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]



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Chapter 9 On the Twelve Bones of the Upper Maxilla, Including the Bones of the Nose

Index of the First Figure of the Ninth Chapter, and Its Characters

This figure 1 represents the anterior surface of the skull so as to display the bones of the upper maxilla as accurately as possible. We have placed a canine skull below the human so that Galen’s description of the bones of the upper maxilla may be more easily understood by anyone. Also, so that the sockets of the eyes and the bones and sutures appearing within may be seen as well as possible, it was useful for the human skull to rest on its occiput and for its anterior portion [regiones ventrales] to be raised above the dog’s skull. I shall arrange the legend of this figure so that the Greek capitals may be applied first to the bones of the upper maxilla (of which there are six on each side); they will all then be used as chance dictates for the remaining bones and sutures. The first few letters will help to identify the foramina of the head: it will be convenient to set them aside for the chapter devoted to these foramina. These are letters A to I.

I, I The frontal bone, I, is also placed in the eye sockets [orbita], marking that part of the frontal bone which constitutes the upper region of the eye sockets.
K Left vertex bone [os parietale].
L Left temporal bone.
M Left mammillary process [processus mastoideus ossis temporalis], next to which is the stylus-like process [processus styloideus].
N Cuneiform bone [os sphenoidale, ala major] marked in the hollow of the left temple [fossa temporalis] and inside the right eye socket. G and H in the left eye socket mark the same bone [ala major], though these letters will serve especially to mark the foramina 2 at this location. Another N [lamina lateralis processus pterygoidei] is placed next to the innermost tooth [dens molaris III] of the left side, marking a small portion of the cuneiform bone and the suture [sutura sphenomaxillaris] dividing it from the upper maxilla at this point.
G, G We shall count this the first bone [os zygomaticum] of the upper maxilla; the G inside the eye socket marks the portion [facies orbitalis] of this bone visible therein. The edges of this bone are marked a, b, Q, R, and P, which I shall explain severally in the appropriate places. 3
D This appears only in the left eye socket, indicating the second bone [os lacrimale] of the upper maxilla; it is bordered by the suture next to the letters D and C that goes around it in a kind of circle, marked after a fashion by X, V, c [sutura frontolacrimalis, s. ethmoidolacrimalis, s. lacrimomaxillaris]. 4
Q Also occurring only in the left eye socket, this marks the third bone [lamina orbitalis ossis ethmoidalis] of the upper maxilla, which is delimited by V, T, c, and d [sutura fronto-ethmoidalis, s. spheno-ethmoidalis, s. ethmoidomaxillaris]. 5


