Part 4

duraq́ꝫ, qua cor circumquaqꝫ integitur περικαρδιον Græcitas nominat. Hæc tue tur cor, ne ab aduenticijs afficiatur, nè ue asperginoso fomento careat, quo feruori suo moderetur. Hæc et uireis cordis unit, et halituosos illinc spiritus uehemēti mo- tu dissolui prohibet. Hic cor se condit princeps membrum, et in turbinem fasti- giatū uiscus, tribus intus uentriculis con- cauum ac assidue palpitans, cui et suæ sunt utrinqꝫ auriculæ in quibus superest quam longissime uita. In sinistro cordis uentriculo spiritus et exigui sanguinis se- des est, à qua uenalis arteria progrediens pulmones subit aëremq́ꝫ ab eis concipit præparatiorem, quem in cordis sinus in- troducat, ne importunius æstuent. Dex- ter uentriculus plurimū et calidissimum sanguinem continet. In hunc iecoris uena caua per mediam spinam scandit ac uita- lis spirtus fomitem infundit. À quo et ue-

na arterialis in pulmones copiosum san- guinem eructat. Medio dexteri et sinistri uentriculo, sanguis temperatus, et quan- titate mediocris, inest. Ab hoc magna ar- teria cui Aorte nomen, nascitur uitalis spi- ritus uehiculum, ea susqꝫ deqꝫ perpetuo agitatur contrarijs motibus dilatatione et constrictione, ac secatur demum in ra- morū myriadas ut percalēteis toto corpo- re parteis miti flatu refocillet. De mēbris uitalibus huc usqꝫ sermonē produximus.

MEMBRANA ossosum capitis or- bem forinsecus obducens, περικρα- νιον Grecis appellatur, et dura est, et spissa et tenax, et exteriori cerebri tunicæ, du- ram matrem eam uulgo uocant, in sub- stantia conformis. Pendet et affixa duræ matris tunica pericranio, sic naturæ ui- sum est, ne in contactu cerebro efficiat, subter quam et tenuis mollisq̀ꝫ membra- na, pia mater ei nomen est, cerebrum in-

uoluit et nutrit, crebris uenis aspersa. Dure matri et ipsius cerebri substantiæ continuatur, et cerebri uentriculos pene- trat. Hinc se, proxime, oculis offert ipsum cerebrum, et eius uentriculi, et postico ca- pitis inditum cerebellum, a quo et me- dulla spinæ in uertebras descendit. Hinc et plexus reticularis (rete mirabile triuia- libus uocatur) summo cerebello, è crebris uenarum ac arteriarum mutuo sese can- cellantibus filamentis, phantasiam sui præbet, in quo spiritus uitalis a corde sur- sum uectus per arterias dum plenius co- quitur rarescit, et animalis fit spiritus: sen- sus et motus caussa in uniuerso corpore. Neruorum enim fons cerebrum est ner- ui uero spiritus animalis sunt deferētia ua- sa, qui à medulla spinæ (Nucha barbaris dicitur) in omneis corporis particulas di- geruntur. Quin et à cerebroseptem neruo- rum coniugationes procædunt. Bini ner-

ui antrorsum nareis spectant, olfactus ni mirum organa. Bini ad oculos feruntur, in itinere sese intersecantes, è quibus uidē- di facultas. Alij bini motum oculis, bini a lij linguæ motum et gustum tribuunt. E duobus et uentriculis sensu pollet, quo mi- nus appetentia illi desit, è totidem et exili- bus neruis sapores discernit palatum. Vnus postræmum neruus utrinqꝫ por- rectus ab uno principio, auribus largitur dexteræ et sinistræ, ne surditate extundan- tur. Hæc sunt quæ de membris animali- bus abs me per compendium dicta, intro- ductionē hanc in Anatomicen iusta pro- lixitate finiāt. Cætera enim quæ ad hanc tractationem pertinent, in alio opere pro- sequemur: ubi ad Anatomices omneis nu- meros sermonem accommodabimus.

