy [Fig. 10].

The other muscle that comes from below [lower part of trapezius]"]^ also arises from the spines of the vertebrae, and especially from those of the false ribs. It is considerably involved with the base of the scapula. It is loosened by excoriation (d arsis). Before it is laid bare it is attached to the [other] muscles there, so that it is regarded as naturally united to them.

* Reading hyper for hypo. f Text reads 'second',

if Here a displaced phrase 'the large one*.

124

BOOK V

Certain anatomists have cited me in giving this view. The 4S4 muscle can, hov^ever, be separated from these, for the associa^ tion is a [mere] concrescence (symphysis), though since the fibres are delicate the outline of the excoriated structure is preserved without rent. Because of this partnership this large muscle is said to unite naturally with both thorax and base of scapula, though it can be stripped from them.

Its origin from the spine is continuous with the other and lower muscle [latissimus dorsi] behind the scapula. For where the former muscle [trapezius] stops, the latter has its maximal origin, lying on part of the spinal muscle below it [Fig. 10].

[Here follow eighteen lines concerning severing the thoracic muscles running to the humerus. We attach them to the next chapter, where they properly belong.]

Chapter 2

[Shoulder Muscles]

4S4 Dissect, as I have explained [p. 123], the two muscles that run up to the humerus [pectoralis major and pectoralis ahdominis]. Begin from below [i.e. with p. ahdominis] and follow to the insertion which the large muscle [p. major] makes with the humerus through a flat tendon. Pull it down to its origin to see its action clearly. Inserted a little below the head of the

48s humerus, it draws it down to the ribs. Being so large a muscle, it has a tendon that is strong and large, inserted near the large muscle.*

The small muscle [pectoralis minor] has a correspondingly small tendon, mounted on the other tendons in the axilla and inserted on the humerus through a very short handle. Pay attention to its origin in the sternum,f lest you tear the mem/ branes apart, making the same mistake as our predecessors in overlooking the muscle because it is small.

[Here begins Chapter 2 in the Greek text.]

* Text here disturbed and evidently a small hiatus, f Text reads nonsensically 'ilia'.

SHOULDER MUSCLES

125

When these muscles to the upper arm have been dissected, the scapula remains attached not only by a large muscle [ser^ ratus anterior] arising from the subcostal arch but also linked with the sternum through the clavicle. Furthermore, it is linked by this [that is, by the clavicle] and another small muscle [suh^ clavius] coming down from the clavicle to the first rib. This [small muscle], being hidden under the clavicle, you will over/ look and tear, unless you perform the operation thus: 4^^

First cut away from the clavicle the muscle of the shoulder [deltoid]. It is continuous and united with the largest of the muscles from the sternum [pectoralis major] lying along the *shoulder/vein' [cephalic], so that the two muscles seem one. The direction of their fibres indicates the first difference between them; then that of their tendons; and next that the shoulder muscle has an origin in the scapula. Two straight lines (of which one is the length of the clavicle and the other the spine of the scapula) bound the higher [deltoid] at an angle that may be compared to the letter lambda A, while two other straight lines in the form of the letter gamma F, as used* in the contests,^^^ form the boundaries of the other [pectoralis major]. The insertion of the muscle [deltoid] which is higher in the shoulder is set below [on the humerus], whereas the apex where the two musclesf come together is set [higher and] under the acromion. 4^7

So in dissecting the other part of the muscle from the clavicle, when you reach the top of the shoulder, change the direction of the cut and dissect the muscle, stretching it up with hooks, and follow the substance of the dissected part, for if you dis/ regard this and cut to the depths of the scapula, you will go wrong. For there another muscle [spinodeltoid] lies beneath, with its own outline, which is separable by excoriation (d arsis) from the muscle of the acromion process [acromion deltoid]. So as you stretch successively each part of the muscle

* Literally 'written'.

f Text says 'ribs' (p L E u r 5 n) where 'muscles' (m y 6 n) is evidently meant. The text of the whole paragraph has needed some rearrangement to give it anatomical meaning.

126

BOOK V

at the acromion with a hook, as it is being cut, you will observe clearly the defined outlines of the underlying muscle. Once you have lighted on it, you will easily loosen and separate this muscle lying above [cleidodeltoid] from the muscle attached to the scapula 488 [acromiodeltoid]^^'^ Moreover, another muscle [teres major] ex/ tends by the side of the scapula, from which you will separate it without difficulty, if you first loosen it well from the aforesaid muscle. There is yet another muscle [teres minor] which runs upon the humerus to its insertion on its front below the articulation.

The attachment of the large thoracic muscle [pectoralis major] is also along the humerus, being extended from the median side. This, however, draws the limb inwards whereas the muscle of the acromion [acromiodeltoid] pulls it up, not inclining the upper arm in any other direction. [Here two lines of repetition.] This activity belongs to the muscle because it has two heads running round the shoulder, so that if you pull on one, the humerus is drawn either anteriorly to the clavicle or posteriorly to the scapula.