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L, L Fourth bone [maxilla] of the upper maxilla. The L in the eye socket marks the part [corpus maxillae] of this bone that makes up most of the lower region of the eye socket. The L there [fissura orbitalis inferior] also marks the beginning of the foramen [foramen infra-orbitale] that is labeled B in the cheeks. This bone is circumscribed by the letters h, g, e, Y, X, c, d, b, D, a, and N in this first figure, and in addition by e, u, t, and y in the following figure. 6
C Fifth bone [os nasale] of the upper maxilla. One C marks the bone on the right side, the other on the left; you will see this practice observed in the other letters. 7
P This letter appears in the second figure of this chapter, marking the sixth bone [lamina horizontalis ossis palatini] of the upper maxilla. The mate of the sixth bone, the matching bone on the other side, will be marked with the same letter. 8
O Septum of the nostrils, considered to be a process [lamina perpendicularis] of the eighth bone [os ethmoidale] of the head, perforated like a seive. 9 Having now explained these letters, we have distinguished the bones appearing in the present figure.
P Suture [sutura temporozygomatica] joining the two bony processes [os zygomaticum, processus temporalis et os temporale, processus zygomaticus] from which the cheekbone [arcus zygomaticus] is formed.
Q The line from Q to S marks the suture [sutura sphenozygomatica] dividing the cuneiform bone [os sphenoidale] from the first bone [os zygomaticum] of the upper maxilla, here visible in the eye socket and rather clearer in the socket of the right eye by the letter Q [os zygomaticum, facies orbitalis] than in the left eye socket. In the third and fourth figures preceding the sixth chapter, this suture is marked d 10 in the hollows of the temples.
R, S, T, V, X, Y, and Z Suture dividing the frontal bone from the upper maxilla and the cuneiform. The portion from R to S marks the part of the suture common to the frontal bone and the first bone [os zygomaticum] of the maxilla; it is seen in the hollow of the temple [fossa temporalis] in the third figure of the sixth chapter, extending there from b to the b next to it. 11 In the present figure, the interval from S to T marks the part of this suture common to the frontal bone from the cuneiform; T to V measures the portion common to the third maxillary bone [os ethmoidale] and the frontal bone. V to X is the portion of this suture common to the frontal bone and the second maxillary bone [os lacrimale], X to Y is the portion common to the fourth maxillary bone [maxilla] and the frontal bone, while Y to Z is the portion common to the frontal bone and the fifth maxillary bone [os nasale].
a The rough and uneven surface of the maxilla where the first maxillary bone meets the fourth. A suture [sutura zygomaticomaxillaris] is marked from a to b that is common to those bones, visible on the anterior surface of the skull. A portion of it which is hidden in the hollow of the temple is best looked for in the fourth figure preceding chapter six, under the letter f in the hollow of the temple. 12
b Part of the suture [sutura zygomaticomaxillaris] dividing the first bone from the fourth 13 is marked from b to Q, seen in the eye socket. It is clearer here in the eye socket on the left, which is occupied by fewer letters.
c The suture [sutura ethmoidolacrimalis] running from V to c is common to the second and third bones. Whatever runs upward next to C and D to X separates the second bone from the fourth.
d This letter helps to delineate the third maxillary bone. T to V [sutura fronto-ethmoidalis] describes this bone’s superior surface, V to c its anterior, T to d [sutura spheno-ethmoidalis] its posterior, where it meets the cuneiform bone. c to d [sutura ethmoidomaxillaris] circumscribes the bone’s inferior portion, next to the fourth maxillary bone.
e The suture [sutura nasomaxillaris] running from e to Y is common to the fourth and fifth maxillary bones.
f From f to Z marks the suture [sutura internasalis] common to the fifth bone of one side and the fifth bone of the other.
g This is placed in the space of the nostrils, marking the suture [sutura vomeromaxillaris] by which the nasal septum [vomer] is separated from the fourth bones [corpus maxillae] of the upper maxilla.
h The suture [sutura intermaxillaris], or rather the harmonia [sutura plana], common to the fourth bones of the upper maxilla, by which they are separated in the region of the upper lip.
i Near the upper edge of the foramen marked B [foramen infra-orbitale], i is placed to mark the suture of the fourth bone running above that foramen; it is peculiar to the fourth bone alone. 14 In the illustration of the human skull being explained here, nothing else is marked by a letter, and nothing else remains to be told. The following key will be accounted peculiar to the dog’s skull, as follows. 15
k Suture [sutura zygomaticomaxillaris] from the cheeks upward to the middle of the eye socket [aditus orbitalis, margo infra-orbitalis], ascending in the lower region of the eyes to l. 16
l, m The line from l to m marks the suture rising to the brows [supercilia] next to the inner angle (canthus) of the eye socket [aditus orbitalis, margo medialis].
n From the suture that runs around the outside of the nasal bones [sutura nasomaxillaris], the suture [sutura maxillo-incisiva] marked n runs between the canine tooth and the incisor next to it. It would have been possible to occupy this skull with more letters, had I not believed that for the present the human maxilla would present the reader with enough to do. 17


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Second Figure of the Ninth Chapter

This figure 18 shows the base of the skull in such a way as to display the palate and the bones of the upper maxilla that were in the previous figure. A great many characters are present which assisted above in explaining the bones and sutures of the head. Their significance may be found in chapter six. Here it is worth annotating those that will be needed in the narrative that follows. 19

Index of the Second Figure and Its Characters

L Here a small portion of the frontal bone is visible.
O, O, P, P The cuneiform bone.
Q, G The previous figure also has this bone, marked G; it is the first bone [os zygomaticum] of the upper maxilla. 20
S, L The previous figure marks this bone L as well; it is the fourth bone [maxilla] of the maxilla.
V, X The part of the skull which anatomists call the jugal bone [arcus zygomaticus] has already been explained. 21
Y Suture [sutura temporozygomatica] joining the two processes which form the jugal bone.
d Here the suture [s. sphenozygomatica] separating 22 the first bone of the upper maxilla from the cuneiform is hidden; also a portion of the suture [s. zygomatica] separating the first maxillary bone from the fourth, visible in the hollow of the temple.
e Suture [sutura sphenomaxillaris] common to the fourth maxillary bone and the cuneiform. 23
f A portion of the suture separating the first maxillary bone from the fourth, appearing in the anterior region of the maxilla and marked in the previous figure from a to b.
g Suture [sutura frontozygomatica] common to the frontal bone and the first maxillary, which we marked R in the preceding figure.
P Sixth bone of the upper maxilla [lamina horizontalis ossis palatinae].
q The suture [s. sphenopalatina] common to the sixth bone of the maxilla and the cuneiform is marked from e to q.
S [facing backward] The nasal septum [vomer], and the point where it is separated from the cuneiform bone.
t, u The transverse suture [sutura palatomaxillaris] separating the sixth bone of the maxilla from the fourth is marked from t to u.
x The suture [sutura palatina mediana] dividing the two sixth bones of the upper maxilla from each other, and common to those two bones, is marked from x to t.
y The suture [sutura palatina mediana] running straight through the palate, common to the fourth bones of the maxilla.
z This specifically marks the foramen [foramen incisivum] appearing in the front of the palate, in the region behind the incisor teeth;
a near its side an obscure suture [sutura incisiva] sometimes occurs, running transversely to some point in the fourth bone of the upper maxilla. This is marked a.


