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 38 On the Cartilages of the Rough Artery, and What Therein Would Be Called by the Greeks Glottis and Epiglottis


THE FIRST FIGURE

of the thirty-eighth chapter represents the anterior [ventral] face of the entire rough artery [trachea] free from all [adjacent] parts.


THE SECOND FIGURE

delineates the posterior [dorsal] face of the trunk [cartilagines tracheales] of the rough artery. It would have been beside the point to draw in the series of branches [bronchi lobares et segmentales] reaching into the substance of the lung for this figure as for the first, since the first figure presents it abundantly.


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Index of the thirteen figures which are set forth here in order, and their characters.
The first of these figures, marked 3, shows the first cartilage [cartilago thyroidea] of the larynx from the right side; because it resembles a shield we shall also call it the shield-shaped (scutiform). The figure which is fourth in order displays the inner or posterior face of the same cartilage. In the fifth is drawn the same cartilage in the outer or anterior face. The sixth represents the anterior face of the second cartilage [cartilago cricoidea] of the larynx. The seventh has the second cartilage of the larynx shown from the right side. The eighth presents the second cartilage of the larynx depicted from the posterior face. In the ninth is drawn the third cartilage [cartilago arytenoidea] of the larynx from the right side. 1 In the tenth appears the anterior aspect of the third cartilage. The eleventh illustrates the same cartilage in its posterior face. The twelfth shows the lower [dorsal] surface of the operculum [epiglottis] of the larynx, where the operculum faces the cavity of the larynx. The thirteenth has the superior [ventral] surface of the operculum of the larynx, which faces the palate. The fourteenth offers to view from the anterior or external face one cartilage [c. trachealis] of the trunk of the rough artery [trachea], built like the letter C. The fifteenth displays the same cartilage in its posterior surface, which looks toward the inner cavity of the rough artery.

A, B 3, 4, 5 The two higher processes [cornua superiora] of the shield-shaped cartilage [c. thyroidea].
C, D 3, 4, 5 The two lower processes [cornua inferiora] of the same cartilage.
E, F in 8 , but only E in 7 Areas of the second cartilage [facies articularis thyroidea] with which the lower processes of the shield-shaped cartilage unite.
G, H 3, 4, 5 At this point the shield-shaped cartilage is seen at its narrowest and shortest, now and again showing the line 2 which separates the right portion [lamina dextra] of the cartilage from the left [lamina sinistra] as if they were two cartilages.
I 6, 7 At these points is seen the area [cavitas infraglottica] of the second cartilage facing the inner mass of the larynx. The remaining parts which are seen in these three figures constitute the outer region or mass of the larynx.
K, L 6, 7 The lower part of the second cartilage, forming a complete circle. K marks the anterior region [arcus cartilaginis cricoideae] of this part, which can be felt beneath the shield-shaped cartilage. L indicates the posterior region of this lower part, brought downward like a process, and marked L in the eighth figure.
M 7, 8 Spine-like line [crista mediana] standing out in the posterior region of the second cartilage. 3
N, O 8 Depressions in the posterior part [lamina cartilaginis cricoideae] of the second cartilage, carved at the sides of the line marked M.
P, Q 6, 7, 8 Two tubercules or heads [facies articulares arytenoideae] of the second cartilage, entering the depressions [basis cartilaginis arytenoideae] of the third cartilage.
R, S 9, 10, 11 Two parts [apices] of the third cartilage [cartilago arytenoidea]. 4
T 9, 10, 11 This region [incisura interarytenoidea] of the third cartilage is empty, occupied only by the membraneous ligaments and tunics [tunica mucosa] of the larynx.
V, X 9, 10, 11 Surfaces [facies articularis] of the third cartilage by which it is articulated to the second cartilage.
Y,Y 9, 10 Processes [processus vocalis] of the third cartilage which form the lingula [rima glottidis] of the larynx.
Z 9, 10, 11 Region 5 of the third cartilage resembling that part of jugs or vases from which we pour water for those washing the hands.
a 12, 13 Base of the operculum [cartilago epiglottica] 6 of the larynx which is connected to the shield-like cartilage of the larynx.


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b 12, 13 Apex or region of the operculum of the larynx proceeding farthest back and to the inside, toward the spine. In addition to the fifteen figures just explained, the figures to be placed at the beginning of the twenty-first chapter of the second book, in which the muscles of the larynx will be explained, are relevant to this discussion. Among the other figures, you will inspect the last three no less appropriately than if they were placed here: those in which the picture of the lingula [rima glottidis] or fissure of the larynx is drawn as accurately as possible.