48^ Comparable with these are the two muscles extended along the scapula [supraspinatus and infraspinatus], the one above, the other below [the spine of the scapula]. They are visible when the muscle [deltoid] over the shoulder has been dissected as I have explained. Proceeding to dissect these muscles, start once more from the base of the scapula [vertebral border] where lies the origin of each. From there proceed to the shoulder^joint, cutting them away as they spring from the scapula, until you see them both expanding into flat tendons by which they move the humerus obliquely, one outward toward the clavicle, the other inward towards the lower part of the scapula. If both are stretched, they produce the same straight tension as between two obliques (as has been said the humerus receives from the deltoid). The higher of the muscles is inserted into the projection of the head of the humerus which the greater head of the anterior

4^0 muscle [hiceps] limits externally. The lower muscle produces an APONEUROSIS continuous with this and also into the head of the humerus, rather more toward the outside.

SHOULDER MUSCLES 127

If you consider the anatomy of the arm as a whole, you may seek to dissect these muscles at once with those next them, following the order of nature. But if you are in haste to reach the thorax, leave them in situ and cut away the clavicles from the sternum, severing the capsular ligaments, raising them at the acromion process, bending them back, and successively cutting the other membranes and ligaments by which the clavicles are attached. Do this till you see the muscle, small and oblique, arising from the inner and lower part of the first rib [suh^ clavius]. Its head is next the scapula when the clavicle is raised. Its end, through which it is attached to the first rib, is the part of it towards the thorax.

Chapter 3

[Muscles moving the Thorax]

When you have cut away this muscle also from the clavicle, 49^ take care of one lying close to the first rib [sternocostalis]. For when the thorax is presently laid bare, as you pull up [the clavicle] toward its head, you will also draw up the first rib. You should separate the clavicle not only from the sternum, as I have just explained, but also from the acromion, by severing the ligaments attaching it to the spine of the scapula.

You need not seek a third bone in an ape besides the two processes (perata = akromion with korakoeides) already mentioned. For Hippocrates does not say that [a third bone] exists in any other animal but man,^°^ and he adds: *In this respect, man's nature is different from the other animals.' If you cut away the scapula here, you may bend it back again towards the sternum, cutting away the membranes binding it to the neighbouring parts.

Now you will see the muscle ot the first rib [suhclavius]. Cut it away, as I have said, from the clavicle, and either remove the bone completely or bend it back towards the breast and let it lie. If you do this, cut the vessels and nerves at the armpit 49^ along with the fascia.

128

BOOK V

Thus the arm can be separated from the thorax, for nothing remains attaching it thereto except the large muscle [rhomy hoideus major] which I described as attached to the vertebral border* of the scapula. This muscle arises from the first [cer/ vical] vertebra and then passes through the whole neck and [into] that part of the scapula where the superior border meets the base [vertebral border] so that the bone is as a [re-entrant] angle there.

I have said before that a thin muscle [rhomhoideus capitis, absent in man] reaches this spot, arising from the inion, is inserted into the muscles on either side near the above/men^ tioned scapular angle. Behind it is the high member of the posterior muscles of the scapula [cervical part oUrapezius], while in front is the muscle under discussion [rest of rhomhoideus]. Reaching the beginning of the base [vertebral border] of the scapula, it is inserted throughout its length.f

This part is occupied by another muscle [serratus anterior], from which the muscle under discussion is separated by excoriation. It is united only with the base [vertebral border] of the scapula, and it is inserted into the middle parts of the ribs at their maximum convexity. Its action is to draw up the whole thorax except the lower part which is moved by the diaphragm, as I shall show. Sometimes, during violent exertion, it is moved with the parts above, just as some of the parts lying above the diaphragm are moved along with it in a way hard to discern. The sum of the activity [of this muscle] is seen in those ribs wherein it is inserted. It is cleft into digitations which are at/ tached to them. Thus its insertion is neither continuous nor uniform, like that of most muscles. It reaches the false ribs and draws up all those that lie above them.

On either side of it [i.e. of the serratus anterior] lie other muscles. One is in the front of the thorax [scalenus longus], the other in the back [serratus posterior superior], both drawing up

* Text says 'under the hollow parts' as in next paragraph, but describes rhomhoideus.

f Text adds again: 'itself lying under the concave part*. See previous note. There seems to be some confusion with the suhscapularis.

MUSCLES MOVING THE THORAX 129

the ribs, so that there are these three muscles higher than the 494 thorax. I call them the 'posterior*, the 'anterior' and the 'middle*. The middle pair [serratus anterior] can by themselves carry on the efficient action of the thorax. You will learn how to handle them in operations on living animals.

The second anterior pair of muscles [scalenus lon^us] begins from the second [cervical] vertebra, but springing from all the others in turn it is inserted in the first five ribs by strong Hgaments.