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24

Why the maxilla consists of several bones, both hollow and light
The upper maxilla is formed not from a single bone but from several, chiefly to make it more resistant to damage, so that when one portion of it is hurt the entire maxilla will not be directly affected and the trouble will stop with a single bone (as has also been stated regarding the structure of the cranial bones). Also, because all its parts did not need to be equally solid, dense, and hard, it was necessary that it be made up of several bones. It is constructed of particularly hard but rather light bones, for the foramina of the nostrils are so large and open that the maxilla gains a remarkable lightness for such a mass. Other openings and air-filled cavities [sinus paranasales] hidden inside the bones are so large and hollow that the upper maxilla on both sides near the nasal cavities is discovered to be somewhat like the waxen images which we pour into various moulds and leave hollow inside. 25 In this part one cannot agree with Galen, who teaches that the upper maxilla is without marrow and constructed of hard bones that have no need of lightness because this bone, unlike the lower maxilla, does not move. 26 But in fact the lower maxilla is much stronger, and is made of far tougher bone to resist injury and is much less prone to be eaten away by Gallic scabies. 27

Structural system of the maxillary bones.
The bones of the upper maxilla are connected to each other by sutures, but in such a way that joints which are effected by harmonia [sutura plana] may also be called sutures. Even Galen agrees that no one should hesitate to call them all sutures, 28 since the most exact harmoniae (if such things exist) display a certain entrance of one bone into another, like that of sutures. The order of sutures in the upper maxilla and the number of its bones is, I believe, much easier to demonstrate than to explain in writing. 29 In spite of the difficulty of this subject, I shall first deal with the upper maxilla in man, and add in passing items in Galen’s description that apply to dogs and monkeys but not to humans. Whatever bones of the skull have not yet been explained will be termed the upper maxilla, with the exception of the upper row of teeth. We have already counted eight bones of the head, surrounded by their own sutures, in addition to four ossicles 30 which enter into the structure of the instruments of hearing.

Brief enumeration of the bones of the maxilla.
The bones of the upper maxilla (not counting some thin, spongy, nearly membranous ossicles that are observed at the top of the nasal cavity in dried or recently boiled skulls, quite cartilaginous 31 ) are twelve in number, six on either side. Of these six (first: G, G in figs. 1 and 2; second: D in fig. 1; third: Q in fig. 1; fourth: L, L in figs. 1 and 2; fifth: C in fig. 1; sixth: P in fig. 2), we shall say that one [os zygomaticum] comprises the outer angle of the eye socket, while the second [os lacrimale] and third [os ethmoidale] will be considered the inner angle. We shall explain that the fourth [maxilla] supports all the teeth of the upper maxilla on its side; the fifth [os nasale] will be one of the two bones of the nose (as we call them). The sixth bone [os palatinum, lamina horizontalis] and its mate will be located at the end of the palate where the nasal foramina [meatus nasopharyngeus] face the area of the mouth. 32 Take a skull into your hands and compare it to the figures placed at the beginning of this chapter. Spend some time and see for yourself: look for the outlines of these six bones that have been marked with their own letters; and just as I am accustomed to do in classes, take a rough pen and black out all the sutures you find in one side of the skull so that whenever you wish you may more readily find all the sutures by which the bones are distinguished. First, concentrate on the eye socket and consider how many bones it is composed of: some of them belong to the upper maxilla, others to the head.

How many bones make up the eye socket
The upper part [pars orbitalis] of this socket (I in the left eye socket, fig. 1) is made up of the frontal bone. Its apex (G, H in fig. 1), which is forced into a narrow shape like a cone or a pyramid, is part [ala major ossis sphenoidalis] of the cuneiform bone, which also forms a large (but deep) portion of the outside [paries lateralis orbitae] of the eye socket, so that there is no reason not to count the cuneiform bone the second bone and the frontal bone the first in the eye socket. The third bone (G in fig. 1) of the eye socket is counted the first [os zygomaticum] of the upper maxilla because it makes up the entire outer angle of the eye socket and half of its lower circumference, the remainder of which (L in fig. 1) as far as the area between the eyebrows is occupied by the largest or fourth bone [maxilla] of the maxilla. This bone, fourth among the bones making up the eye socket, constitutes more or less the entire lower part of its area. The fifth bone [os lacrimale] of the eye socket (D in fig. 1) is in its inner angle towards the front near its edge; it is the second of the maxillary bones. The sixth (O in figs. 1 and 2) [lamina orbitalis ossis ethmoidalis] of the bones of the eye socket lies in its inner side; located behind the bone just mentioned, we consider it the third of the maxillary bones. Thus, two bones of the eye socket, the first two, count as bones of the head, and four belong to the upper maxilla, viz., the last four mentioned. After you have carefully studied these six bones in the eye socket and inspected the sutures bordering them, it will be possible in this way to outline each separate bone of the maxilla precisely at its sutures.