EXCVDEBAT ROB. REDMA- nus Londini Anno

M. D. XXXII. CVM PRIVILEGIO.

_To the Distinguished and Illustrious Henry, Earl of Surrey._ _David Edwardes, Physician, Sends Greetings_

How often, Henry, I have recalled the honourable achievements of those noble dukes, in what great honour all Englishmen held your grandfather during his lifetime for his remarkable ability and happy successes in warfare, as well as his extraordinary prudence in the administration of civil affairs; and also at present how expertly everything that pertains to us English is daily managed by your famous father. I cannot sufficiently admire your family, but not so much for those reasons as because I see you established above what can be said for many other young men in this age, and turning your mind so seriously to those things which will render it better. I am by no means certain whether I ought to ascribe this to the benefit of that stock from which you have been brought forth to us, whether to the gods who through you smile upon and favour us English. However it may be, let us hope what has occurred will be to the advantage of our commonwealth, and that the more so since you have pursued worth-while things for so long a time. Thus you will approach the next age better prepared, and good habits will meanwhile strengthen your mind so that later you will not easily fall into worse. But the more you may be strengthened by counsel and prudence, with confidence placed in your family, so much the better guidance will Norfolk have when you succeed as heir to your father’s estates. Meanwhile how much more useful you will be to your people as Earl of Surrey, and finally so much the more will all Englishmen desire you to undertake the affairs of the commonwealth. There is no doubt that you can achieve all these things which will be to the increase of your honours and to the honour of your family.

As your talent and gravity of character promise, so we have great hope that you will be like your father and grandfather. I wish you both the greatest successes and the most fruitful increase of all the best things. And once more I wish that this whole year from its beginning may be happy for you and yours. With this augury I dedicate to you this our introduction to anatomy. For as this part of the art of medicine is not known to all, because it is something very difficult to comprehend, it requires an easy arrangement by which readers, as if led by the hand to it, may lean upon it. This is indeed a slight work, but wholly useful for all physicians and surgeons, because it explains many things briefly. It contains nothing obscure, nothing elaborate, very readily accessible to the talents of all those who are neither dull nor ill-adapted to matters of knowledge. In this, if anything differs from the common opinions of physicians, let no one be astonished because the learned do not believe the same in these matters.

Hereafter, if God permit, I shall compose a complete book of anatomy in which I shall further the opinions of all the learned, to which my own opinion will be added. I could have done this at present but not, however, with the same effort or with the form of an introduction preserved. It remains that this little book, which we have enlisted in the service of the commonwealth, may be pleasing to you, for it recognizes the existence of those very few unlearned physicians by whose mistakes many perish, from which this fact will be gathered, that no parts of the body should be unknown to physicians. Farewell. Cambridge. 1 January.

THE INTRODUCTION TO ANATOMY OF DAVID EDWARDES ENGLISHMAN

The whole lower venter—for thence it is necessary to begin the dissection of the human body because that part putrefies very readily—from the outer skin to the peritoneum is called EPIGASTRION by the Greeks and _mirach_[1] by the Barbarians, of which the following are the parts.

The superficial skin which covers the whole body is completely insensitive. The skin lying and stretched under the very thin and superficial skin is sensitive.[2] The Greeks call it HYPODERMA. A kind of fat occupies the whole venter and is spread under the sensitive skin except for the middle.

A sinewy and thin membrane immediately follows this. A membrane taking origin from the muscles is subjoined firmly to this where a straight line appears in the middle.[3]

Two oblique descending muscles[4] lie under these toward the lowest venter. The oblique ascending muscles[5] are placed under these. Two rectus muscles have a close relationship. And lowest of all are the transverse muscles.[6] Therefore there are these eight for which there are nearly individual sinewy coverings by which they are distinguished from one another.

An aponeurosis, or rather a thick and firm membrane, is stretched under them which some falsely call the peritoneum. So much for the epigastrium and its parts.

Certainly the peritoneum is a sinewy part, soft to the touch, of ordinary firmness, occupying the whole venter, and resting under the aponeurosis or membrane which I mentioned. The Greeks gave that name to it. The Barbarians call it _siphac_.

