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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 39 By What Method the Bones and Cartilages of the Human Body
May Be Prepared for Inspection
A system for soaking bones in lime and then cleaning them in a
stream
Physicians who applied themselves properly to the Hippocratic art, who
were born not just for scribbling about syrups
and
imposing upon people, were in the habit of laboriously assembling bones for
inspection, either joined together or separately, to assist in their teaching.
It was their practice with a person dead of hanging or some other cause first
to free the cadaver of of most of its flesh and to cut out the inner organs
without taking apart any joint of the body. Afterwards, they would put the body
thus dissected into a long box, filling the whole box with lime and then
sprinkling some water on it. Later, when they had observed such a box for eight
days, they perforated it with small openings on each side and tied it down in a
rapid stream so that the lime together with the decaying remains of the flesh
would wash out over time and leave all parts of the bones.
After several days, the cadaver was taken out and cleaned all over
with knives, with care taken that no joint of the bones be separated in the
process and that the ligaments binding the bones (by means of which they stay
together) be kept whole while everything except the joints of the bones would
be shiny. The cleaned cadaver would be exposed to the sun in whatever position
they wished it to be seen, sitting or erect, arranged in this or that posture
so that the ligaments would dry in the heat of the sun and hold the joints in
that position. Besides being unpleasant, dirty, and difficult, this system of
preparation shows almost none of the processes, epiphyses, heads, recesses, and
other such features in the bones that must be viewed with particular care: all
of these are still heavily overlaid with blackened ligaments, to such a degree
that this means of cleaning bones is all but useless for study. In the same
way, another laughable method for viewing muscles, tendons, ligaments, nerves,
veins, and arteries (with which professors of our art until recently afflicted
medical students) is of no use, but only interferes with the minds of scholars
and keeps them from seeking a demonstration of these organs by the High Priests
of the profession.
These authorities
used to declare that the parts were to be learned only from bodies that have
been reduced in running water (heaven help us) but not from the recently dead;
as if anything worth learning could be learned in bodies so modified and
totally ruined in this manner,
and as if the parts
were not all much better demonstrated by us in a person recently dead than they
are accustomed to do when pointing out the surface of the liver, the
intestines, or the heart to students. But this too they taught quite ineptly,
at the same time having nothing to do with the other parts of the body.
A way of preparing bones by cooking
We shall give a sufficient explanation in the appropriate place how the
other parts of the body should be approached. As for the bones, as I shall now
set forth, you will readily prepare them if you are eager to learn and meet
Galen’s chief requirements for a student of anatomy — tolerance of work and
industry.
Get any kind of cadaver somewhere (you will find one wasted with
disease much more satisfactory); be sure a container is at hand for the
disposal of flesh, viscera, and skin and the drainage of blood, together with a
large, capacious cauldron of the sort with which women fire lye: this is most
suitable for cooking bones. The bones will be thrown into this. Next, a large
paper should be stretched on a plank so that cartilages that are not to be
boiled away may be placed one by one on the plank.
Make a circular incision with a sharp knife through the forehead,
temples, and occiput, penetrating to the skull. At the ring made by this
incisvion, cut through the skull with a saw; do not worry about damaging the
brain or dividing the skull a little too high or too low, since at this point
the only purpose is to preserve the bones and cartilages for inspection. After
the skull is cut apart,
the brain should be
removed from it using nothing but the hands and put in the container. The part
of the skull removed from the rest of the head is put in the cooking pot after
the skin of the vertex has been removed. Now cut away each ear very close to
the temporal bone and set it aside on the plank
where the cartilages are placed, together with the eyelids and
the end of the nose, which is made of cartilage; these must be resected very
close to the bones to which they are connected, along with the skin. Then with
a small knife you will free the lower maxilla from its connection with the
bones of the head and cut the cartilages
[disci articulares], which we have
said are particular to its joints with the head, from the ligaments that
contain the joint. Place the cartilages one by one on the paper sheet, to which
they will readily stick. When you take away the lower maxilla, and in the
process free it from the skin and the tongue (leaving, if you wish, the muscle
attachments), and throw it in the cooking pot, be careful not to damage the
hyoid bone or the larynx;
remove the whole larynx with the hyoid bone and part
of the tongue, gullet, and rough artery together from the pharynx and put it on
the plank with the ears, with no further cleaning. Now make a cut from the
point of the breastbone
[sternum, processus xiphoideus] to the pubes,
penetrating as far as the omentum. Next, add another incision extending
transversely from the right flank to the left; like a butcher, pull out
everything
contained in the peritoneum and throw it into the container. While doing this,
you will cut the skin of the abdomen and the muscles away from the bones,
catching the blood with sponges and squeezing it out into the container. Make
your incision from the throat to the point of the pectoral bone deep enough to
penetrate to the pectoral bone so that along with the skin you will be able to
remove the muscles from the ribs and their cartilages that are spread over the
thorax, and so that the clavicles will at the same time appear bare and free of
flesh. These will have to be freed from the pectoral bone with a small, sharp
knife, and the cartilages
[disci articulares] peculiar to
these joints
[articulatio sternoclavicularis]
must be carefully removed (just as you approached the cartilages of the lower
maxilla) and laid each one in turn on the paper sheet. The pectoral bone and
the rib cartilages will be freed carefully from the rib bones, with incisions
made through the cartilages with a sharp, not too thick knife at the point
where the rib bones revert into cartilage
[articulationes costochondrales].