So too, the third and last of these membranous muscles [serratus posterior superior] — for so they can be called. It begins from the ridge of the last three cervical and the first thoracic vertebrae, each of them having a membranous ligament as its head interwoven with the spinal muscles. When you separate 495 it, first [you will see] fibres attached to the ligament that pro/ duces the muscle. These in apes are very weak and delicate, but stronger in other animals. Particularly in pigs, dogs, bears, and all jagged/toothed animals [carnivora], this muscle is more powerful than it is in apes. It is attached to ribs 3 to 7, and if you pull on it from the head you will see them dragged up/ wards and dilating the thorax. If you do the same with the middle and anterior muscle, you will see the thorax dilate in proportion to the size of the muscles.

These three pairs then of the higher muscles of the thorax are responsible for respiration. There is a fourth [pair] belonging to the first ribs [scalenus hrevis anterior]. If you stretch them in their original position, you will see the first ribs drawn up and the upper part of the thorax dilate.

If the thorax be laid bare, you will see along it two other pairs of muscles along its length, one pertaining to the spine, the other to the sternum. The pair by the spine is made of 496 nothing but fleshy tissues and lies on all the ribs of the thorax near the spinal muscles [iliocostalis dor si spinalis]. That by the sternum [thoracic part of rectus abdominis] is of membranous tissue, except that the upper end is fleshy, but even that, taken all in all, has little flesh. The membranous part of them is not like the other membranes in strength; but it is a sort of ligament

B. 2353 K

130

BOOK V

or flat tendon, powerful enough, being marked off by a white line. At the point where they rise, separated from the abdominal part of the rectus muscle, this marking off is divided by the trans/ verse lines [inscriptiones tendineae\ and extends along the ensi^ form bone to the cartilages of the false ribs there, left and right. I mentioned this before,^^^ bidding you spare it in dissecting the muscles from the sternum; for it adheres to them below and is removed with them, so that anatomists are ignorant of it.

This tendon, as I have said, is continuous with the rectus in the region of the abdomen and overlies the ends of all the ribs that approach the sternum. It rises to the first rib in all animals where its fleshy character is obvious and where it gains some breadth. The delicate flesh is buffered by the tendon, and especially at the side parts, where the first rib passes from its diarthrosis with the spine towards the sternum.

The other muscle [iliocostalis dorsi] has a similar action. It is independent but extended along the spine so that it could be thought a part of some other muscle, just as that by the sternum is thought to be part of the rectus of the abdomen. Yet it begins and ends with the thorax in accordance with its own outline, which is rather more round than flat. The lower end is in/ serted into the spinal muscle, turning backwards with a slant so that, when taut, it both protects and pulls in the ribs. Nature seems to want these, to contract the thorax vigorously at need, when the abdominal muscles also visibly act. But I shall speak of them later.

There is another pair of muscles [serratus posterior inferior] outside the thorax which, inserted along the last ribs, draws down this end of the thorax. The head of this pair too coalesces with one of the muscles in the abdominal region. I shall explain it more clearly when I dissect them. For the time being let this suffice, that it draws down the last rib of the thorax along with the rib next to the last in most animals, especially the carnivores, and it sometimes reaches the third rib. I call the last rib, for the moment, not the small rib that is really false, which is separate from the others and is attached to the

MUSCLES MOVING THE THORAX 131

fleshy part of the diaphragm, but the rib that comes next to it, under which lies a delicate membrane now plainly visible and continuous with the membrane that undergirds all the ribs. I shall speak more clearly of these muscles a little later.

Chapter 4

[The Intercostal Muscles]

It is now time to expound the so-called 'intercostal' muscles. 49^ Neither their nature nor function was recognized by the experts in anatomy, any more than those of the muscles mentioned 499 before by which the thorax was said to be moved. They have, however, got as far with the intercostals as to know that their fibres are not extended along from spine to sternum but cross one another. Yet none has written that their position is oblique or that they are twofold, the outer fibres slanting in a direction opposite to the inner.

Ignorant of this, it is obvious that they did not know any/' thing about their function. For the present it will suffice to grasp their nature alone. When I deal with the living animal, however, I shall say a word on their activity, though in my De causis respirationis^ I made clear the function of all the muscles moving the thorax. Now I say only this, that when all the previous muscles are [cut] away, the position of the fibres is clearly seen to be oblique in the mid/part of the ribs.

One must start examining them from the spinal muscles. 5^^ Observe that the higher of the two ends of each fibre is nearer the spinal muscles and the lower farther away, so that each runs slantwise anteriorly, and does not extend straight up. If you cut out the spinal muscles too, you will see there also the fibres under them slanting in the same way. To observe these at their best, the animal should be thin, large, and old. In sleek young animals the quantity of moisture and flesh conceals them. But given these conditions you will plainly see, springing from the bones and nourishing the flesh, delicate fibrous ligaments.