Where the nature of the rough artery will be thoroughly described
Although the sixth book is to be devoted to the heart and the organs of respiration and will deal extensively with the nature of the rough artery [trachea] (all of figs. 1 and 2; H, I, K, L, M, M in the figure for ch. 4, Bk. 9), at this point its cartilages come up for discussion, so that we may sum up in this book all the parts by which the body is supported, and so that we will not be delayed from the account of the muscles in the following book by the omission of bones and cartilages here. In the sixth book we shall explain how the rough artery is brought down from the pharynx into the thoracic cavity and spread out by a multiple growth of branches [bronchi] into the lungs [pulmones], so as to bring them air and take it out again. Not only shall we depict this as an instrument of respiration, but we shall also declare that it is the principal organ of the voice and then explain in exact detail the nature of its substance. It is composed in part of cartilages, in part of membraneous vincula and simple membranes or tunicae, and finally of muscles peculiar to its own head.

First laryngeal cartilage [cartilago thyroidea]
This head of the rough artery (which I have thought preferable to call larynx rather than guttur) consists first of three cartilages, the first of which (all of figs. 3, 4, 5; g and h in the figures of ch. 40, Bk. 2) is the largest and broadest and is anterior, externally convex [prominentia laryngea] and hollow inside, somewhat like a shield — not round but elongated, such as we see the ancients used in their battles and still see some of the Turks use, especially in ships. For this reason experts in dissection have called it qureoeidh= 7 and laymen “shieldlike” (scutalis and peltalis), and likewise we too shall regularly, when we talk about it, call it scutiform or cartilage like a shield—unless it also seems best to call it the first cartilage. In man, its appearance is bigger in its upper than below, much different from that of cattle and pigs, where it is wider in the lower part but much narrower in the upper, and is less extended forward into a point than the larynx of man. But what has a greater bearing on the appearance is that the human cartilage looks the same on the superior and inferior part. For it puts out two processes [cornua] from both upper (A, B in figs. 3, 4, 5) and lower (C, D in the same figs.) sides, one on each side, and of these the two upper ones [cornua superiora] extend farther than the lower ones [cornua inferiora] and are attached (C in figs 2, 3, ch. 21 Bk. 4) by membranous vincula [ligamentum thyrohyoideum laterale] to the lower sides (E, F in figs. 1, 2, ch. 13) of the hyoid bone. The lower processes of the shieldlike cartilage are united and joined to the sides (E, F in fig. 8, E in fig. 7) of the second cartilage [cartilago cricoidea] towards its posterior surface. This shieldlike cartilage juts out more toward the front in men [prominentia laryngea] than in women, and is more exposed to the touch; it is sometimes double: this is especially observed in males. In its middle (G, H in figs 1, 2, 3), where the cartilage of humans is narrowest and protrudes most towards the front, a line is often extended along its longitude which when carefully cleaned of the fine membranes shows that two pieces of cartilage had been joined to each other even before the dissection. 8 Now this is certainly unique to humans; the cartilage of cattle is simple, and the shape differs considerably from the cartilage of man. I should like this to be carefully observed by architects: for it is remarkable how the scutiform cartilage of cattle resembles the shape of a rampart, and how skilfully it is accommodated to lookouts in its upper edge (because of the separate recesses cut into it), and how aptly contrived to deflect the blows of artillery, just as if it were a portable machine which could be fixed into the ground by its two lower processes as by two stakes and placed in front of an army. 9

Second laryngeal cartilage [cartilago cricoidea]
The second cartilage (figs. 6, 7, 8; i and k in the figures of ch. 21, Bk. 2) is smaller than the first and larger than the third [cartilago arytenoidea], and the greatest part of it is placed back in the posterior parts of the larynx where the food passage (H in figs. 2, 3, 5, ch. 21, Bk. 2; A-D in figs. 14-15, Bk. 5) (which we will call the stomachus with the Greeks 10 ) [esophagus] is brought downward from the pharynx.