The _zirbus_ or omentum is extended under the peritoneum. The _zirbus_ is a kind of fat derived from sinewy threads and the slender adipose substance of the nerves; it is less thick than the fat previously mentioned. It covers much of the intestines and the lowest part of the stomach and assists the coction of aliment.

The intestines take origin from the stomach; of them, that which is called rectum and _longanon_[7] is the lowest of all the intestines and contains the dry burden of the bowel, and its head extends outward between the nates so that it may dispose of its burden. The colon is continuous with it and in its ascent goes around the left kidney, and at the sides of the stomach it falls away to the right.[8] What the Greeks call TYPHLON and MONOPHTHALMON, the Romans the blind intestine and one-eyed,[9] is attached to the colon, of which it is the only passage; for the other end is closed so that it may assist coction more suitably in the manner of the stomach. Hence the name for the thing. And such is the number of the thicker intestines.

The caecum is continuous with the ileon,[10] an intestine twisted into numerous sinuses; from its shape the Greeks gave it the name PARA TOU EILEISTHAI, that is, from its involvement; and its disease is called _iliacus_. The jejunum follows it. Dissectors of bodies gave this name jejunum to the latter intestine because of the fact that it is always found empty and contains nothing. For the liver first snatches away whatever the jejunum might contain. Above all these intestines arises the duodenum which is continuous below with the jejunum and above with the pylorus. It is called DŌDEKA DAKTYLOM by the Greeks from the measure of twelve fingers. These three [intestines] by reason of their substance are called the slender intestines.

The stomach is located under the diaphragm, of which the upper mouth ends in the oesophagus, properly called _stomachus_; the lower opening through which aliment is sent into the intestines is called PYLŌROS.

The spleen is an organ of rare substance and lies at the left side of the stomach; the liver being in the right hypochondrium. The latter is rounded and to some degree lunate, the former longish and somewhat quadrate. The gibbous part[11] of each of these extends toward the lower ribs, because there is a concavity in each of them which is very close to the stomach. The liver gives rise to the blood.[12] The spleen purges it of black bile. The spleen increases with loss to the rest of the body. The size of the liver is useful to the whole bodily structure, because it provides copious blood and natural spirit. The liver has lobes which the Greeks call LOBOUS, sometimes three, sometimes more,[13] and in its hollow extends the gall bladder by which the blood is freed of bile and issues forth pure. It is especially by exhalation and transpiration of this bladder that the duodenum and jejunum are sometimes stained;[14] sometimes they are irritated if there is a very large transpiration of particularly corrosive bile.

From the hollow of the liver[15] arises the portal vein which is formed from the concurrence of the many slender veins of the liver. On the other hand, it divides again into innumerable parts and gives off an immense multitude of veins which afterward are inserted here and there into almost all the intestines and to the little adipose membranes mixed together, so that they provide nutritional substance for the liver in the generation of blood. For chyle and food are sent down from the stomach directly to the intestines; the pylorus yields an exit as soon as the stomach has received as much as suffices for its uses and has accomplished its coction. Unless it be transmuted into the nature of blood [this food] contributes very little toward the nourishment of the rest of the body. Therefore these numerous venules serve to draw out from the intestines the best juice of the nutriment as yet not sufficiently concocted, and deliver it to the hollow of the liver where the blood is made. Doubtless those venules can be called meseraics, or by the Greek word mesenterics. The Latins call them milk veins.[16] For their protection, lest in their numerous ramifications some of them be torn apart or rent by a more vigorous motion of the body, the PANKREAS, that is, glandular flesh which is sometimes called KALLIKREAS by the Greeks, attaches to the duodenum so that the venules may individually be more firmly supported.

The blood passes from the hollow of the liver, in which it was formed a little earlier, to the gibbosity[17] of the liver; however, it is not the same kind as was made in the hollow but more pure and simple, since both biles have been strained from it and transmitted to their receptacles so that the blood may be more unsullied for nourishing the body wholesomely and for producing spirits. From the gibbosity the blood is extended throughout the whole body through the vena cava—called KOILĒ by the Greeks—and by the many branches of that vein. This vein surpasses all the rest of the veins of the body in size and arises from the gibbosity of the liver. Descending from this through the middle of the spine, one [branch] on each side seeks the kidneys, each branch extending a palm’s length.