The first bone of the maxilla
The first bone [os zygomaticum] of the upper maxilla (G, G in figs. 1 and 2) is one part of the jugal bone [arcus zygomaticus] and includes much of the temple and the rim and socket of the eye, which is to say its entire outer angle, forming no small part of the mala (cheek) as well. This first bone [os zygomaticum, processus temporalis] of the maxilla is joined to the temporal bone [os temporale, processus zygomaticus] by a suture [sutura temporozygomatica] (P in fig. 1, Y in fig. 2) which joins the two processes constituting the jugal bone. Then it is joined


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to the cuneiform bone by the suture [sutura sphenozygomatica] (d in figs. 3 and 4, chapter 6) which is brought sloping down through the hollows of the temples [regio infratemporalis] and is visible also in the eye socket (Q in fig. 1); the suture is common to this first bone of the maxilla and the cuneiform bone. In its upper part it is knit [sutura frontozygomatica] (R in fig. 1) to the frontal bone, at the point that is considered the end of the eyebrow. This joint is made by the suture (R, S, T, V, X, Y, Z in fig. 1) that is brought from the hollow of the temples through the eye sockets to the area between the brows, and separates the frontal bone from the upper maxilla and the cuneiform. 33 Being in its lower portion of conspicuous breadth, the first bone is attached to the fourth by a suture [sutura zygomaticomaxillaris] which is visible in three places: in the hollow of the temples beneath the jugal bone (ff in ch. 6, fig. 4), in the anterior region of the maxilla next to the cheek (from a to b in fig. 1), and in the lower part of the eye socket (from b through D to Q in fig. 1). The part of the suture visible in the hollow of the temples begins from the lower part of the suture [sutura sphenozygomatica] dividing the cuneiform bone from the first bone of the maxilla. From that end, this suture is carried obliquely downward and slightly forward until it reaches the lowest part of the cheek (a in fig. 1), where it is rough and uneven. The part of this suture appearing in the anterior part of the maxilla runs obliquely from the cheek upward to the eye socket, toward the middle region of the lower perimeter surrounding the eye socket here. The part or interval of this suture joining the first bone to the fourth that is visible in the eye socket ascends from the middle of the lower perimeter of the eye socket obliquely backwards through its lower parts [paries inferior orbitae] towards the outside [margo lateralis] until it reaches the lowest part of the suture separating the cuneiform bone from the first maxillary. In this way the first bone is circumscribed, joined (as we have said) to four bones: to the process [processus zygomaticus] of the temporal bone that forms one part of the jugal bone, then to the cuneiform bone, the frontal bone, and the fourth maxillary bone.

The second maxillary bone
The second bone (D in fig. 1) [os lacrimale] of the maxilla, far smaller than all the others and thin like a scale, is located in the inner angle [angulus oculi medialis] of the eye socket where there is a foramen [fossa sacci lacrimalis] (C in fig. 1) in front of which is a caruncle [caruncula lacrimalis] that occupies the inner angle of the eye. This is said to have been created to prevent any phlegm purged from the brain into the eye sockets from flowing down onto the cheeks, but instead to fall completely through this foramen [ductus nasolacrimalis] into the space of the nostrils. This ossicle [os lacrimale] is terminated in its upper portion [crista lacrimalis] by a short interval of suture [sutura frontolacrimalis et sutura frontomaxillaris] (from V to X in fig. 1) that distinguishes the frontal bone from the upper maxilla; it is therefore by this suture that this ossicle is joined to the frontal bone. From this suture, a second one [sutura ethmoidolacrimalis] (in fig. 1 from V downward beside D and c, and from there up again to X) descends along the posterior side of the ossicle, runs along the bottom of the ossicle, and ascends upward along its anterior side finally to the same suture which we said separates the frontal bone from the upper maxilla. The suture which is brought in this manner almost in a circle from the suture just mentioned separating the frontal bone from the maxilla, is common in its [os lacrimale] posterior region (towards the cone of the eye socket) to the second maxillary bone and that which we call the third [os ethmoidale]. At the ossicle’s lower end and along its anterior side, this suture connects it to the fourth bone [maxilla] of the upper maxilla. On its upper end, this ossicle meets the frontal bone, on its posterior the third maxillary bone, on its lower and anterior end the fourth maxillary bone. Because this ossicle is loosely attached, and is joined at its anterior end to the fourth bone by a harmonia [sutura plana] rather than by a suture and is itself quite thin, it rarely occurs in skulls dug from the earth; because it is placed in this damp location, it easily decays and readily falls off because of its extremely loose connection. But in boiled heads and in those skilfully prepared for instruction on the bones, it is carefully preserved.

