THE EPITOME OF
ANDREAS
VESALIUS
TRANSLATED
FROM THE LATIN WITH
PREFACE AND INTRODUCTION BY
L. R. LIND
WITH ANATOMICAL NOTES BY
C. W. ASLING
FOREWORD BY
THE M.I.T. PRESS
MASSACHUSETTS INSTITUTE OF TECHNOLOGY
CONCERNING THE ORGANS WHICH MINISTER
TO NUTRITION BY FOOD
AND DRINK
CHAPTER
III
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INCE man has been unable to form the substance
of an immortal being by means of the genital semen and the menstrual blood
(the origins of our generation and of those parts of which we are composed [11), the
great Creator of things has carefully devised that man should live as long as possible and
that his species, never failing, should continue to exist forever. In order
that man might attain to the stature for which he was intended and that those
elements upon which his innate heat is continually fed might be restored as
quickly as possible, he possesses organs which serve to nourish him in many
ways.
The food is broken up by the teeth in
order that the task may later be completed more easily. Food, as well as
drink, passes from the mouth to the stomach as into a storehouse along a path
called the esophagus or gullet [2]. This is extended by two special tunics
appropriately formed to descend from the fauces behind
the rough artery [3] and then along the vertebrae of the thorax
through the transverse septum to the upper, or left-hand, orifice of the stomach.
The stomach lies between the liver and
the spleen under the septum. It is particularly roomy and rather long
transversely, larger on the left-hand region of the body than on the right; it
is equipped with two tunics suitable for distending and contracting [4] and enclosed by a third covering derived from the peritoneum. The stomach
is intertwined with many veins, arteries, and nerves. It concocts what is sent
down to it from the mouth and changes this
by an innate force into a thick milky juice [5]. This passes through the lower
orifice of the stomach from the higher region of its right side and is sent into the intestines. The intestines are
rounded, extending from stomach to anus in a continuous course made tortuous
by innumerable coils and turns; like the stomach, they are fashioned from two tunics. To these is
added from the peritoneum a third
tunic adapted for relaxing and contracting no less than the first two tunics
proper to the intestines but not everywhere equally extensive [6]. The origin of the intestines proceeds
from the stomach; along the posterior side
of the stomach, reflected toward the back, lies the organ we call the duodenum. Following this is the part of the
intestines known as the jejunum and
that which is called the ileum or volvulus. The coils
of the latter fill the ilia and the region lying
under, and contiguous on all sides to, the umbilicus; it is of almost constant diameter. The narrowness
of this organ provides the reason for
designating as small intestines the parts just mentioned. The part of the intestines in which the terminus of the
ileum lies is broad and very thick; in its entire course it constitutes the
colon. Joined to it is a small appendage,
narrow and curled like an earthworm; this has one
orifice and is therefore called blind
by the masters of dissection [7]. The thick part of the intestines itself ascends
from the region of the right kidney to the concavity of the liver. Thence it
proceeds along the base of the stomach to the region of the spleen, then turns downward along the region
of the left kidney, and bends back to
the left region of the pubis in a sort of coil [8]. This last passes above the beginning of the os sacrum straight down to the anus, thereby obtaining the name-of the straight and
principal intestine [9].
Thus,
whatever has been prepared in the stomach is sent down through these
intestines to be forced through their various coils. Veins in innumerable
series pass from the concavity of the liver, together with the arteries drawn
off from the great artery, between the two membranes which fasten the intestines
to the back. These veins are quite thick and dense, abounding in much fat
and glands; they are called the mesentery and extend to the intestines [10]. The veins suck
out from the intestines (especially the small ones) whatever is suitable for
the making of the blood [11], together with the aqueous and thin refuse of the
stomach's concoction, and carry it to the workshop of the liver, where the blood is
made. But that refuse which is thicker and less adaptable to suction is
gradually collected in the thick intestine; it is kept there only until, it
becoming troublesome to man, the muscle surrounding the rectum in circular
fashion relaxes, and the refuse is borne forth at once and completely at the
will of man.
The liver is not divided into fibers or
lobes [12]; it occupies a position higher than that of the organs ministering
to it [13] and for the most part lies in intimate relation to the stomach;
the liver is placed close beneath the transverse septum and fills the right,
rather more than the left, region of the body. It is gibbous above and hollow
below, conforming exactly to the shape of the parts lying near it [14].
It is formed by the intertwining of many veins and is surrounded by the substance
proper to the liver, similar to
recently coagulated blood [15 ]. It is
clothed with a thin membrane [16] proceeding from the ligaments with which it is
secured to the peritoneum. It admits
two small nerves [17] and one artery.
