Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]

Chapter 5 The Structure of the Head: Why It Is Shaped As It Is, and How Many Configurations It Has 1

[Introduction to Chapter 5]
In the first drawing of the fifth Chapter, the natural figure 2 of the head or skull is represented, shaped like an elongated sphere slightly depressed on either side and swelling outward in front and behind. The second drawing shows the first unnatural shape 3 of the head, in which the anterior protuberance is missing. The third drawing reveals the second unnatural shape, 4 in which the posterior protuberance is gone. 5 In the fourth drawing is indicated the third unnatural shape of the head, 6 in which both anterior and posterior protuberances are lost. In the fifth drawing we have depicted the fourth unnatural shape of the head, 7 in which both protuberances face the sides instead of the front and rear.


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The head was formed for the sake of the eyes
That the human head is formed for the sake of the eyes, is clearly demonstrated, according to Galen, 8 by the eyes of crabs, beetles, and certain other animals that do not have a head. In these animals, the eyes are placed on very long processes and are not hidden deep in their chest as are their mouth, nose, and ears. That eyes require a high location is attested by lookouts for attacks of enemies and bandits, who climb walls, mountains, and high towers for the same purpose as sailors climb the masts of ships, to see land more quickly than those in the ship below. Because the animals just mentioned are covered by a hard, testaceous skin, it was a simple thing for the eyes to be located safely on long processes, because they would be harder and could be covered on the outside by a tunic which, being derived from the skin of those animals, would likewise be very hard and testaceous. But for man, who on account of the substance of the body and the soft, thin membrane [tunica conjunctiva] by which the eyes are covered would necessarily have eyes that are soft throughout, they could not be placed on very long processes without danger. And so, while it was not suited to the function of the eyes that they be located deep in the human body, it was also in no way appropriate to attach them to bare necks; and since Nature was willing neither to prevent the use of eyes nor to diminish their safety, she built a lofty part [cavitas orbitale] that also nicely protected the eyes from danger.

How Nature protected the eyes
Above them, she placed eyelids, lashes, and the bone of the forehead [os frontale, pars orbitalis]; below, besides the eyelids, cheeks 9 protect the eyes. In the parts between, the nose is placed between the eyes like a wall; then an extremely strong bone [os zygomaticum] surrounds the outer angle of the orbit, so that the eyes are hedged in on all sides by raised and protruding parts and lie conveniently hidden as in a recessed valley [cavitas orbitale].

The brain is located in the head for the sake of the eyes, and the other senses on account of the brain. 10
The head is not just an aggregation and collection of these parts that guard the eyes, though they cannot exist without the head. What need therefore was there that the other parts, whose structure earns it the name “head,” be assembled here also? Each of the organs of sense—vision, smell, taste, and hearing—requires a soft nerve [nervus sensorius]: a nerve, in fact, to be the instrument of sense: 11 soft, since it should be affected and displaced in some way. 12 Indeed, it is quite fitting that the organs undergo some


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stimulus coming from outside in order for sensation to occur. And so because the eyes needed the soft nerves of the brain, and if they extend too far all soft things are soon pulled apart, broken, or damaged, 13 it was right that the brain be located not far from the eyes. 14 These things being as they are, we now discover what was sought from the beginning about the reason for the structure of the head. 15 It may be inferred that the brain is located in the head because of the eyes, and the organs of smell, hearing, and taste on account of the brain. But there are other reasons why these organs are properly allotted the topmost place. For since the ears should perceive sound, which is by nature borne upward, 16 they are rightly located high in the body. Similarly the nostrils, because every odor is taken upward, are deservedly high; and because much judgement of food and drink also belongs to the nostrils, it is not without cause that they seek the vicinity of the mouth. Now taste, which should sense the kinds of things we eat, conveniently dwells in that part of the mouth where Nature has opened the path for food and drink. Touch, on the other hand, is evenly distributed throughout the body, so that we may feel all blows and all excessive onsets of cold and heat. 17

The natural shape of the head 18
Now the skull (omitting for now the temporal muscles, the connection of the head upon the vertebrae of the neck, and the round shape most suitable of all for constantly repelling injuries) not wrongfully borrows the shape of the cerebrum 19 (first figures of Bk. 7), whose container and defense it must be — the shape of a sphere slightly depressed in front on both sides [fossa temporalis]. For since the cerebellum is placed below the posterior portion of the cerebrum [fossa cranialis posterior] and the dorsal medulla comes down from the head there, and since the processes [nervus opticus, bulbus et tractus olfactorius] 20 grow from the forward part of the cerebrum toward the eyes and the seats of the organs of smell [os ethmoidale, lamina et foramina cribrosa], the cerebrum fittingly resembles an elongated sphere. This is why a skull which is arranged according to nature (figure 1 and most of the figures in chapter 6) is constructed for the most part in the shape of an oblong sphere, having a more prominent, elongated anterior and posterior portion.