Third maxillary bone
The third bone [lamina orbitalis ossis ethmoidalis] of the upper maxilla (Q in figure 1), like the second, appears thin and translucent like a scale. When it is broken, it is seen to abound with large, air-filled cavities [cellulae ethmoidales]. It is nearly quadrangular, located in the inner side of the eye socket. On top (from T to V in fig. 1), it ends at the suture [sutura fronto-ethmoidalis] common to the frontal bone and the upper maxilla. Anteriorly (from V to c in fig. 1), its suture [sutura ethmoidolacrimalis] is common to the second maxillary bone; posteriorly (from T to d in fig. 1), its suture [sutura spheno-ethmoidalis] is common to the cuneiform bone [os sphenoidale]. In its lower portion (from c to d in fig. 1), it has a suture [sutura ethmoidomaxillaris] common to the fourth maxillary bone. This third bone is therefore connected to four bones: the frontal bone above, the second maxillary bone [os lacrimale] in front, the cuneiform [os sphenoidale] behind, the fourth maxillary [maxilla] below. On the inside, where it faces the nasal cavity [cavum nasi], it meets an irregular construction of bones [labyrinthus ethmoidalis] in the top of the nostrils.

Fourth maxillary bone
The fourth bone (L, L in figs. 1 and 2) [maxilla] of the maxilla is by far the largest of them all; it receives all the teeth on its side, and is surrounded by various sutures, reaching various places here and there according to its own varied shape. First, it ends at that suture [sutura zygomaticomaxillaris] which separates the first bone from the fourth—which is seen at the same time in the hollow of the temples (ff in fig. 4, ch. 6), in the anterior region of the maxilla (from a to b in fig. 1), and in the eye socket (from b to D in fig. 1). Then, the fourth bone is terminated by the sutures separating it from the second [os lacrimale] and third [os ethmoidale] maxillary bones; these sutures (from X along C to c, then to d) run the entire length of the lower part of the eye socket and in the anterior region of the second maxillary bone. In addition, near the point between the brows the fourth maxillary bone ends at the suture [sutura frontomaxillaris] (from X to Y in fig. 1) that separates the upper maxilla from the frontal bone. This length of suture runs from the anterior part of the second bone to the outer side of the nasal bone, on that side where you are now looking at the bones of the upper maxilla: that will be the fifth maxillary bone [os nasale]. The fourth is separated from it by the suture [sutura nasomaxillaris] (from Y to e in fig. 1) extending from the top of the nose near its outer side downward the length of the nasal bone. Along the course of the nasal foramina [cavitas nasi], the fourth maxillary bone is separated from the septum [septum nasi] of those foramina by a suture [sutura vomeromaxillaris] (g in fig. 1)


