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 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.

page 156

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

page 157

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,

page 158

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.

page 159

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.

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