This is readily accomplished if you do not forget that the cartilage of the
first rib is borne more to the side from the middle of the pectoral bone
[manubrium sterni, incisura costalis
I] than the
cartilage of the second rib. Not only must the cartilages attached to the
pectoral bone be separated from the ribs, but all cartilages of the false ribs
as well, which will attach to the upper cartilages
[cc. costales I-VII] with the aid of
intercostal muscles. After the cartilages have been separated in this way, lift
the pectoral bone away from the throat and free it from the veins and arteries
going to it from the throat, and from the membranes
[pleura parietalis] that separate
the area of the thorax. Finally, resect the cartilages from the transverse
septum
[diaphragma] and without cleaning
them further place them with the pectoral bone on the paper before cutting the
scapulae and clavicles from the thorax. Now with a long incision in one arm
from the acromion through the upper and lower arm to the thumb, strip the
scapula, humerus, forearm, and hand of skin and flesh, without worrying too
much even if some portion of tendons and muscle is still left hanging from the
bones. It will also suffice if some skin is left on the hand to cut it with
some incisions here and there so that the hand can be boiled more easily later.
Now cut the clavicle from the acromion, noting whether a third bone occurs
besides the process of the scapula, which we call the acromion, and the
clavicle. When you have done this and placed the special cartilage
[discus articularis] of this joint
[art. acromioclavicularis] on the
sheet of paper, throw the clavicle in the cooking pot and separate the scapula
from the humerus and the humerus from the bones of the forearm. Preserve the
joint of the forearm
[art. radiocarpalis] with the hand
and place everything together in the cooking pot. But before the scapula is put
into the pot, you will do well to separate from it the cartilage
[labrum glenoidale] that sometimes
enlarges the socket of the scapula where the head of the humerus is received
and put it on the sheet with the other cartilages. This should be likewise
performed on the arm of the other side. Move directly afterward to the thorax,
from which you will first excise the lungs with the heart and the transverse
septum
[diaphragma]; before you throw the
heart in the container, divide the base of the heart transversely from the
remaining body of the heart, and then in turn remove the base from the vessels
that go out from it in such a way that you keep the orifices of the arterial
vein
[vena cava] and the great artery
[aorta] undamaged. Afterward, if you
wish, put these on the sheet among the cartilages and preserve them.
When the remaining items
in the thorax have been found, throw them in the vessel, turn the cadaver face
down, and clean the neck and the rest of the spine together with the entire
width of the thorax as well as you can of flesh,
taking special care not to break a rib (they are fragile) or
damage a spinous process by cutting out flesh too close to it. This must
especially be avoided when you are about to free individual ribs from thoracic
vertebrae. With
the cadaver turned back to the
supine position, the capitulum of a rib
[caput costale] must be separated
from the recess
[fovea costalis superior, f. costalis
inferior] of the
vertebral body with a sharp knife, and then when the ligaments have gradually
been parted, the ribs must also be removed from the vertebral processes
[proc. transversi], given a
preliminary cleaning, and placed in the cooking pot. Handle the legs in the
same way you approached the arms, cleaning the entire femur of flesh, then the
lower leg and the entire foot. But when you expose the knee, cut out the
patella
from the tendons
[m. quadriceps femoris, tendo et lig.
patellae] occupying
the anterior part of the knee and throw it into the cooking pot as you did the
femur as soon as you freed it from the hipbone and the lower leg and resected
the cartilages
[meniscus lateralis, m. medialis] which augment the
depressions of the tibia that receive the heads of the femur. These too you
should take the opportunity to add to the sheet. Then put the tibia, together
with the fibula and the foot, in the cooking pot. When this has been
accomplished for each leg and the bones
[os coxae] attached to the sides of
the sacrum have been somewhat cleaned up, the cartilaginous ligaments between
the bodies of the vertebrae
[disci intervertebrales] must be
precisely cut out and placed in order on the sheet. After taking a sharp knife
to remove the ligaments that cover the surface of the vertebral bodies
[ligg. longitudinale anterius et
posterius], make an incision between the top of the sacrum and the
cartilaginous ligament
[discus intervertebralis] which
comes between the sacrum and the lowest lumbar vertebra so as to part the
ligament, or, as it seemed to Galen, the cartilage,
from the sacrum. Again, make an identical section between the
body of the lowest lumbar vertebra and the upper region of the cartilage
just mentioned; in this way
you will remove the cartilage in one piece. When you have put it on the sheet,
remove the others until you come to the second vertebra
[axis] of the neck. When you have
put twenty-three cartilages or cartilaginous ligaments in this way on the
sheet, the spine should be divided into three or four parts: carefully and
gently, so as not to use force and accidentally break a vertebral process.