132

BOOK V

It is as in the wicker baskets in which they curdle milk [for

501 cheese]. The fibres from the bones that I called ligaments are comparable to the reeds [of the basket], the blood to the milk itself, and the flesh to the cheese, for it originates from blood as cheese from milk.^^^

Beginning then from the spine and following the fibres, examine each one and observe its obliquity. If you do this going forward to the sternum, at one point you will see the direction of the fibres changing as the ribs do. For the rib does not reach the sternum with the same slant as that with which it started from the spine, inclining from above downward, for when it approaches the sternum it becomes [costal] cartilage instead of a bone and takes the reverse direction to before, running obliquely to the sternum, with which it articulates.

Where the [costal] cartilage is first produced, the ribs have a bend [anterior angle] that is curved rather than angular. The cartilages* [there] reverse their direction, running obliquely from

502 below upward. This happens with all the ribs except only those the ends of which do not reach the sternum. The direction of these [floating] ribs, from origin to termination, is uniform, and devoid of such a bend as that of the ribs articulating with the sternum.

They call those ribs Talse' which terminate in a cartilage of considerable size and have the diaphragm attached. [The carti/ lage of these is] a guard for its attachment, since Nature acts, as ever, with foresight in causing the diaphragm to spring forth not from the outside parts of each rib, nor from the end, but short of it, and from the inside parts. These ribs have their fibres slanting downwards along an oblique line. Those articulated with the sternum accommodate their fibres to the change of direction.

The outer fibres of the intercostal muscles He, according to their nature, in a reverse direction from the inner, crossing like an X. Try to see them by detaching the ribs from the sternum,

503 for thus the whole expanse of the thorax cavity will be visible and with it the direction of the fibres. To facilitate investiga^

* Text reads 'fibres'.

THE INTERCOSTAL MUSCLES I33

tion, bend [the ribs] all back to the spine. You will see the false ribs from within, with fibres running in opposite direct tions within and without, throughout their length. All the other ribs have a division at the cartilages, being like the false ribs throughout their extent, but in the cartilages as far as the breast of the opposite kind.

Chapter 5

[The Diaphragm]

There remains one muscle of the thorax, and that not the least 5^5 important, called p h r E N E s. Plato thought the p h r e N e s [or diaphragm] to be merely a partition between two parts of the soul, the appetitive and the irascible [or spirited].^ But the diaphragm is not only this but — as was shown in my De causis respirationis^ — of all muscles the most useful to the animal in respiration.

This muscle has an origin of such a kind as I have described for the costal muscles, in numerous delicate ligaments springing 5^4 from the bones with simple flesh coagulated round them. In the middle of the diaphragm, which may itself be likened to a large circle, there is a smaller disk of tendinous nature, in the midst of the first. There the fibres lose their fleshiness.

These parts of the diaphragm can be observed when the sternal ribs are loosened from the upper parts. It is not possible, however, to get a clear grasp of its whole nature without previa ously severing the eight abdominal muscles. We must therefore proceed to the dissection of these. [See p. 140.]

Chapter 6

[The Abdominal Muscles]

Though I know that you remember them, I would remind you 504 of the next steps I take. For it is not likely that this work will remain solely among friends. It will pass through the hands of

134

BOOK V

many, some ready to cavil at everything, others to extract and

505 learn the best in it. It is for them that I recall what is known to my friends, and repeat what I now say.

I have often dissected the abdominal muscles immediately after the death of the animal by suffocation, and then [dis^ sected] the intestines, stomach, liver, spleen, kidneys, bladder and, in females, the uterus also. To avoid putrefaction I have been accustomed to dissect on the first day these parts only for my friends to see, and then on the next day to turn to the other parts and to dissect them in the order followed here from the start. I shall explain a litde later how to handle the parts within the abdomen when one starts from them. Now I shall pass to that part of the teaching which follows on what has been said.

The ribs, detached from the sternum, which I advised you to bend back to see within them [p. 132], you must bring back to their original position. Then strip off any remains of skin on the abdomen and start dissecting the muscles under it.

506 Begin with the largest and outermost of all [ohliquus exterms]. It arises from the thorax, and is spread upon the abdominal muscles. You see its origin clearly when the muscles described [Bk. V, Ch. I, p. 120] have been dissected. It lies next the largest of the high muscles of the thorax [pectordis major] with its digitated terminals inserted on the ribs. The ends of these processes represent the origin of this muscle, bilaterally sym/ metrical.

The first of the attachments, situated by the sixth rib, Hes under the termination of the anterior [serratus anterior l] of those muscles moving the thorax. Next it springs from all the other ribs, near where bone passes into cartilage [costoy chondral jtmctions]. The first false rib also has something analo/ gous to this bend, for this eighth [rib], counting from above,

507 runs up toward the ensiform cartilage, while the other [false ribs] fall increasingly short of it, the lower being always shorter than the one above.

