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 6 On the Eight Bones of the Head and the Sutures Connecting Them

Appendix C: The cuneiform or sphenoid bone (1555 pp. 39-41)

Toward the sides and in the temporal hollows [fossa temporalis] it is thin, extremely solid, and dense. But in its middle [os sphenoidale, corpus], and still more at the base of the head, it is by far the thickest of all the bones of the entire head, though by no means at the same time the densest and most hard. For in the middle of its thick part [corpus], between the surface coterminous with the brain or the hard membrane [dura mater] of the brain, and the surface which faces the cavity of the mouth, rather like the hollow images which we see poured from wax, it is empty and hollow [sinus sphenoidalis] almost in the same way as the frontal bone [sinus frontalis] near the brows is empty, or the fourth bone of the upper maxilla [sinus maxillaris] where the sides of the nostrils are located. This is partly for the sake of the voice and partly to avoid weighing a person down with too much weight as they would if they were solid all the way through, though their thickness is necessary for the common use of the bones. 137

The nature of the middle region of the cuneiform bone

The region [corpus] of the cuneiform bone that is hollow in this way thus shows two distinct chambers [sinus sphenoidalis] (C, D in figure 8) separated by a thin, bony septum [septum intersinuale sphenoidale] (E in figure 8) in whose lower portion, where it is split as it were into two, there is a small chamber (G in figure 8) just as if the septum in this hollow place were promoting the strength of the bone as a whole like a wall in the middle of a house. This cavity is covered by a continuous plate and is never perforated except into the cavity of the nostrils, to which it extends via two foramina [apertura sinus sphenoidalis] (one of them marked F in figure 8) that admit air. Nothing but air is contained in this cavity, along with some soft medulla 138 not proportional in size to the spaces in which it is contained. If these chambers [sinus] are ever not present in certain skulls, Nature has provided for the thickness of this bone in the same way (this is in the figure inserted in chapter 1 at A, B and L, L, m) as the ankle, the heel, or the appendices of these bones are formed. For in such a case it is made porous inside like more solid and compact pumice or sponge [osseus spongiosus], and on the surfaces of its structure continuous but not thick plates [osseus compactus] are drawn over it. Whether the thick part of the cuneiform bone is composed in this fashion or contains the chambers, its inner surface [sella turcica, fossa hypophysialis] (where M is located in figure 3, chapter 12) which faces the brain, I never see it rough, porous, or full of little foramina when the bones are healthy and undamaged by decay, 139 but smooth like the neighboring surface of the head. This interior surface // 1555 p. 40 // of the cuneiform bone (M in figure 3 chapter 12) has a broad depression containing a gland [glandula pituitaria] (A in figures 16 and 18, book 7) by which phlegm is dripped into the brain. The most prominent parts [sella turcica, processus clinoideus anterior, et p. clinoideus posterior] (the four angles around M in figure 3, chapter 12) of this depression are like four processes to which the hard membrane [dura mater] of the brain is strongly attached and which somehow or other resemble the lower part of a litter or table and are therefore called klinoeidei=j (clinoid). From this depression, two oblong depressions [sulcus caroticus] (O, P in figure 3, chapter 12) run off in both directions in which the sleep arteries [a. carotis interna] (c, c in figure 16, book 7) lie, and through which phlegm is seen to run down to the foramina (G, H, Q, R, S, Y in figure 3, 140 chapter 12) which are carved out chiefly to transmit separate veins, arteries, or nerves, and to certain fissures 141 (N in figures 2 and 3, chapter 12) common to the cuneiform bone and temporal bones. I shall deal with the foramina and depressions on the entire skull in the twelfth chapter; here, however, passing mention is necessarily made of some of these for an account of the cuneiform bone, to make it clear that this bone does not seem to me full of pores on the surface near the brain or without a covering of a plate or smooth bone [osseus compactus], or that it resembles pumice or sponge [osseus spongiosus]in the way that a broken-off epiphysis does (A in the figure inserted in chapter 1), or the bone of the vertex between its plates (like ai between ei and oi). 142 Now many people, more given to the opinions of writers than to the truth, quibble that I am unwilling to see such small foramina, thinking that phlegm must percolate through the pores and small foramina resembling spongy fabric (as Galen taught); 143 and some, while considering my view about the purging of phlegm, believe Galen thought otherwise because they have persuaded themselves that in the ninth book of De usu partium the word h)qmw=, i.e., seive or colander, was written there by copyists and scribes instead of sfhni/ or wedge when Galen, while explaining the exit of phlegm to the palate, says that the gland [glandula pituitaria] into which the phlegm of the brain is dripped is received from the cribriform bone [os ethmoidale, lamina et foramina cribrosa]. It is just as if Galen had “not even in a dream” (as they put it) thought that the phlegm in the cuneiform bone percolated through the pores and torturous foramina that do not pass directly through it, that is, if it had been read that the gland was received from the wedge-shaped bone [os sphenoidale]. But at this point in the description of the cuneiform bone, as nowhere else on the occasion of some term or