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running along the lowest part of the septum [vomer]. In the posterior portion, the fourth bone is distinguished from the cuneiform [ala major ossis sphenoidalis], both in the eye socket (from D to H in fig. 1) and next to the innermost tooth [dens molaris III] (N in figure 1, e in fig. 2) [processus pyramidalis ossis palatini], at the point where a suture [sutura sphenomaxillaris] separates the cuneiform bone from the upper maxilla. At the end of the palate toward the inside, the fourth bone is separated from what we call the sixth bone [os palatinum] of the maxilla, located here with its partner at the foramina [apertura nasalis posterior] of the nostrils, by a transverse suture (from u to t in fig. 2) [sutura palatina transversa]. The fourth bone has all these sutures in common with its conterminous bones; another suture (from t through x to z in fig. 2) [sutura intermaxillaris] comes in to the fourth bone of the left side and the right side following the longitude of the palate, 34 visible not only in the palate, but also in the nasal cavity. This same suture (h in figure 1) is also seen in the anterior part of the maxilla under the nostrils where the furrow [philtrum] of the upper lip is located. Here is it evident that the suture belongs to the fourth bone of either side, though it should be considered a line rather than a suture. Out of this crowd of sutures terminating the fourth bone, it is gathered without difficulty that it is connected to sixteen bones: 35 for it is joined to the first, second, third, fifth, and sixth bones of the upper maxilla, then to the frontal bone, cuneiform, and eighth bone of the head, viz. the septum [vomer] between the foramina of the nose, and finally it is attached to its own mate, the fourth bone of the other side; likewise, when eight teeth are also attached to the fourth bone, the upper maxilla is adorned with sixteen teeth. The present bone makes up most of the sides and lower area of the nostrils, and near these sides it is quite hollow 36 and not at all solid, but rather elegantly like waxen images that are hollow inside. 37 In addition to its other foramina, this bone has one (L in the eye socket of fig. 1, then B) that begins in the lower region of the eye socket and extends downward into the anterior part of the maxilla. 38 Where this first begins in the eye socket, its upper part for a notable distance consists of a kind of bony scale; but when it reaches the anterior part of the maxilla, it now appears deeply carved in the bone, and there is even a noteworthy interval to be seen between the perimeter of the eye and the upper part of the foramen. This interval is very often not continuous, but has a suture 39 (i in fig. 1) belonging to this part of the fourth bone (where the foramen is located) and peculiar to it. I shall explain in my general discourse on all the foramina of the skull what is thought to be the use of this foramen; for the present I have made passing mention of it only to give a better description of the suture belonging to the fourth bone, lest by chance someone might see it and believe it adds to the number of bones, or that it runs deeper than from the periphery of the eye socket to the foramen. Another foramen [foramen incisivum] (z in figure 2) presents itself in the front of the palate in the region behind the incisor teeth, common to the fourth bones of the upper maxilla and looking from the palate into the nasal cavity. At the sides of this foramen a suture (a, a in figure 2) [sutura incisiva] sometimes appears, or rather a line, filled with cartilage in children, which reaches more or less to the anterior side of the canine teeth. But it never goes so deep that the fourth bone of the maxilla could be considered divided into more parts because of it; this happens (as I shall say a little later) in dogs, monkeys, and pigs, where the suture dividing the fourth maxillary bone in two is conspicuous not only in the palate but also outside on the anterior surface of the maxilla (n on the dog’s skull in figure 1), and does not at all resemble a joint between bones and their epiphyses. 40

The fifth bone of the maxilla
The fifth bone (C in figure 1) [os nasale] of the upper maxilla is one of the two bones of the nose: a hard, solid, broad, thin, elongated little bone resembling a quadrangle more than a triangle. At its upper part (Y to Z in fig. 1) it does not end at a sharp angle, but is so blunt that it has two angles there. It is ended at that point by a suture [sutura frontonasalis] separating the frontal bone from the upper maxilla. The outer side of the bone has a suture [sutura nasomaxillaris] (from Y to e in fig. 1) that it shares with the fourth maxillary bone, running steeply downward along the side of the nose the entire length of this fifth maxillary bone; it is much shorter in humans than in dogs and monkeys. The inner side of the bone (from Z to f in figure 1), where it is joined to its mate, has a suture [sutura internasalis] not unlike a harmonia, common to both bones of the nose. This suture begins 41 between the brows [glabella], from the suture [sutura frontonasalis] common to the frontal bone and the upper maxilla and extends straight down the length of the bones of the nose. Below (from f to e in figure 1), the fifth bone is not interrupted by a suture, nor is it joined to another bone, but like its mate it is rough and uneven, and ends in cartilage (K and L in the 4th table of muscles) 42 that continues downward, becoming softer the farther it runs toward the tip of the nose. We shall talk about this cartilage separately with the remaining cartilages of the nose and the entire body, following the account of the bones.

The sixth bone of the maxilla [os palatinum]
The sixth bone of the upper maxilla (P in fig. 2) [lamina horizontalis ossis palatini] and its mate constitute no small portion of the palate and nasal cavity. It is situated at the end of the palate where the nostrils reach into the throat; 43 it is a thin bone, but solid and broad. At its posterior end (from x to e in fig. 2) it is in part connected to the cuneiform bone [processus pterygoideus] and in part free, shaped like a parenthesis: “(” . Where it is joined to the cuneiform bone, it is circumscribed by that suture [sutura sphenopalatina] (e in figs. 1 and 2) which runs along the posterior side of the innermost tooth [dens molaris III] and separates the upper maxilla from the cuneiform bone, particularly where the cuneiform puts out its processes resembling a bat’s wings [ala major ossis sphenoidalis] (P in figs. 1 and 2). In its anterior and its outer side, this sixth bone ends at a suture [sutura palatina transversa] (from t to u in fig. 2) common to itself and the fourth bone [maxilla] of the maxilla, running transversely in the palate. On its inner side (from t to x in fig. 2), where it joins


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its mate, it is separated by a certain suture [sutura palatina mediana] which is common only to the sixth bone of either side, and there is a portion of it (t, y, and z in figure 2) [sutura intermaxillaris] which runs the length of the palate and separates the fourth maxillary bones from each other. The sixth maxillary bone therefore touches the cuneiform [os sphenoidale], the fourth maxillary [maxilla], its own mate, and finally the nasal septum [vomer]. It is separated from the sixth bone, as it is from the fourth, by the suture [sutura vomeromaxillaris] (g in fig. 1) previously mentioned as running to the lower part of the septum.