This first pair of abdominal muscles [ohliqui externi] arises from all these, and its oblique fibres pass towards the front of the

THE ABDOMINAL MUSCLES

135

abdomen. They are extended through the length of the abdomi^ nal wall, reaching the innominate bone at the pubes, each on its own side, and inserted in front of it through a strong mem^ branous tendon.

The strength of this tendon is sometimes diminished at the groin. This area, thus becoming relaxed with the tendon, admits into itself some parts of the underlying organs — intes^ tines or omentum — and this is now called a *hernia*. This membranous tendon is set a Htde above the groin, so that the peritoneum passes through along with the tissues surrounding it, about which I shall speak again. The parts of these muscles, which are extended over the front of the abdomen, end in a 508 delicate tendon, mounting the rectus muscles superficially.

So too the tendon of the second pair of the muscles in the abdomen [ohliqui abdominis interni] whose fibres have an oblique position at right angles to the first, becoming membranous, lies on the anterior muscles. Each of these [oblique abdominal muscles] begins from the bone of the flank [ilium], and has a fleshy origin. From there they are carried up obliquely, riding on the transverse muscles (at right angles), and are inserted fleshily into the ends of the four false ribs. Their tendon, the delicate one, in which they were said to terminate, is between the rectus muscles and the tendon of the muscles we spoke of before. The tendons of the two muscles you will think become one, for it is difficult to separate them, especially when we begin with these parts, in dissecting the animal as a whole. In this operation, when we start it is easier to separate the tendons if we follow up each muscle, for the tendons are continuous with the fleshy part where it ends.

Observing it delimited by its own borders, you will find 5(^9 without difficulty the membranous tendon springing from each muscle. This tendon is produced at the side of the rectus, at the rib. In front, the recti touch each other with their anterior sides. To right and left they have the membranous tendons mounting on them [as the rectus sheath]. Their substance is fleshy above throughout, never true tendon, so that they are even attached

136

BOOK V

fleshily at the pubes. There they adjoin as they do below the animars navel. The higher part of them, as I said, lies side by side but not united. Regard them as the third pair of the eight abdominal muscles.

The remaining fourth pair [transversi ahdominis] extend from the straight line of the ilia and the transverse processes of the

Sio vertebrae in the loins. The muscle is not produced immediately, but a strong membranous ligament springs from the said bones and as it goes forward it acquires transverse fibres, assuming the appearance of a muscle and extending under the inner sides of the ends of each of the false ribs. Just as they turned into muscles by acquiring fibres, so later discarding them anteriorly, they terminate in a flat tendon.

This tendon, like most of the phenomena I have mentioned, has remained unnoticed by most physicians. Being membran/ ous and light, it is attached to the peritoneum, and the resultant tissue is not thought to be, as it looks and in fact is, composite, but a single membrane. You must try then to examine its unification where first the tendon arises from the flesh and mounts on the peritoneum, since if it be rent there it cannot be separated [from the peritoneum] unless one has practice and knowledge of the nature of each.

In abdominal wounds, in 'suturing* as it is called, they

5^^ stretch up and sew together the composite tissue formed from both these parts, to wit, the peritoneum proper and the terminal tion of the membranous muscle [transuersus ahdominis]. The peritoneum itself is very like extended webs of spiders, simple and very delicate, not like some tendons which dwindle to membrane and yet show (to those who examine them in a good light) delicate interwoven fibres within; but not so the peritoneum, for it is simple (as has been said), wholly continue ous, homoiomerous,^^ and indeed one of the primary tissues. And you see it clearly, as it is by nature, in the lower parts [i.e. below the linea semicircularis] where it is alone, the oblique muscles being separated from it. For they mingle and are con/ joined with the recti, leaving the peritoneum.

THE ABDOMINAL MUSCLES 137

Enough has been said of the eight muscles of the abdomen, at least for a first review of the anatomical operations.

Chapter 7

[The Abdominal Muscles continued]

I must next explain how best to conduct the dissection from here. 5^ 1

Remove the skin of the abdomen where there is no danger of cutting or injuring any of the underlying tissues, for the sub/ 512 cutaneous tissue here is separated from the muscles. Anyone guided by the nature of the tissues can do this.

In passing laterally to the false ribs, if you are careless you may tear away the head of the small muscle* which, I said, runs into the armpit and was unnoticed by the anatomists [panniculus carnosus]. For the membrane continuous with the skin acquires at intervals fleshy fibres, first greater, then less, and then again robust, which extend as far as a muscular strand which is both thin and flat. This runs up to the armpit, where its fibres con/ verge into a narrow fleshy strand. If you strip away its expanded lower origin with the skin, you will find that the fleshy part extended to the armpit is rent. If on the one hand you are di\u 51 j gent and seek the point from which it is torn and do not find it, you will be full of doubt, as I was at first. But on the other hand, if you are careless and easy/going (as our anatomical predeces/ sors demonstrably were in many of their operations), holding this fleshy sheet to be of no account, you will cut or tear it away from the underlying tissues and throw it away. As to the need for exercising precision in removing the skin there, enough has now been said [Fig. 8].