Attention must be taken not to be careless and try to separate the first
vertebra from the head. It is all right to put the cervical vertebrae in the
cooking pot together with the head and the thoracic together with the lumbar
vertebrae, so long as you first separate them from the sacrum. There is no
reason not to put the sacrum in the cooking pot together with the bones
attached to them (which make up the iliac, hip, and pubic bones
), since the iliac bones are still raw and hard to separate from
the sacrum, and the cartilage of the pubic bones
[discus interpubicus] would in that
case be damaged; you will keep it intact if you put the pubic bones in the
cooking pot unseparated.
After the bones have been thus placed in the cooking pot, it is
completely filled with water so that the bones subside deep into the water and
no part of a bone protrudes. This precaution must be taken above all throughout
the period of cooking, lest any bone be uncovered with water, and more
important, that it not absorb smoke as it projects from the pot. For this
reason it is recommended that the pot be large. No special technique is
required for the cooking process as a whole except as in all boiling the foam
should be carefully removed to make the broth clearer and the bones themselves
less dirty when you take them out. For the same reason, all grease (of which a
good deal
floats to the top) must be drawn
off and be put in some vessel, if only for the sake of the common folk who set
great store by it for removing scars
and
lengthening nerves and tendons. No time is prescribed for cooking, since it
varies considerably with age. The bones of small children in particular tend to
be cooked two or three hours longer than necessary, since care must be taken
with them lest the epiphyses fall off during cleaning; their attachments
in people of more advanced age are scarcely
ever dissolved no matter how much you cook them. The objective of cooking is
that the bones be able to be cleaned readily with knives, as if while eating.
To do so more conveniently, carefully remove some bones with tongs while they
are cooking and clean them by yourself — unless perhaps there is a willing
friend at hand to lend a hand to the task. The greatest care must be taken lest
someone less experienced with bones damage the brows, processes, heads, and
recesses by scraping, or carelessly remove a smooth cartilage
[c. articularis] covering the bones
like a coating. This especially must be preserved while you take off the flesh,
ligaments, tendons, and membranes
[periosteum] surrounding the bones.
It is not for this reason alone I should wish this task not entrusted to
someone unsuitable and careless of Anatomy, but so that when you strip each
bone separately you will closely examine its recesses and heads, and especially
the nature of ligaments, the insertion of tendons, and the origin of muscles. I
could not easily tell you how great a knowledge of the parts you will acquire
in this work. When you duly extract the bones in their turn from the seething
broth and after cleaning place them on the ground or in a basket, do not worry
too much what bone comes first. But watch carefully when you take out the hand
with the bones of the forearm that you do not separate the carpus from the
bones of the forearm too violently: part the ligaments of the joint gradually
with a knife, and carefully free the carpus from the bones of the forearm. Do
likewise in separating the metacarpal bones from the carpus. You should be
careful not to separate the carpal bones from each other: detach the carpus
straightaway in one piece from the forearm, the first bone of the thumb, and
the metacarpus; pull away only the tendons and ligaments attached to it, being
careful not to clean the bones completely of ligaments on their inner and outer
surface so that the carpal bones will hold together by means of their
ligaments. For when the carpus has been put by the fire in this condition,
the ligaments will dry slowly and hold its bones
together firmly; it will then be easier to attach the carpus to the forearm and
metacarpus in assembling the bones — unless perhaps you are trained in
articulating bones and dare to disassemble the carpal bones, clean them of
ligaments, and afterward join them together with brass wires, or even wish to
keep them separate. As soon as you have put the carpus in this way near the
fire, take a sheet of paper on which to put the carefully cleaned metacarpal
and finger bones (do not overlook the sesamoid bones) so that these can be
rolled in it and not add to the work of assembling the bones by becoming
confused with the bones of the other hand. It will help to wrap the bones of
the hands and feet in four separate sheets of paper. Before wrapping the bones
of this or that hand or foot in the paper, you should always try to find out
first whether a bone is left over which has not been cleaned, lest when you
have the residue and the broth thrown out you accidentally let some bones be
carried away. If you decide to save a nail, pull it out when you are cleaning
the hand and foot bones. We see human nails no less than those of birds or
quadrupeds disappear from feet placed in hot water for boiling. When you clean
the ulna and radius, do not neglect the cartilage
[discus articularis radioulnaris]
which starts from the radius and is what chiefly separates the ulna from the