First, Second, and Third Unnatural shapes
All shapes varying from this are considered unnatural, such as the one (figure 2) in which the anterior eminence [tuber frontale] grown from the sinciput or higher part of the forehead [os frontale] is missing, but the posterior [tuber occipitale] which belongs to the occiput is kept; likewise the one which looks quite the opposite of this (figure 3), having lost the posterior or occipital swelling while the anterior one [tuber frontale] remains. The third (figure 4) is still more unnatural, in which both eminences of the head, that is the front one in the forehead and rear one in the occiput, are done away with and the head looks absolutely rotund, like a perfect sphere. This is the shape Homer attributes to Thersites, for many say it is the one he called foco/j; 21 but most prefer to use this name and o)cukefa/loj for all pointed shapes.

Fourth Unnatural Shape
The fourth unnatural type (figure 5), mentioned also by Hippocrates, 22 protrudes more conspicuously to the sides [os temporale, pars squamosa] near either ear than in the front and rear. This is everywhere unlike the natural shape of the head, as if you imagined the face near one ear of the naturally-shaped head, and the back of the neck near the other. In fact Galen affirms that this type is otherwise conceivable but cannot exist in nature, 23 although in Venice a boy can be seen today with this shape, deformed in many parts 24 and quite mad.

Other variations
Also there is a beggar walking around in Bologna who has a squarish head, but a little wider than it is long; 25 at Genoa a little boy is carried around from door to door by a beggar woman, 26 and had been displayed by performers in Brabant, the noblest province of Belgium, 27 whose head is without any exaggeration larger than any two mens’, and swells out on either side. 28 We sometimes see other unnaturally shaped heads, even in those who are unusually intelligent. We very rarely see such skulls in cemeteries; but they would surely appear promptly if we were to search the cemeteries of the Alpine people who face Styria. 29 That those people have heads shaped not only in the ways I have mentioned but in many far different and more deformed ways, I have heard more than once from a most zealous student of the works of nature and a most high-minded young man, Christopher Pfluegel of Salzburg, who is learned in many languages, skilled in other arts, and particularly distinguished for his knowledge of civil law; he recently gave an outstanding example of his utterly superb courage when as commander of the students of the University of Louvain he so swiftly and rapidly freed Louvain from its second great seige. 30

APPENDIX A: Natural Shapes of the Skull: 1555 version
Now all persons define the most natural and pleasing shape of the skull (figure 1, and most of those in chapter 6) as one which looks like a sphere slightly compressed towards the front on either side; and as if because of the compression, it is made much narrower in front than behind. Galen attributes this shape to the brain, adding that the skull, since it is the container of the brain, and as it were its helmet and defense, must reflect its shape. 31 He explains besides why the cerebellum is placed next the posterior part of the cerebrum, and why the dorsal medulla proceeds from it: in the anterior part (he says), processes are put forth from the brain to the organs of smell and the eyes. But we shall easily show in the seventh book that the brain needed no particular shape, and its posterior part juts backward more than the cerebellum itself (figures 1-2, Book 4, chapter 2); in addition, the olfactory processes and optic nerves originate from about the middle of the base of the brain, not from its anterior part, with the result that the design of the brain presents no obstacle why we should not see a skull like a perfect globe or sphere, the shape best suited to repelling injuries. But provision had to be made for the upper maxilla, nose, eye sockets, and temporal muscles; also, because of the skull’s connection with the dorsal vertebrae, the posterior part of the head needed to be made broader and larger, at least if the fact of its own weight was not to be neglected. Hippocrates 32 is seen to have attributed the cause of the shape that we call natural to midwives and nurses when he states that some people believed elongated heads were beautiful and therefore compressed the heads of infants into that shape, and finally heads were reproduced by nature into this oblong shape. It is known that many nations acquire some unique quality in the shape of their head almost in the same way. For example, the heads of the Genoese and to an even greater extent the Greeks and Turks look almost like a sphere because their midwives often comply with the fervent requests of mothers for this look (which many of them consider elegant and well suited to the head covering that they variously employ). Germans are often seen with compressed occiput and a wide head because as infants they always lie on their backs in their cradles and are tied by their hands, almost without swaddling clothes, to the sides of their cradles on both sides. The Belgians as a rule retain longer heads than others because their mothers wrap their infants in swaddling bands and let them sleep on their side, particularly on their temples. 33 However that may be, anatomists call that shape of head natural which is constructed most like an oblong sphere, having the forward and posterior part more prominent.