These branches of the vena cava are the emulgent veins.[18] In the body of that one whom we dissected very recently the left branch had a higher place of origin.[19] Very often, however, the opposite occurs, so that the right emulgent vein is carried higher in the body. Nature employs these emulgent veins for carrying down the watery part and bile of the blood from the liver to the kidneys. A like number of little branches of arteries in the same site, from the great aorta artery going under the vena cava, run an equal length into the kidneys under the emulgent veins, unburdening the heart of bile and watery blood; these have the name of emulgent arteries.

A vein and artery descend from the left emulgents into the testis of the left side. They are the seminal passages swollen with blood and spirit; the seminal matter contained in them procreates females, because their humour is watery and requires coction. Seminal passages, likewise an artery and vein, are extended downward from the right [emulgents] into the right testis; but having arisen from the trunks of the vena cava and aorta artery, therefore the juice in them is less watery, and properly concocted is more suited for the generation of males. In these passages blood is concocted, and afterward transferred to the glandular flesh of the testes it acquires the form of semen.[20]

The kidneys are solid and hard organs, not sentient, and the attractive force in them is very powerful. They purge the blood of its watery part and bile, but they retain [some of] the blood so that they may be nourished by it and expel the rest of the humour. For the OURĒTĒRES are attached to them,[21] that is, the urinary passages, whitish, reed-like and tensile which it may be said extend to the bladder and are similar to its substance.

The diaphragm is a membranous substance, running between the vital and natural members. It is called DIAPHRAGMA by the Greeks. It strengthens the expulsive force in the intestines, it is assigned to the members selected for spirit, and it curbs the smoky vapours lest they blacken the vigorous spirits of the heart and brain. Above, there is affixed to it a sinewy covering[22] which clothes the thorax inwardly and binds the pectoral ribs to the interstitial spaces, which covering the Greeks in good part name PLEURA, but sometimes it is called HYPOZŌMA[23] by them. By its inflammation pleurisy occurs, the name taken from the covering.

From the pleura near the spine arises a membrane separating the lungs and lower thorax into equal parts through the middle. It is commonly called the mediastinum, and is so well adapted to the lungs that a defect of one lung is not easily communicated to the other.[24] Certainly the lungs inhabit the middle palace of the chest, invigorate the spirits of the heart and brain, temper the heat and avert the danger of suffocation, and have lobes like the liver. They hold the heart constantly in a kind of embrace in the manner of very caressing nurses and sing a harmony of qualities by which they soothe the individual parts of the body and make them vigorous. From that part of the mediastinum which holds the middle of the lungs, a thick and hard membrane appears which completely covers the heart,[25] called in Greek PERIKARDION. This protects the heart lest it be afflicted by accidental things; and lest it lack the moistening fomentation by which its heat is moderated. It unites the forces of the heart and prevents the exhaled spirits from being dispersed by vehement motion. Here the heart establishes itself, prince of members[26] and an organ sharpened into [the shape of] a top; hollow within; continuously palpitating by its three ventricles,[27] with an auricle on each side in which life remains the longest.[28] The seat of the spirit and a small amount of blood is in the left ventricle of the heart, from which the pulmonary vein advances and enters the lungs to receive better-prepared air from them;[29] this it introduces into the ventricles of the heart lest they become unduly heated. The right ventricle contains more and very hot blood. The vena cava rises into this[30] through the middle of the spine and pours in the tinder of the vital spirit from the liver. From this the pulmonary artery belches much blood into the lungs. In the ventricle between the right and left there is tempered blood of slight quantity. From this ventricle the large artery called the aorta arises, the vehicle of the vital spirits; it is constantly agitated up and down by the contrary motions of dilatation and constriction, and finally it is divided into myriads of branches so that it revivifies the living parts in the whole body by a gentle flatus. This is the end of the account of the vital members.