There are in all twelve bones of the upper maxilla
I have thus far described six bones on either side of the maxilla, which if counted with the six of the other side, come to a total of twelve maxillary bones, to which I have added none of the eight bones 44 of the head.

Not everything thus far stated in this chapter fits the opinions of Galen; some items are enumerated at the end of the chapter.
If you closely examine each of the things I have described in this chapter, and afterwards read carefully Galen’s description of the upper maxilla, many particulars will occur in which I depart from his opinions. Though I shall not (trusting in your diligence) mention all of them here, I will add a few items from which you may sample my diligence or neglect (depending on whether you perceive them as consonant or dissonant with the truth). 45 When Galen is about to describe the peculiar sutures of the maxilla in his book De ossibus, 46 he begins his list of them from the lowest and outermost part of the cheek [os zygomaticum, facies lateralis] (in fig. 1, a in the human skull, k in the canine), which I stated is rough and uneven; that is because the masseter muscle runs the strongest and most sinewy portion of its beginning from here. Galen therefore describes a suture here [sutura zygomaticomaxillaris], the one separating the first maxillary bone from the fourth, calling the part of the suture visible in the hollow [fossa temporalis] of the temple (f in the hollow of the temple in fig. 4, ch. 6) the first suture. The portion of this suture [sutura zygomaticomaxillaris] occurring in the anterior part of the maxilla, which extends from the rough area of the cheekbone upward to the middle of the lower perimeter of the eye socket (fig. 1: from a to b in man, from k to l in the dog), he calls the second suture. This, he says, afterward divides into three, and he declares that the first part of this second suture [sutura lacrimomaxillaris et sutura frontomaxillaris] (in the dog, from l to m in fig. 1) proceeds along the large or inner angle [canthus] of the eye socket [aditus orbitalis, margo medialis] on the outside to the point between the eyebrows and the suture common to the frontal bone and the maxilla [sutura frontomaxillaris]. Humans lack this part of the suture, but it is quite obvious in dogs and in apes with tails. It does not, in fact, run quite to the point [glabella] between the brows, but only to the point where it has been said the fourth maxillary bone [maxilla] is separated from the second [os lacrimale]. If you follow Galen, you will have to look for this part in a dog’s skull. Furthermore, he says that the second part of the second suture runs through the hollow of the eye socket below the large angle to the suture [sutura frontomaxillaris] between the head and the maxilla (imagine that a continuous suture is run in figure 1 from b through c and d to T, as can be seen in a dog), and that it includes this same angle. This part would be the suture [sutura ethmoidolacrimalis] which we have explained separates the second [os lacrimale] and third [os ethmoidale] bones of the maxilla on their lower side from the fourth. But in man, this suture is by no means joined to Galen’s second suture; much less does it reach the first part of the second suture, since this is seen only in dogs and apes but not in humans. In addition, the foramen [fissura orbitalis inferior] (D in figure 1) which according to Galen lies beneath this second part is, I believe, the long, quite open one in the eye socket, appearing between the fourth bone of the maxilla and the cuneiform [os sphenoidale, ala major, facies orbitalis]. The portion of suture (from b along D through Q to S in fig. 1) separating the first bone from the fourth [sutura zygomaticomaxillaris] which is seen in the eye socket, together with the suture [sutura sphenozygomatica] that divides the cuneiform bone from the first bone of the maxilla and is also seen in the eye socket, is what Galen calls the third part of the second suture. For it is Galen’s opinion that under the two sutures mentioned (the two first parts of the second suture) “its third part [fissura orbitalis inferior] ascends the lower perimeter [paries inferior] in the eye socket [orbita] and goes to the bottom on the inside, and there it is joined to the suture common to the head [os frontalis] and the maxilla.” 47 Galen later adds that three bones 48 of the upper maxilla are surrounded by these sutures, by which they are joined to the head [pars orbitalis ossis frontalis]. The first would be what I established as the first bone [os zygomaticum] of the maxilla (G in figure 1); the second [os lacrimale], those which I was counting the second and third: those two would be numbered as a single bone in Galen’s opinion. The third [corpus maxillae, facies orbitalis] (L in the eye socket of figure 1; this bone of Galen would be surrounded after a fashion by b, C, c, d, H, D) would be part of our fourth bone, namely whatever is situated in the eye socket where the foramen [fissura orbitalis inferior] (L in the eye socket, figure 1) begins which extends from the eye socket into the anterior region [foramen infraorbitale] of the maxilla. Consider carefully here whether up to this point Galen has explained the bones of the maxilla in man more truthfully than I, and how much he has omitted so far in apes and dogs; then, whether my understanding of Galen is based on my knowledge of the subject, or on a translation, 49 and what sort of Delian swimmer 50 Galen’s treatise on the bones of the maxilla requires, particularly when certain persons indifferent or even hostile to the common good so suppress the Greek copy [of Galen’s De ossibus] that I was unable for any reason to obtain permission from them to use it for a time. Except for Balamius and Cardinal Rodolphus, 51 they even admitted that they had it, but only on condition that it not be shared with me. Yet I shall devote every effort not to seem to have suffered the lack of that book or of certain others of Galen on anatomy, all of which they hide and render useless, or in any case they prefer that the better editions be eaten by worms (since they cannot use the books themselves). 52 Galen’s establishment of special bones [os incisivum] in which the incisor teeth are fitted can be accounted for by his excessive regard for his apes, which he imagined were more like humans than they are. In dogs, apes, pigs, and other animals whose canine teeth are strong and prominent, two quite conspicuous sutures (n in the canine skull) [suturae maxillo-incisivae], or rather harmoniae, are seen, as I have said before, which man lacks. For from the suture [sutura nasomaxillaris] separating the fifth maxillary bone [os nasale], which is one of the nasal bones, from the fourth,