carpus. This should be freed from the ulna so that it will still be attached to
the radius and may again come between the ulna and the carpus when the bones
are articulated. When you clean the skull, take the utmost care that when you
pull off the membrane
[membrana tympanica] covering the
foramen of the organ of hearing, you do not inadvertently remove the ossicles
[malleus, incus]
that go
into the construction of this organ. They must be painstakingly pried loose
with a stylus inserted into the foramen and then shaken out. Add these ossicles
to the remaining collection of bones and put them away somewhere. Take all the
vertebrae as well as the sacrum out of the broth last of all, unless you want
to free the coccyx from the sacrum after a little less boiling: its ossicles
[vertebrae I-IV] become detached
from each other when the cartilaginous ligaments
[disci intervertebrales] that join
them are cooked too long. If, however, you take out the sacrum in order to cut
off the coccyx, it must be put back in the cooking pot and the coccyx placed
separately on the sheet of paper or in the basket where you are placing the
small ossicles; so also the teeth, if any of them has fallen out, or any piece
of a bone accidentally broken. To preserve the cartilage of the pubic bones,
before you free the iliac bones from the sacrum, the pubic bones must be gently
cleaned
on the anterior and posterior surfaces
and then separated using only the hands so that the intervening cartilage
[discus interpubicus] will separate
from one of the bones and remain attached to only one. It will easily be
attached to the other when the bones are assembled. Make a count of the bones
that have been cleaned in this way — not the bones of the hands and feet which
you wrapped in paper and set aside; but include the part of the skull which you
removed from the rest of the head with a saw. Consider whether small pieces of
the temporal bones,
which are attached like scale to the bones of the vertex and
have a way of being taken off by the saw from the rest of the temples, have
fallen away in the course of boiling: do not have them discarded with the bone
residues
and the broth. They readily fall off the
bones of the vertex if by chance the saw cut has been made much above the ear.
Consider next whether a tooth has fallen from the upper or
lower maxilla, and count the twenty-four vertebrae and the same number of ribs,
two clavicles, two scapulae, two humerus bones, two ulnas and two radii, and a
sacrum, from which the coccyx has already been removed; two large bones
[ossa coxae] knit to the sides of
the sacrum, two femora, two bones of the tibia, two fibulae, and likewise two
patellae. When you have counted everything, it will be a very good idea to
immerse the bones again in clean boiling water, take them out soon and wipe
them one at a time with a rough, coarse cloth. If there are any remains of
ligaments, membranes, or the insertions or origins of muscles, they should be
rubbed off and wiped away, taking care that no slippery cartilage
[c. articularis] attached like a
coating on the bones be removed at the same time. While these are being gently
dried, placed in a circle around the fire, the cartilages of the ears
[auricula] should be stripped of
skin and placed on the sheet of paper with the other cartilages. The same
should also be done for the cartilages of the eyelids
[tarsus superior et inferior] and
nostrils
[cartilagines nasi]; then with
small, sharp knives, clean the hyoid bone of the muscles attached to it; it
should be as completely raw as possible. Having cleaned that bone, carefully
free the cartilages of the larynx, likewise raw, of flesh and membranes, along
with one or two C-shaped cartilages of the trunk of the rough artery
[trachea]. Now clean the pectoral
bone with care and the cartilages
[cc. costales] attached to it. This
will be hard to do, as it has several membranes covering it and is fatty; but
it should not be cooked, and scarcely splashed with hot water. When you strip
the cartilages of flesh, be careful not to remove the membrane
[perichondrium] immediately covering
the cartilage and resembling it, which because it surrounds the bone is called
perio/steon by the Greeks.
When this membrane has been removed from
the cartilages, they are more weakly attached to the pectoral bone and become
shrunken, short, and crooked. To prevent these cartilages from contracting, the
pectoral bone should not be dried near the fire but elsewhere until you are
ready to assemble the bones, in a place not too damp lest the cartilages become
too flaccid and afterward distort the structure of the thoracic bones.
For there is absolutely nothing which mars the
elegant construction of a skeleton so much as a pectoral bone and its
cartilages if they have been carelessly attended to, and are not allowed to dry
out after the bones have been assembled, rather than before. The other
cartilages, which have been placed on the paper, may be placed somewhat near
the fire, but not so much that they are pulled out of shape, since it is better
that they too dry after being fastened together. Now it is possible for you to
assemble the bones and cartilages in the manner which I shall soon state, or
keep them separate — which will be far preferable if there is to be a need for
bones attatched or unattached.