The membrane covering the bony roundness of the head outwardly is called PERIKRANION by the Greeks, and it is hard, thick and firm, and conforms in substance to the exterior covering of the brain which is commonly called the dura mater. The covering of the dura mater hangs affixed to the pericranium, so it seemed to nature, lest in contact it have an effect on the brain; under this covering a thin and soft membrane, which is called the pia mater, sprinkled with numerous veins, envelops and nourishes the brain. It is continuous to the dura mater and the substance of the brain, and it penetrates the ventricles of the brain. Hence the brain displays itself very clearly to the eyes, both its ventricles and the cerebellum placed at the rear of the head from which the medulla descends into the vertebrae of the spine. Here the reticular plexus (commonly called the _rete mirabile_), woven together from numerous slender threads of veins and arteries at the summit of the cerebellum, displays its _phantasia_; in it the vital spirit carried upward from the heart through the arteries, having been fully concocted and rarefied, becomes animal spirit, the cause of sensation and motion in the whole body. For the brain is the source of the nerves, but the nerves are the vessels which distribute animal spirit;[31] from the medulla of the spine (it is called _nucha_ by the Barbarians) they are distributed to all parts of the body. Furthermore, there extend from the brain seven pairs of nerves.[32] Two nerves look forward to the nares,[33] the olfactory organs. Two are carried to the eyes,[34] intersecting in their course, from whence comes the faculty of vision. Another two [carry] motion to the eyes,[35] another two give motion and taste to the tongue.[36] From two the stomach acquires sensation[37] so that appetite may not be lacking to it, and from as many slender nerves the palate distinguishes flavours.[38] Finally, from a single origin one nerve is extended on each side, provided for the right and for the left ear lest they be struck by deafness.[39] These things which have been said by me briefly regarding the animal members, within the proposed limits, end this introduction to anatomy. Other matters which pertain to this subject I shall discuss in another work where we shall adapt the discourse to all aspects of anatomy.

Printed by Rob. Redman in London M.D.XXXII With Privilege

Footnotes

[1]The term _mirach_ means the anterior abdominal wall, but here Edwardes refers to the abdominal wall as venter. Lower venter proper means the abdomen or abdominal cavity together with the pelvis.

[2]There is confusion here for, of course, the skin of the body is most sensitive. The subcutaneous tissues, on the other hand, are relatively insensitive.

[3]He refers to the aponeurosis of the external oblique muscle. It joins with its fellow of the opposite side in the mid-line at the linea alba.

[4]External oblique muscles.

[5]Internal oblique muscles.

[6]Transversus abdominis.

[7]_Longanon_ is the medieval Latin term for rectum. In the text which follows it will be noted that Edwardes describes the intestines from below upwards.

[8]The hepatic flexure of the colon.

[9]The caecum was termed the _monoculus_ by medieval anatomists. There is no mention of the appendix; this was first described in 1523 by Berengario da Carpi.

[10]The ileum.

[11]The curved surface.

[12]Galen maintained that the major veins had their origin in the liver.

[13]Multiple lobes to the liver was another teaching of Galen derived from comparative anatomy.

[14]Post-mortem staining of the viscera with bile is very common.

[15]The porta hepatis.

[16]This is a good account of the function of the lymphatic vessels.

[17]The gibbosity of the liver is its curved, upper surface.

[18]The emulgent veins are the renal veins.

[19]This is normal in man but in some animals the right renal vessels arise higher than the left. It will be noted that he speaks from his own experience. It is a pity that he qualifies this statement in the next sentence with a reference to the then current teaching, derived from Galen.

[20]The fallacious idea of the testis filtering off the sperm from the blood brought down to it by the testicular artery lasted a long time. Note too the old fallacy of the left testis producing a female foetus and the right producing a male.

[21]The ureters.

[22]The pleura.

[23]Either Edwardes or the printer was at fault in the form of the Greek script, while the word has more the meaning of diaphragm than of pleura.

[24]Edwardes is obviously aware of the individuality of each pleural sac.

[25]The pericardium.

[26]Note that the heart is the most important organ of the body.

[27]The three-ventricled heart was a myth which remained entrenched in anatomy until Niccolò Massa (1536) and Vesalius. Leonardo da Vinci showed that there were only two ventricles but his drawings were not seen by his contemporaries.