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another suture [sutura maxilloincisura] runs obliquely downward between the canine and the incisor next to it; this suture joins the one [sutura incisiva] at the end of the palate next to the incisor teeth, which runs transversely in those animals. Even without intervening cartilage, this suture is so conspicuous that dogs show what I count as the fourth bone [maxilla] of the maxilla divided in two. But it must not be thought that this suture running between the tooth sockets in dogs or apes comes from between the brows [margo supraorbitalis] downward in a continuous course (even though Galen does say so), but as we have just pointed out it [sutura nasoincisiva] begins about halfway down the suture which constitutes the outer side of the nasal bones. When you examine this in a dog or an ape, consider carefully how impossible it is that this suture should extend between the teeth of a human, who possesses an extremely short jaw as well as small canine teeth. Ponder also what Galen meant in De usu partium when he wrote in passing that there are twelve bones of the upper maxilla; likewise the author of Introductio seu medicus 53 counts just twelve bones of the maxilla, doubtless from the opinion of the Ancients; or when Galen, describing these bones more fully, 54 numbers only nine, not including in that number the cuneiform bone, and attributes no bone specifically to the incisor teeth.

Appendix A: 1555 version of the first two paragraphs of the narrative section

What part of the skull is called the upper maxilla
In our account of the bones, we call the upper maxilla that part of the skull which still remains to be described after the eight bones of the head that together make up the area where the brain is contained and the two ossicles of the organ of hearing [malleus et incus] on each side. It makes up the lower part and sides of the eye sockets, the large cavity of the nostrils, the upper nasal region, and the palate, and it includes the upper row of teeth.

Why it consists of many bones, both light and hollow
We believe it is constructed not of a single bone but of several so that it may be made readier to resist injuries and sustain harm with less inconvenience, since damage to some part of it is limited by the boundary of that part and will not extend throughout the maxilla as through an earthen vessel. But there is still another reason for the number of bones, that being the variety of areas which do not everywhere produce bones equally dense, hard, thick, or soft. Though it consists chiefly of hard bones, they are quite light; for outside the cavity of the nostrils which they form, the bones are quite hollow inside near the sides of this cavity, and they contain such conspicuous hollows that you might well compare the composition of the upper maxilla to figurines which we pour from wax and are hollow inside. 55 The result is necessarily a special and unusual lightness for such a large mass which does not weigh down the head and is also wonderfully suited for voice production. 56


Appendix B: How to distinguish the maxillary bones
. . . These bones are attached to each other and to adjacent bones of the head by sutures and harmoniae [suturae planae]. Now since such harmoniae, if they are ever broken apart, greatly resemble on their inside an attachment to each other which is more or less comparable to a suture, anatomists identify them as sutures in their accounts of the upper maxilla. But in order conveniently to study all such joints with the bones surrounded by them, and to observe how the otherwise obscure and inconsistent descriptions of Galen conform here better to dogs and apes than to humans, cover up all the sutures of the human skull that you can find, however hard to see, and even those that look like harmoniae: cover them on one side with blacking just as I am accustomed to do in the schools — for in this way they will be easier to see as if made heavier and dyed — and you will more readily understand the entire outline of the bones according to the account which I shall now set forth, and consider thereafter the structure of the dog and the ape.


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]