What bones are most useful for teaching
Unassembled bones, placed individually in a long box, can be viewed
separately at any time and can teach everything bearing on the knowledge of
bones. When assembled and set upright, they do not show the depressions and
heads of the bones so well, and to tell the truth they are more conducive to
display than to teaching. The bones best suited to teaching are those which
have been removed from Italian graves built like storage cabinets
(as they nearly all are here) and put beneath an impluvium
or at any rate exposed to the breeze in such a way that from time to time they
receive rainwater. Besides the fact that such graves are damp, water often
comes in as well; as a result everything attached to the bones very quickly
rots, so that when removed after a few years and rinsed off they are quite
intact and show everything that needs to be seen
if they are placed severally and unassembled in a box. They are
quite useless for assembly, not only because of their extraordinary hardness
but also because the cartilages of the ribs and the
whole body are destroyed; if any are found they are brittle from decay and
everywhere separate from the bones. Also useless for this purpose are bones
which are dug from the ground in other nations and piled in heaps in
cemeteries. Besides the fact that they are affected with decay because of the
dryness of the earth, you will never find all the bones of the same person as
you will in the graves I mentioned earlier, even in the cemetery of the
Innocents at Paris.
There if anywhere you will
find a great many heaps of bones which are dug from the earth. When I was first
learning the bones with Matthaeus Terminus, an outstanding physician in all
branches of medicine, and, while I live, my most learned companion in the
pursuit of studies,
these heaps supplied
us such a rich abundance of bones that once instructed by the long and tireless
habit of inspecting them, we sometimes dared to wager with our friends that
even blindfolded, no bone could be handed us from so many heaps for the space
of a half hour but we could distinguish by touch what kind it was. We had to do
this the more intensively as we were at a loss for instruction in this part of
medicine, eager though we were to learn.
How the cleaned bones should be joined
As for the assembly and erection of cooked bones, these must be joined
together soon after cleaning (lest they harden too much). Immediately after
cooking, the bones are easily perforated with nothing but awls with which shoes
are pierced for sewing,
and are tied together with brass
wires. Each person will accomplish this with his own skill according to the
diligence of his hand and his attention to what we have described so far in
this entire book. First, after some awls have been obtained and brass wire of
heavier and lighter gauge, let the wire be placed in the fire to make it more
pliant and resistant to breakage no matter how variously twisted.
To
these will be added two holders or forceps: one with which the wire will be
twisted, the other with which the twisted wire will be cut off.
Begin the articulation of bones from the feet; first join the
talus to the calcaneus, then the cuboid bone to the calcaneus, the navicular
bone to the talus, and the three inner bones of the tarsus
[ossa cuneiformia] to the navicular.
To these then attach the metatarsal bones and to them in order the bones of the
toes along with the sesamoid bones. Perforate these carefully with a thinner
awl the harder and more solid they are and the more easily divided and split by
the action of the awl. When you have articulated both feet, the protuberance of
the tibia
[tuberculum intercondylare] which
separates the recesses that take the heads of the femur must be perforated with
a long but narrow knife.
This opening should be
big enough to receive a hard rod which will be pushed into the femur like a
spike and thus join the tibia to the femur, as we see beams attached without
glue. An extra hole must be made in the lower end of the femur aligned with the
one that I wished made in the tibia so the same rod may be inserted in the
femur and the tibia and by this means the joint may remain unbent at the knee.
But besides this rod, the femur must be joined to the tibia on each side with a
heavy wire, so as not to leave out the cartilages
[meniscus lateralis, m. medialis] that enlarge the
depressions in the tibia. When these bones are joined and fastened together
with them, the cartilages will be kept in the knee joint. The fibula will then
be attached to the tibia above and below, and the patella secured to both femur
and tibia. When this has been accomplished on both legs, the iliac bones must
be bound to the sides of the sacrum with a heavy wire, and then the pubic bones
must be joined with their cartilage between them. Now there will be at hand a
round plank upon which the bones will be erected. The diameter of this plank
should be sufficient for the feet to be properly secured to it in whatever
position you decide to erect the bones. A hole is made in the center of the
plank so that when you put away the bones in an upright case the bottom of the
case will have an axis which, when put into the hole, will allow the circular
base to turn. Besides this hole, another is made near the plank’s circumference
into which a piece of wood can be fitted that is made like a weapon, spear, or
scythe (however seems best) to support the hand of the skeleton.