When the whole abdominal region has been laid bare, you must dissect the eight muscles as follows. The body is bisected by a straight line from above through the whole thorax. If you obtain clear indications, which I shall now mention, with reference to this line, you will get a useful survey in* many places.

* The reference is probably to a passage missing on p. 477 of Greek text.

138

BOOK V

The first landmark is the end of the ensiform cartilage. Passing

514 upward from there through the middle of the sternum, you will have as your last mark the top of the sternum. This region is hollow, being bounded by the clavicles and the muscles running down from the head, as is clearly visible when the skin is removed. Extend this line downward to end at the junction of the pubic bones as limit. In the middle, between the point of the ensiform [and the pubes] lies the navel. For dissection of the first abdominal muscles, the skin being removed, start from the ensiform, cutting superficially round the navel. You see beneath a line [linea alha] whiter than the tissues on either side. This is the surest token of a satisfactory incision, for the fleshy muscles that I called recti are bounded thereby. It is whiter because no flesh lies under it.

The membranous tendons surrounding the recti, which are

515 produced from the oblique muscles, meet along this line. So cut it gently, so as not to incise any of the underlying tissues but only to sever the tendons from one another. If you do this well, you will find, as the proverb goes, that *well begun is half done'. The saying takes every beginning to be half of the job, yet many beginnings are easily made. But the beginning in dissect^ ing the muscles is really and truly half the task; for, unless well performed, there is confusion and disorder in all the subsequent operations. Nevertheless, even when it has been done as I directed, a double operation awaits you.

It is better to practise the easy alternative first, for there is hope that thus when you later undertake the harder you will not miss the mark. It is a simpler and easier operation either to pull up the rectus with a hook or pull it to the side with the left hand ^16 and then make the incision gently, separating it from the under^ lying tissues. (As in this dissection you aided the cutting hand with the left, so it is better to do the same thing in first dis/ sections in general, for in this way you will make the direct incision from the ensiform better.)

The four fingers of the [left] hand should be laid along the muscle and firmly and gently draw it to the side. If this is

THE ABDOMINAL MUSCLES

139

properly done for the two muscles, the space between them in which I directed you to make the first cut will be plainer to view. When you have separated it correcdy, one hand will be enough, drawing the muscle that is being dissected gendy to the side.

You must complete the operation as far as the navel region, till you are sure that a large portion of the muscle is bared. The peritoneum lies under it, along with the aponeuroseis of the transverse muscles, from which the large muscles [recti] come naturally away, so that I myself separate them with my fingers. You must not do this at the first incision, but in the 517 course of the operation.

When they have been clearly separated, the job may be quickly accomplished. Put your fingers beneath and strip off what remains of the underlying muscles. This done, either: [a] Cut away their upper end where lie their connexions: dis^ place the muscles a litde to make their outlines visible, for on the outside the tendon common to the oblique muscles lying upon them hampers their connexion; or [h] if you do not wish to cut their heads but would keep them all uninjured, try to strip off the tendon lying on them, which is thought by those who dissect carelessly to be a sheath peculiar to these muscles, but which is the kind most possess, being their own membranes united. Strip it off first in one piece, so that the outlines of the recti appear. Then divide it in two, assigning one part of it to the first and largest of the muscles [ohliquus externum abdominis] 51 5 and the part under this to the second [ohliquus internus ahdo^ minis]. Let these then be designated the 'oblique' muscles, and *first' and 'second' of that kind. Under them is the 'third', stretched out lengthwise [rectus abdominis] under which lies the Tourth', the muscle that runs transversely and adheres to the peritoneum [transuersus abdominis]. [Here four lines of almost verbal repetition.]

When you have had enough practice in the processes I described, make an attempt, after the first straight incision, to separate from the recti first the superficial tendon of the 'first' muscle, then that which comes from the 'second' muscle.

140

BOOK V

Having shown that the two are mutually connected [as anterior layer of rectus sheath], begin the dissection of the recti. Thus you will get the whole business clear and avoid confusion when the muscles are separated with their own aponeuroseis. 51^ What you did at first with the thorax on the first pair of the muscles, beginning from above, do now in the opposite way, taking in hand the membranous tendon. Stretch it up gradually and try to strip off the first and largest muscle [ohliquus externus] up to its origin. You will not be able at this attempt to trace its entire length, because of the thoracic muscles over/ lying it. Dissect it far enough to show its origin. Yet the remain/ ing three muscles you can cut away without removing any of the overlying tissues [except the *first']. Just as you dissected the first, starting from its tendon to its origin above, following the continuous substance of the fibres, so dissect the second [ohliquus intemus], passing from tendon to fibres and preserving their continuity up to their origin. You had already dissected the third fleshy muscle [rectus] to the navel. Somewhat below, you will see the one [second] muscle uniting with the other [first], and intermingled with them there the lower part of the underlying pair of the transverse muscles [the fourth]. For the latter recedes from the peritoneum and leaves it bare [at the linea semicircularis]. This is enough for the present about the abdominal muscles.