For as much as the scutiform cartilage falls short of being a perfect figure of a circle, to that degree this second cartilage completes a circle in its superior and posterior part. In its lower part (K, L in figs. 6, 7) it completes a perfect circle whose anterior beneath the root of the scutiform cartilage we perceive by touch in the front of the larynx. The inner area (I in fig. 6) of this cartilage is perfectly smooth, while its posterior facing the gullet bulges in a long line [crista mediana] (L, M in fig. 8, M in fig. 7) following the longitude of the cartilage as if stretched out in the manner of a spine. 11 This separates the two recesses (N, O in fig. 8) of this cartilage in which are fixed two muscles (P in figs. 6, 7, ch. 21 Bk. 2) [musculi crico-arytenoidei posteriores] attached in a straight line from the second cartilage into the third. The superior surface of this cartilage, where it forms the posterior region of the larynx, comes to an end in two oblong tubercles [facies articulares arytenoideae] (P and Q in figs. 6, 7, 8), one on each side, which you will soon hear are articulated [art. cricoarytenoidea] into the depressions of the third cartilage (V, X in figure 10) [basis cartilaginis arytenoideae]. Also, this second cartilage is joined [art. cricothyroidea] to the first in the manner explained above, when I was saying that the lower processes of the first cartilage [cornua inferiora] join together with it. In order that the connection of these processes will be stronger, the second cartilage swells slightly (E and F in figure 8) at the point where the processes join it, and is thicker; in this protuberant part is seen the recess [facies articularis thyroidea]

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which receives the process of the first cartilage [c. thyroidea, cornu inferius] with great strength. The lower portion of the second cartilage (L in figures 6, 7, 8), where it forms the posterior of the larynx, appears quite thin, more stretched out below than the remaining area of its inferior part. This is so the muscles [mm. crico-arytenoidei posteriores] (P in fig. 6, ch. 21 Bk. 2) may take their beginning from a more remote area, stretched straight along the length of the second cartilage [c. cricoidea] and inserted into the third cartilage [c. arytenoidea]. To this second cartilage no name has been applied, and for this reason we shall call it by a special name, the innominate. But if someone carefully examined its appearance and wished to compare it to the shape of something and finally from that to give it a name, he would discover nothing more fitting to it than that ring of the Turks which they put on their right thumb when shooting the bow, so that with its aid they may pull the bowstring harder. 12 This ring, in the part where it faces the inside of the thumb, resembles the anterior surface [arcus cartilaginis cricoideae] of the second cartilage. But where it covers the outside of the thumb, it is quite like the posterior region [lamina cartilaginis cricoideae] of the second cartilage, as it is possible to see from the picture of a ring which I provide in the margin. 13

Third laryngeal cartilage [cartilago arytenoidea]
The Greeks called the third cartilage of the larynx (figs. 9, 10, 11; l in the figs. for ch. 21, Bk. 2) a)ru/taina and a)ru/tainoeidh/j, 14 because when it is still intact and still overlaid by the membrane or tunic [tunica mucosa] covering the inside of the rough artery, it would be very like that part of a pitcher with which we pour water for people washing their hands. It more closely resembles that part of the mouth of jugs than the wooden shell-shaped vessels with which we see sailors empty bilge-water, 15 or vegetable farmers water gardens. At any rate, if the Greeks seem to have compared this cartilage to vessels or small containers of this type 16 , it was not indeed to the entire vessel, but to its tip. 17 However that may be, all the professors of dissection have described the third cartilage of the larynx as single and simple, though at the same time when freed from its membranes, it is double: it is made up of two cartilages (R and S in figures 9, 10, 11), quite loosely joined together only by ligaments and the membrane surrounding the larynx. One of these rests upon the right side (Q, P in figs. 6, 7, 8) of the second cartilage, the other on the left [facies articularis arytenoidea], possessing a smooth and rather deeply engraved depression (V, X in figures 10, 11), by which it accepts the tubercle of the second cartilage; and so it is articulated so that it can be moved to the inner space of the larynx and then again away from it. This is the most mobile of all the cartilages of the larynx. The base of either cartilage is broad, and comes to an end on its anterior side in a long process (Y in figures 9 and 10) [processus vocalis] extending into the interior of the larynx. The upper parts of these cartilages (Z in figures 9, 10, 11) [cartilago corniculata dextra/sinistra ], 18 gradually draw apart from each other on each side from the base (T in figures 10 and 11) [incisura interarytenoidea], and then become thinner, softer, and fatty and are joined together; the upper part of the right cartilage, being joined to the corresponding part of the left cartilage, forms the area of the larynx (l in figs. 3, 9, 10, 11, ch. 21, Bk. 2) that is like the part of vases by which, we mentioned above, water is poured for the hands. Now in fact this part of the larynx is so soft and pliable that when people vomit it is bent forward into the inner space of the larynx and so perfectly covers the rough artery that not even the least of the vomit slips into the artery itself. Although this third cartilage is a twin constructed of two cartilages, we shall not for that reason count it as two cartilages; but it will be considered just a single cartilage by me as it is by the other anatomists, and will be called the third, so that I might not seem unfairly to confuse the opinions of those who have numbered the cartilages rather than described them.