When the
round base
has been set up in this way, attach the
feet to it, and with the aid of an assistant make sure the remaining leg bones
rest on top of the feet. Then place the heads of the femora into the acetabula
of the hipbones so you can accurately measure with a string or a rod the
distance from the circle to the lower part of the foramen
[canalis sacralis] incised in the
sacrum for the dorsal medulla. This distance will tell you how long the iron
rod must be made which will be fitted to the round base and put into the
foramen of the sacrum and the vertebrae that carries the dorsal medulla, and
will handsomely support all the bones. The iron rod must be prepared so it can
be firmly nailed into the middle of the circle; from the round base to the
lowest part of the foramen
[hiatus sacralis] just named it may
be rounded or square. From there upward it should be wider than it is thick, so
that later it can be bent to the curve of the spine and the vertebrae fitted to
it
so as to be immovable and never turn upon it. For this, the iron
should first be made thin where the sacrum must be supported to keep it from
slipping downward. Unless this bone is secured and supported, the remaining
vertebrae will gradually subside along with it, and over time the legs of the
skeleton will be awkwardly bent.
This is why the the distance from the circle to the bottom
of the foramen of the sacrum
must be carefully measured. The length of the remaining rod is
not so important since it can easily be cut off after the bones are assembled
if it is too long. Even if you have decided to put the skeleton in a case, it
will be very useful that a rod be made more or less two palms longer than the
whole skeleton so that the part of it extending beyond the top of the head can
be put in the hole at the top end of the case and turned therein. When the rod
has been fitted perpendicularly in the round base, take a sharp knife and
slowly carve out the foramen of the sacrum made for the dorsal medulla so the
rod can easily be pushed into it. Since this foramen is naturally too tight and
quite oblique, it does not admit the rod unless it is enlarged as we have just
stated to enable you to push the rod through from its point to the part of it
which we said should be made no longer round or square. If this part seems
unsuited for supporting the sacrum, it will be worth the trouble to roughen
this part of the rod with a file and wrap a nodule on it with brass wire which
will readily support the sacrum. Once the sacrum is supported in this way,
bind the heads of the femur into the acetabula of the hipbones with
a heavy wire, carefully considering how much you turn the femora outward or
inward, lest you attach the legs with an unsightly twist, or the patellae face
the inside of the legs rather than the front. This will surely happen unless
you join the heads to the sockets correctly.
But however you do it, the wire must not be twisted too much in
this connection before you fasten the feet to the circlar base and to the
tibiae in the position that looks most elegant to you. You will determine this
best from the shape of the staff on which the hands will be steadied. A scythe
calls for one position, a spear another, another still a pike, or a Neptune’s
trident, or some other instrument. All the vertebrae must be fitted in order;
observe the place and order of each, which is not hard to ascertain: the shape
of the vertebrae and the manner of articulation will readily show this. As soon
as you have put them all in order on the table, join the five lumbar vertebrae
at two connections made in the side
[proc. articularis superior et
inferior] of the bodies; these should include the cartilaginous ligament
[discus intervertebralis] which we
have said comes between the vertebral bodies. These ligaments should be taken
up in order from the paper on which they were laid, always leaving behind the
one that lies between the vertebrae which you are not connecting. Of such a
kind, for now, is the ligament or cartilage between the sacrum and the lowest
lumbar vertebra and the one that comes between the highest lumbar and the
lowest thoracic vertebrae. After the lumbar vertebrae have been joined, the six
lower thoracic vertebrae and then the six upper will be connected to the lower
cervical vertebra. The remaining cervical vertebrae do not need to be connected
to each other, but the cartilage
between them must be only glued to the body of the lower
vertebra. Though the cervical vertebrae are not even attached but only placed
around the rod, they keep their place; they have no need to be immovable like
the thoracic vertebrae that support the ribs. When you attach the vertebrae in
the manner suggested, before the rod is put through them, place the attached
lumbar vertebrae on the rod and carefully bend it to their position and
curvature;
then connect the lowest vertebra to
the sacrum in the same way you previously joined together the lumbar vertebrae.
Then add the lower thoracic vertebrae to them, always bending the rod as
accurately as possible as necessity requires,
and attaching the lowest thoracic vertebra to the
highest lumbar. The upper thoracic vertebrae will be added in the same way and
the lowest of these attached to the highest of those just now placed on the
rod. Insert a rather wide, long stick, stained black, placing it along the back
part of the rod as low as possible between the rod and the vertebrae to hold
the vertebrae more firmly against the rod and to prevent them from being turned
in any way, lest afterward the whole thorax be able to turn this way or that in
an unsightly way. To attach the skull to the rod, it is necessary for the
vertex to be perforated with a hole exactly matching the width and thickness of
the rod, so that when you have put the rod through it
the
skull will not turn every which way for any reason. According to whether you
wish to have the face look straight forward
or
sidewise, this foramen should be carved with a knife either transversely or
obliquely. Similarly, the skull should again be perforated so that the cut
which you made in the skull with the saw may be closed with straps and when
desired the skull can be removed from the iron rod and dismantled again.