Chapter 8

[The Diaphragm again]

^20 Taking up the thread [of discourse] on the diaphragm, let us add what we left unexplained [p. 133] on its nature, since that could not be clear until the abdominal region had been revealed. Obviously — unless we would make many demonstrations on one animal — we can, by cutting through the parts in front, reach the subject of our investigation at each dissection. What if one wished to demonstrate the nature of the

THE DIAPHRAGM AG AIN

141

PHRENES alone, or if some problem arose about their struc/ ture requiring a separate anatomical operation ? Would it not be reasonable on such occasions to cut right through the abdominal wall, including the peritoneum and, removing the viscera, to show first the origin of the phrenes from the false ribs (of which I have spoken) and next the junctions into the spine and 521 then display and divide its parts, which differ in substance, position, action, and use 5"^

The muscle produces its aponeurosis as a flat tendon, the mid/point of the diaphragm, which is surrounded on all sides by the fleshy muscles. On both its surfaces, above and below, is a delicate membrane [i.e. pleura and peritoneum]. These membranes you will display exactly if you attend to the following account.

The higher of them [pleura] being twofold lines the cavity of the thorax, right and left. The wide space within the thorax is, however, not continuous but partitioned by these membranes, which run straight up, through the length of the thorax, side by side except for the area containing the heart, where they retreat from each other and are separate. For where they receive in their midst [the heart] — itself girt by a membrane thicker than they — they reach as far as the ensiform cartilage.*

They are simple in their nature and are interwoven, and 522 spoken of as undergirding (hypezokotes)^^'^ the ribs, but, where they run straight up to the throat, as ^partitioning' (diaphrattontes). They surround and protect the lungs. Their base lies on the upper suface of the diaphragm, corre^ sponding to a similar membrane on its lower surface, which is very justly called the *apex of the peritoneum'.

This [lower] membrane is continuous, lining the whole undersurface of the diaphragm, and where it is pierced for essential purposes, there it surrounds the structures that pass through it and extends along them. So also the membranes from above that underlie the thorax, extend along and encircle the vessels that pass through them.

* Here three lines of near repetition.

142

BOOK V

There are two perforations in the phrenes. The larger, where the phrenes adhere to the vertebrae, is prepared as a

523 path for the oesophagus (stomachos) and the great artery [aorta]. The smaller receives the vena cava [i.e. v. cava mferior]^ which brings blood to the upper parts of the animal, and escorts it safely on its way, surrounding it with a connexion that is quite indissoluble in its passage to the thorax on the right.

None of these organs, vena cava, oesophagus, or artery, can escape the notice of anyone, when the lower part of the dia^- phragm is laid bare. The vena cava comes to the notice of dis/ sectors first, since it is above and has nothing in front of it, when the [abdominal] muscles have been removed. To examine carefully the other perforation of the phrenes, set about two operations. Firstly, open up the thorax through its length and follow the oesophagus as it descends to the diaphragm. Secondly pull and draw aside the stomach, and you will see its [cardiac]

524 end lying by the phrenes. It is not firmly united with them as is the vena cava, but separated from them by slack tendons. This perforation is not quite circular here, but rather triangular, with the apex upward and the base firmly fixed at the back.

Of course Hippocrates is right in saying: *Thus the phrenes in this region surround both the arteria and the STO^ MACHOS, as the ARTERIA is fixed in the very middle of the rhachis and the stomachos lies alongside to the left. And what is more, a certain small phleps and two neura pass through along with them'"^ — of which this is not the time to discuss details. For what is said of the artery or the oeso/ phagus is not said so much in reference to them as such, but is incidental to the exposition of the perforation of the dia/ phragm — a thing that will be more completely expounded in its place.

Because of these parts that traverse it, and even more because of the loin muscles, the diaphragm does not fit naturally to the

525 spinal column as it should. For this circular muscle is active longest of all the muscles in the thorax. Wherefore it needed to be attached strongly by ligaments to firmly fastened bones.

THE DIAPHRAGM AGAIN

But since the said organs perforce run down from above, and the muscles in the loins had to extend upward above the diaphragm, its muscle was bereft of union with the spine, or rather, deprived of union at this part.

For Nature, with her ready invention, never and nowhere fails in solicitude for the animal creation. Thus in the lower parts she does unite the diaphragm to the vertebrae by two very strong [arcuate] ligaments. And the parts of the diaphragm surrounding the artery and the cardia [i.e. crura] extend over the succeeding vertebrae, to a greater extent in other animals whose thorax is strong and robust, though it is true that in apes they 526^ are there, but connected by weaker ligaments. Later I shall deal with these differences.

