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 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 1 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. 2 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. 3 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, 4 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. 5 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.

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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, 6 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 7 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; 8 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 9 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 10 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. 11 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, 12 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

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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 13 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, 14 from the sacrum. Again, make an identical section between the body of the lowest lumbar vertebra and the upper region of the cartilage 15 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 16 ), 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 17 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 18 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 19 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,

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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] 20 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 21 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, 22 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 23 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. 24 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. 25 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.

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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 26 (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 27 if they are placed severally and unassembled in a box. They are quite useless for assembly, not only because of their extraordinary hardness 28 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. 29 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, 30 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, 31 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. 32 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. 33 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. 34 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. 35 When the round base

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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 36 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. 37 This is why the the distance from the circle to the bottom of the foramen of the sacrum 38 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, 39 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. 40 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 41 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; 42 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, 43 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 44 the skull will not turn every which way for any reason. According to whether you wish to have the face look straight forward

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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. 45 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. 46 One hole is best made in the occiput, and one in each of the temples. Join the lower maxilla to the upper 47 with a brass wire, making the connection with its heads into the depressions of the upper maxilla. 48 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. 49 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. 50 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. 51 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. 52
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, 53 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. 54 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

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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.

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. 55 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 56 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.

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]