It is extremely useful to look into the
inner cavity of the skull where the brain is contained. To make this possible,
both parts of the skull should be perforated with three matching holes, using a
red-hot iron or the point of a knife.
One hole is best
made in the occiput, and one in each of the temples. Join the lower maxilla to
the upper
with a brass wire, making the connection with
its heads into the depressions of the upper maxilla.
But since this connection is
not strong enough to bring the teeth together precisely, the lower maxilla
hangs down, and it is elegant to have it open and close. In addition to the
connection mentioned, the acute processes of the lower maxilla should also be
perforated and a string tied to them which is threaded under the jugal bone and
rests on the vertex. It can be pulled now toward the forehead and now toward
the occiput, and in this way the teeth can be snapped shut. But however that
may be, the greatest care should be taken with the iron rod that it not be
ineptly bent backward and forward and support the body in an unbecoming way.
To prevent this, it
is quite important to know the course of the backbone. Now is the time to
attach the ribs to the vertebrae and their cartilages. To do this exactly and
with care, first separate all the right ribs from the left, basing your
conjecture on the depression
[sulcus costae] in which the vein,
nerve, and artery are extended out along the ribs, as well as on the upper
surface of the ribs, which is wider and thicker than the lower. Then put the
ribs in order on a table in more or less this way ((( ))), taking care that the
right ribs match the left. It will be easy to put each in its place if what we
said above about distinguishing the ribs is not forgotten. From this row of
ribs attach the first rib of each side to its cartilage on the pectoral bone;
then give your partner the pectoral bone and its cartilages to hold in place,
and tie the first ribs to the transverse processes of the first thoracic
vertebra. Connect the second ribs to their vertebra and after that to their
cartilages, and so all of them in order, seeing to it that you allow those ribs
to stay apart over their entire length which prior to dissection had been
separated from each other by cartilages.
Now tie
the humeri to the scapuli with a heavy wire, and after that the clavicles to
the acromia with a thin wire, the scapulae to the ribs, and the clavicles to
the pectoral bone. But when you attach the humeri to the scapulae, it must be
considered in what position you want the hands placed. For at this point it
makes a considerable difference how the head of the humerus is attached to the
depression
[cavitas glenoidalis] of the
scapula. The cartilage
[labrum glenoidale] by means of
which the depression of the scapula is sometimes augmented must not be
overlooked in this attachment; so also the cartilages
[discus articularis] peculiar to the
joints of the jaw and the clavicle are not neglected and are attached to their
joints. The bones of the lower arm must not be attached to the humerus before
the entire hand has been connected. The radius must be tied to the ulna above
and below.
If the carpal bones are separated
and free of their ligaments, they must be connected to each other; otherwise
they are sufficiently held together by their own ligaments. To their lower end,
attach the first bone of the thumb
[os metacarpale I] and the four
metacarpal bones, and then to these the bones of the fingers
[phalanges] together with the
sesamoid ossicles. Finally, join the carpus to the radius, then the ulna to the
humerus. When this has been accomplished for both arms, tie the hands to the
staff which I said must be firmly attached to the circular base like a sickle
or otherwise set up. With the bones now erected, a necklace may be made from
the hyoid bone, the ossicles of the organ of hearing, the cartilages of the
rough artery
[trachea], the ears and the eyelids,
and from a nail and the cartilages of the heart, all of these being attached to
a little chain or the dried sinew of a leg or arm.
From this it is clear with how little trouble the bones of the human
body, extremely desirable for a physician, can be prepared: a task in which
nothing will seem to a person who has not attempted it more difficult than the
actual connecting. But it turned out well enough when I first tried it, taking
my example from people I had occasionally seen putting together broken dishes
and stone crocks, will have fair results. Its effectiveness in medicine for
softening had taught me the technique of cooking. When I returned from Paris to
Louvain because of the commotion of war and I walked out with Gemma Phrysius,
equally celebrated as a physician and a Mathematician with
very few peers, to look at bones at the place where (to the great convenience
of students) everyone who had been subjected to the ultimate punishment was
exhibited to the rustics on a public road, I came upon a cadaver dried out in
the same way as the bandit had been that Galen says he had seen.