Chapter 9

[The Lumbar Muscles]

Since our scheme involves an exposition primarily of the ape, 52^ you should dissect that form and observe its diaphragm. You will observe also the muscles [longus colli] under the oeso^ phagus (sTOMACHOs), when you reach them, following the proper order in dissection and moving down to the fourth thoracic vertebra. For while the spine as a whole has muscles on the inner side, you will find only the six middle vertebrae of the thorax to be without them.^^'^

Some of the muscles of the vertebrae, beginning above from the head, bend the upper portion of the spine, whereas those of the lumbar [vertebrae] bend only the lower portion. The vertebrae of the part between [i.e. T.4--9] are moved by [the intrinsic spinal] muscles on either side.

Since you have laid bare most of what is below the dia^ phragm, there would be no harm in removing from the lumbar muscles the membrane that lies over* them. This, as I shall explain later, is the peritoneum.

* Text reads 'under*.

144

BOOK V

When it is stripped off, you will see the psoas muscles;

527 strictly speaking they are single muscles, one on either side along the spine, for the two [parts on either side] are united at their origin above throughout the loin. When they approach the broad bone (called by some, as you know, the sacrum),^ they separate, and are applied to the inner side of the ilium. At the same time they are joined there by many strands ( s A R k A i ) from the ilium [iliopsoas].

Following now from below the strands that we call psoai you will find two tendons joining them from the ilia, one for either of the muscles. These tendons anatomists generally call APONEUROSEis of the muscles.

One of them, the inner [psoas minor], can be better regarded as a ligament than a tendon. It is inserted where the pubic bone joins the ilium. The other [psoas major] descends to the small trochanter of the femur. The former arises at the higher portion of the fleshy lumbar mass, and advances through the inner region. The latter arises [somewhat] lower, beside it and on the

528 outside and [lower still] that which comes to it from the ilium. The ligament of the former is longer. The tendon [of the latter], descending to the small trochanter, is shorter but powerful. Preserve it for the dissection of the muscles moving the joint at the hip.

If you examine carefully the other [i.e. the tendon of psoas minor], you will find it harder and whiter than tendons [com/ monly] are, as if of ligamentous substance. You must therefore regard it as a head rather than a termination of the inner parts of the psoas. So each head of the outer parts [of the iliopsoas] from the ilium has its head [ekphysis] much smaller than that of the inner [psoas minor] but serving the same end. For the said two portions of the psoas, extending downward, bend the spine at the loins, and also the neighbouring METAPHRENON."^ Similarly the muscles under the oesopha/ gus — and of them I shall speak later — bend the upper part of the spine while involving also the vertebrae of the

METAPHRENON.

THE LUMBAR MUSCLES

145

The psoas provides the head of the tendon that reaches the trochanter of the femur. That which lies on either side of this head is the termination — not a head — of two muscles bending the spine. Thus each psoas muscle^mass has three parts: [a] the inner, with origin high up [psoas minor]; [h] the middle one, starting from a lower origin [psoas major]; and [c] the outside one, with its fleshy origins lower down [iliacus]. However, the ligament below this last starts from the upper parts of the ilium and therefore differs widely from the other two in length, as in thickness.

Chapter 10

[The Intrinsic Spinal Muscles]

Examine carefully the origins of all the spinal muscles. They s^9 start from the second cervical vertebra [longissimus infermedius and/or iliocostalis], each having two separate heads. The space between them is fully occupied by the muscles missed by anatomists. (I have already gone through them thoroughly enough [pp. 109-12].) They become progressively more robust. Their origins are delicate, but at each vertebra an additional 55^ slip fuses with them and, passing through the neck, they be^ come considerable in size and strength. They coalesce with one another at the end of the neck, becoming muscular there, on either side of the spine, so that the heads of both muscles number four.

Their fibres are oblique, some running from the spine for/ wards and downwards, and some the opposite way, starting from APOPHYSEis at the side, but tending backwards and downwards. Give care to them when, in dissecting each muscle, you arrive at last at the loins. For there, from a certain mem/ branous Hgament arising in the regions by the spine, muscles spring which run up gently slantwise to the last ribs of the thorax [iliocostalis lumhorum]. In other animals they are of con/ siderable size, but in apes small, like all the muscles in the thorax.

B. 2363

L

146

BOOK V

These muscles draw down the last ribs. In other animals they 551 extend as far as the third and fourth ribs, counting the ribs from below; but in apes they reach [only to] the second and third of the so/called false ribs, sometimes only the latter. Anatomists have overlooked them too, cutting away part of them, I think, with the eight abdominal muscles, and leaving the other part adhering to the spinal muscles.

BOOK VI

On the Alimentary Organs

Chapter i

[Principles of Comparative Anatomy]

I decided that it was best to write this work in the same order 53^ as my De usu partium,^^ wherein the account of the limbs is followed by that of the organ