Operculum of the larynx
In addition to these three cartilages of the larynx there is another, [cartilago epiglottica] (figs. 12, 13; L in figs. 3-6, 11 in ch. 21 Bk. 2), soft and in substance quite similar to the upper part of the third cartilage, 19 which quite elegantly forms the covering of the larynx, precisely keeping any food or drink from running down into the larynx. This covering of the larynx arises from a wide and anteriorly curved base (a in figs. 12 and 13), starting from the inner region of the scutiform [cartilago thyroidea] next to its higher part; proceeding hence inwards (b in the same figs.), it takes the shape of a triangle 20 whose base is formed by the beginning of the operculum [petiolus epiglottidis] from the scutiform [thyroid] cartilage, or its connection [by the ligamentum thyro-epiglotticum] with that cartilage. The apex of the triangle is that part which is drawn inside as if to the region of the gullet. Where this body faces the palate, it is bulging and softer; but where it rests on the larynx it is hollow and concave, and much harder than on its upper part. In its extremity, where it faces the gullet, it is remarkably soft, and overlaid by a fatty membrane [tunica mucosa], somewhat recalling the nature of a ligament; 21 where it is joined to the scutiform cartilage, there is also a great deal of fat 22 , and it does not look as hard there as in its middle.

Lingula of the larynx, or fissure and primary organ of the voice
Many have thought that this is the especial organ of the voice, indiscriminately calling it glwtti/j and e)piglwtti/j: but these names signified quite distinct and completely different parts to the ancient professors of anatomy. glwtti/j denotes the fissure (c in fig. 11 and d in figs. 12, 13, ch. 21, Bk. 2) [rima glottidis] of the larynx which two processes of the third cartilage [processus vocales] (Y, Y in figs. 9 and 10), covered by fatty membrane [tunica mucosa], make in the middle of the laryngeal cavity, and which we shall show in the fifth book is the primary organ of the voice. They called such a fissure glwtti/j or lingula from its resemblance to tongue-like devices which we see assembled out of two layers of reed when a reeded pipe is put together. The other term e)piglwtti/j (compare L with c in fig. 11, ch. 21, Bk. 2) is the name for the covering of the larynx, placed over what we just now called the lingula of the larynx and preventing any food from falling inside it. Now the fact that this is unknown to doctors of our time is not so much their fault, as they follow nothing but the opinions of authors and have no experience of dissection. Indeed, even Celsus 23 misunderstood this matter (as he did a very large number of things having to do with anatomy) and called the operculum of the larynx the lingula, 24


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not reckoning that this had been called e)piglwtti/j by the Greeks because it rests upon the fissure of the larynx which we compare to the little tongue of reed-pipes; or he ignored the fact that there is another place or part in the larynx besides the operculum which we might compare to a little tongue. This operculum also somewhat resembles the human tongue. Moreover, Theodorus of Gaza 25 , misled by the error of Celsus, translated Aristotle’s e)piglwtti/j 26 as lingula, though in fact Aristotle meant the operculum of the larynx and not the part or area which the ancients called the lingula [rima glottidis] and which is rightly considered the principal instrument of the voice. I will pass over how many times in Galen, both by the fault of the translators and of the writers of the Greek copy glw/ttij is read for e)piglwtti/j and vice versa. 27 But I shall pursue this subject more fully in the appropriate place: here it suffices to have treated of the cartilages of the larynx so far as we need for the discussion of muscles in the second book.

The other cartilages of the rough artery, resembling the letter C
I shall deal with the remaining cartilages of the rough artery (figs. 14 and 15), which more or less resemble our letter C [cartilagines tracheales], together with everything pertinent to the rough artery, in Book Six. Now it is time to add the method and manner by which bones and cartilages are prepared for teaching, or are studied through dissection, viz. in accordance with the system by which I shall always append, after a description of the parts, the technique of dissecting them (as I consider appropriate to each occasion). 28


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]