APPENDIX B: Variant shapes of the head (end). Expanded 1555 version
But I think that boy was suffering from a similar affliction to the one I observed at Augsburg in a two-year-old girl whose head had so grown in about seven months that I never saw a man’s head which did not yield to it in size. 34 This was the disorder which the ancients called hydrocephaly from the water that gradually accumulates and is retained in the head. Yet in this girl the water had not accumulated between the skull and the membrane [dura mater] that covers it on the outside or on the skin (where the books of physicians say water is otherwise retained), but in the cavity of the brain itself, and in both left and right ventricles, whose volume had so grown and the brain itself so extended, that they contained almost nine pounds of water or three Augsburg wine measures (believe it or not). 35 In addition, as the cerebrum in the vertex of the head was as thin as a membrane [falx cerebri], and its body nearly of a piece with its own thin membrane, so too the skull was quite membranous [fonticuli cranii] and its bony portion no thicker than the girl’s skull had been before it grew oversize, in much the same way as in newborn infants we see the frontal bone [tuber frontale, os frontale] and the bones of the vertex [tuber parietale] placed where they otherwise border on each other, and in many children appear membranous [fonticulus anterior] for a noticeable interval and area. 36 Meanwhile the cerebellum and the entire base of the cerebrum were normal, as well as the extensions of the nerves [nervi craniales]. In no places whatever did I find water other than in the ventricles of the brain that were swollen in the manner described, and the girl had full use of all her senses until her death. When I examined her a few days before she died, each time her head was moved by those attending her and was elevated a little, no matter how gently, a violent cough with difficult breathing immediately assailed the girl; there was a strange flush over the entire face, a suffusion of blood, and a flood of tears. 37 Her condition in the rest of her body was moderate, though her joints were slack and weak but not limp; there was no great emaciation, serous tumor in her limbs, or signs of epilepsy or tremors. When her liver was examined soon after death, it was slightly pale and somewhat smaller and harder than natural in other cases. The spleen was extremely enlarged and soft, 38 as if it had for a considerable time functioned in place of the liver, so that along with the other physicians present I was less astonished at this than I was that such a mass of water had been so long collected in the ventricles of the brain without greater symptoms. Similarly, at nearly the same time the heart of a very noble and learned man caused us no ordinary astonishment. We found about two pounds of glandular (but blackish) tissue in his left ventricle. 39 The heart was stretched 40 about this mass of flesh like a uterus or that girl’s brain, and the man before his death was in a melancholic state and rather sleepless; his pulse was strangely uneven and irregular, and he clearly showed a contraction of the artery [aorta]. 41 Thus, many months before his death (even though he walked about in other respects like a healthy person) his pulse or artery had been seen to contract more and remain contracted for an interval of three or four pulses or beats as if it were preparing to drive something out. Indeed, in the final weeks of life, after an interval of nine beats only two or three dilations of the artery could be felt afterward. 42 Thereupon, the animal faculty 43 remained sufficient along with the chief functions of the anima until death, which came not so much from damage to the heart as from gangrene of the left leg resulting from an inhibited arterial pulse, 44 as if the weakened pulses of the irregular heart inadequately vented off the innate heat 45 of the leg, particularly because as the result of a wound from a culverin some years previously the artery to his fibula had been damaged. We will pursue countless such cases at greater length in another book, 46 wherein I shall present accounts of dissections I have made that are especially suitable for knowledge of diseases and the practice of the entire medical art. Meanwhile in the present work we have decided to explain only the well knit human body, passing over in silence all things freakish and those which occur only in the unhealthy and diseased. Here we have mentioned unnatural shapes of the head because they have been generally treated by professors of anatomy, 47 and because likenesses of the head that are called unnatural, even by the unusually conscientious (since to be sure the brain requires no special shape, as we now agree) will sometimes be observed, even though such skulls, and particularly those differing from the natural shape in the type of sutures, present themselves to us in cemeteries quite infrequently, as will be stated in the next chapter. Such skulls would perhaps show up now and again if we were to search the cemeteries of the Alpine people who face Styria, 48 as I hear those people’s heads are deformed not only in the shapes of head just mentioned, but in far different ways.


Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]