another which may be wrong-headed, I do not disagree with Galen. For however much a recently used term may change, the meaning of an entire book could not be so vitiated that we would not be able somehow or other to follow Galen’s meaning. When Galen in the eighth book of De usu partium stated (inaccurately) that the organs of smell [tractus olfactorius] (C, D in figure 12, book 7, L, L in figure 13; but they are not hollow like channels) put forth processes like nerves from the anterior parts of the front ventricles of the brain [ventriculus lateralis] (LM, LM in figure 4, book 7), and of two channels like phlegm when it comes out a little more profusely than it should, diffuses it to the small foramina [lamina et foramina cribrosa] (I over L in figure 3, chapter 12 and D, D, G, G in figure 13 book 7) carved out to transmit odors, and saying that phlegm percolates through them, he has distinguished the time of painstaking percolation from the time of passage when something is poured through a seive that is perforated straight through. 144 In the ninth book of De usu partium when he is about to complete his entire account of the purgation of cerebral wastes, he examines in detail the first reason why the bones of the vertex, forehead, occiput, and temples needed to be porous and full of foramina for the purgation of smoky and quite minute wastes. 145 Then, when he reasons that such a rough construction could not be made there, he finds that sutures assist this elimination, and gradually he constructs reasons why there needed to be porous bones full of small foramina in the base of the head for the purgation of phlegm rather than a continuous plate coated inside and out. And so when he discovers the necessity of its composition (quite cleverly, as he himself thinks), in order to bring the phlegm to that composition he soon adds that he has described two passages in the eighth book (themselves presumably organs of smell) by which phlegm is taken to the nostrils, and here two others to be explained besides which are carved in the material of the brain, meet [hypophysis, infundibulum] (D in figure 14, book 7) in their own depressions, and carry phlegm into a wine ladle (cyathum) (C, C [glandula pituitaria] in the same figure, and from E [infundibulum] to F [foramina durae matris] in figure 15) and funnel formed from this membrane of the brain, through which it // 1555 p. 41 // flows in turn into a gland [glandula pituitaria] (A in figures 16, 18, book 7). While mentioning this, Galen brings the phlegm to the bony construction [os ethmoidale, lamina] that he inferred in his conclusions must be porous and full of holes [foramina cribrosa] for the sake of phlegm. 146 Then again concerning the way it percolates, he so proceeds that he gives the same account in the eighth and ninth books, and describes no other way for the descent of the phlegm to the palate but through the small foramina [ff. cribrosa] hollowed out for odors. So since the substance of the little chambers which Galen propounds throughout this structure resembles sponge and pumice, and since he so painstakingly distinguishes the way of percolating through a spongy body (which we see happen in the so-called cisterns of the Venetians 147 ) from what happens through a colander, and confutes the ancients as if they had been ignorant of its function, it must have been clear to anyone what Galen’s view is, anyone who did not believe that phlegm runs down through large, straight foramina that are open on both ends as we see in the cuneiform bone, without a ridiculous and quite incompetent delay, no matter how the language which I have been discussing is interpreted. But what Galen [said] in the eleventh book of De usu partium, where he everywhere called the bone “cuneiform” and elsewhere in that work he named the palatal bone (though it scarcely touches the palate), and what in accordance with his own view ordinary physicians call it the colander bone, 148 and likening it to a wedge, they have passed on the tradition that it is dense and hard but nonetheless have not forgotten the little foramina in it that purge phlegm, they judge the same as they do many things that occur in Galen. I will not mention how beautifully it harmonizes; the vacant or empty area [sinus sphenoidales] (C, D, G in figure 8) of the cuneiform bone, the chambers, and the construction of the entire bone here attest how consistent with their own true nature they are; how on account of a strength made for itself and meant to be established in the material of the brain, the infundibulum, the thin membrane, the gland receiving the phlegm, and in countless other parts rather than in the bone, it produces here a rare and special appearance: not considering that the occipital bone where it meets the cuneiform bone [synchondrosis spheno-occipitalis] (n in figure 5, P in in figure 6) is nowhere less dense and hard than here, and is therefore constructed of a kind of epiphysial material because it needed to be thick at that point but not so hard and dense. But since this account is not concerned with refuting objections that people throw in my path or with seriously expounding of the purgation of phlegm, we shall simply complete what remains of our account of the cuneiform bone. On its lower surface, where it is rough primarily for the tunic that surrounds the cavity of the nostrils and is attached to the bony nasal septum [vomer] (S in figure 5), it puts forth four conspicuous processes [processus pterygoidei, lamina medialis et lateralis] (P, P in figures 4 and 5, and numbers 1, 2, 3, 4), two on each side, thin and prominent like the wings of butterflies: from their appearance they are called pterugoeidei=j, pterygoid.



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 6 On the Eight Bones of the Head and the Sutures Connecting Them