In the same way the birds had freed that corpse
of flesh, so I imagine they had cleaned this one as well, because the man had
been only scorched with straw the year before and toasted, as it were, then
tied to a pole. Such a fine feast had he presented to the birds that his bones
were everywhere bare and held together by the ligaments alone, with only the
origins and insertions of muscles preserved. This never happens in the cadavers
of those who have been hanged, since on account of the thickness of the skin
the birds tear nothing apart but the eyes (though the common folk think
otherwise). The skin being undamaged in such cases, the bones are affected with
decomposition within and are quite useless for study. Looking as I did at a
dried-up body that was nowhere damp or dirty, I did not pass up this
unanticipated opportunity, for which I had often looked. With Gemma’s help I
climbed the pole
and pulled a femur away from the
hipbone, and as I pulled, the scapulae followed, along with the arms and hands;
but the fingers of one hand, both patellae, and one of the feet were missing.
When after a series of secretly repeated visits I had brought home the arms and
legs (leaving behind only the head and trunk), in order to get the thorax which
was secured up high by a chain, I let myself be locked out of the city at
night; so ardent was I with longing and zeal for obtaining bones that I did not
shudder to pull away what I was looking for at midnight in that multitude of
bodies, climbing up the pole with no small labor and industry, with no
witnesses present. Taking far off the bones I had removed, I hid them in a
secret place, and piece by piece I brought them home the following day through
another gate of the city. When I began to cut away the ligaments, I made no
progress on account of their extraordinary hardness and was compelled to soften
them in scalding water. And to fulfill my hope, I finally boiled all the bones
in secret, and having cleaned them in this way I built the skeleton which is
preserved in Louvain at the home of my very best friend Gisbertus Carbo, a
prominent physician trained in many disciplines and my comrade in studies since
boyhood. With such speed did I prepare this skeleton, acquiring elsewhere a
hand, a foot, and two patellae with no less labor and industry, that I
persuaded everyone I had brought it from Paris. By this means I evaded all
suspicion that the bones had been stolen. The burgomaster of the city was
afterward so well-disposed to the studies of medical students that he was glad
to grant them any corpse; he himself had no ordinary knowledge of anatomy, and
he was an eager spectator whenever I gave an anatomy there. When, therefore,
sucess so quickly attended our first efforts, what now must we think lies
ahead, after we have described the method of assembly to others as well? In
addition to the plates now to be added, are skeletons on display in several
universities, thanks (if you will) to me? Not only should the bones of humans,
but also of apes and dogs, on account of Galen, and for Aristotle’s sake the
bones of birds, fish, and reptiles, joined together or at least in pieces — all
should be available to the student of medicine and natural philosophy. Unless
perhaps we think this part of philosophy has nothing to do with us and persuade
ourselves that it is enough if without Anatomy we can impose on mortals with
our syrups, and fill our cash-boxes.
Appendix: Vesalius’ Bow Drill To Perforate Bones for
Articulation
Now whenever there are harder or dryer bones than can be freely drilled
as people do who pierce a hide with an awl, it will be fitting to apply to the
job an instrument which I have sometimes prepared for this purpose when I have
encountered extremely hard bones that are most agreeable to view because of the
dry temperament of a man of middle age.
In this figure we have illustrated an instrument with which
hard bones can easily be pierced. A and B identify two posts which can be
inserted into a table or workbench at an angle; C,C are the shaft, D the part
of the shaft in which the iron is inserted like a pin. E is the bow with which
the shaft is rotated.
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I took two posts about three palms in length and about three
fingers thick, which were then pierced with a round opening not far from one
end big enough to admit a thumb so that a shaft about three palms long and a
thumb’s thickness at its ends but of double thickness in the middle would turn
in them; this shaft was smoothly rounded so that the ends would fit the holes
in the posts and would turn in them easily and the middle thickness would hold
the shaft so that when the posts were forced into the angle of a table or
workbench along the longitude of this thickness and tightened with the shaft
fitted into them, the shaft would be able to rotate only within the posts, and
would not be moved forward or backward. In this way, one end of the shaft was
smoothly rounded like a thumb for a length of about three fingers’ breadth; but
for four or five fingers’ breadth, twice as thick. The rest of the shaft was a
thumb’s diameter so as to project beyond the other post and for a distance
beyond the width of the table or workbench; into it an iron bit would be
inserted with which I would pierce the bones, sometimes taking a thicker bit,
sometimes a thinner one according to the task, following the method used by the
men who daily prepare beads suited for pious counting in Lord’s Prayers and
salutations to the holy Virgin.
The middle diameter of the shaft, situated between the
braced posts, was perfectly smooth so that a slender thong would more easily
turn around it; this was wrapped once around the shaft and tied to the ends of
a long rod as on a bow, so that when the rod was moved up and down as in
playing the lyre
the shaft with the iron bit placed in it would rotate in
the posts and perforate the bone which I would hold in my right hand. Pierce
the bones with the aid of this instrument or of awls alone; have brass wire
ready, some thicker, some thinner; it should afterward be put in the fire until
it glows for awhile to make it more flexible and less often broken no matter
how much it is twisted.
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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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