It is the tinder of the natural or
nutritive faculty or, as Plato said, of the part of the soul which desires the pleasures
of love, food, and drink [18].
One series of veins diffused through the liver lies in its
gibbous part, extending to the vena cava [19]. Another
series forming the stem of the portal
vein lies in the hollow of the liver. This vein sends two branches first to the bladder which receives the yellow bile [20],
then to the lower region of the stomach near its lower orifice [21].
Thence a branch runs to the right part of the base of the
stomach [22), from which small branches spread out to the
stomach and the upper membrane of
the omentum [23]. The omentum
is a membranous body fashioned like a sack
and especially adapted for conducting vessels in safety. However, since it is full of veins, arteries, and the fat
attached to them, it also assists in preserving
the warmth of the intestines. It is borne in a circular fashion, be,
ginning from the middle of the back under
the posterior region of the stomach, through
the hollow of the liver, to the base of the stomach (from the third tunic of
which it here arises). Then it is carried down to the hollow of the spleen and thence to the middle of the back where
it started [24]. Like a sack stretched downward, the omentum
covers the anterior region of the intestines, or there where the colon is
stretched under the stomach, it arises, joining the back in place of a mesentery. The stem of the
portal vein, after having been supported
by the omentum, sends out the branches just
mentioned.
The stem is divided into two trunks; the right one [25], which is larger, is carried
in various ways through the mesentery and is offered to the intestines (first the duodenal intestine); the right trunk
also presents a branch to the beginning of the jejunum. The right trunk
is supported by a glandulous body stretched
out in this region of the intestines [26]. The left trunk, having been
woven into the lower region of the omentum, sends a
small branch to the posterior region
of the stomach, where the latter faces the right part of the back, then also to the inferior membrane of
the omentum. Next the branch goes to the glands, fleshy in color, which are in charge of the
safe distribution of the vessels here. A branch ascends from it along
the posterior side of the stomach; this
branch sends out other branches to the region of the stomach which faces toward the middle of the back and embraces the upper orifice of the stomach in the manner of a
crown [27]. From this, in addition to the branches sent upward and downward,
one creeps forward along the posterior
side of the stomach to its lower orifice.
The left trunk of the stem of the portal vein, extending ever
to the left [28], sends an outstanding vein woven into the omentum and the colon; it is divided into various branches and sends an offshoot as far as the
lower membrane of the omentum [29]. It
is inserted into the hollow of the spleen by means of its own offshoots before they enter the spleen. To the left
side of the stomach, it sends little
branches [ 30], among which a notable one creeps along the base of the stomach in the left region and sends shoots to the
stomach and to the upper membrane of
the omentum [31].
Offshoots of
the portal vein are distributed through the substance of the liver; within them
is contained whatever is brought to the liver from the intestines, to say nothing of the
stomach. The liver, concocting the best part of
that chyme, changes it into blood, obtaining also a
twofold refuse of its concoctions,
such as we see in all wines and other similar concoctions. One is thicker than the other and, because it is
considered, as it were, the dross and
offscouring of the blood, is commonly called the
black bile. It is carried through
the portal vein to the spleen, which lies below and behind the left side of the
stomach. The spleen looks like a rather thick tongue-[-32]; it adjusts itself to the shape of the organs lying
close to it, just as the liver does. It is likewise interwoven with many veins
and arteries, by which the proper
flesh of the spleen is rendered similar to muddy blood. The spleen is covered with a thin tunic sent forth from the omentum [33]. We believe [34]
the spleen draws to itself the
thicker refuse of the liver and converts it into nourishment for itself, and whatever it cannot assimilate, it throws
up into the stomach.
The thinner
refuse of the liver, which is regarded as a sort of flowers of the wine, is
the yellow bile. It is drawn into passageways between those offshoots of
the portal vein and the vena cava which are distributed through the substance
of the liver. These passageways, gathered together, end in a single channel
which proceeds from the hollow of the liver and extends to the gall
bladder [35]. This, like a rather long pear in the concavity of the liver, arises
in the middle of the liver's breadth and is provided with a body adapted for
distending and relaxing. The professors of anatomy are convinced [36] that, in the
case of this bladder, the bile is preserved until, by the action of its special
duct, it is thrust forth into the duodenum. The bile must be
carried out along with the dry refuse of the stomach. With its biting quality it
irritates the intestines for propelling this refuse and frees them from the
phlegm which clings to the refuse [37].
The blood,
cleansed of the excrement just referred to, rushes from the narrowest
branches of the portal vein into the smallest offshoots of the vena cava [38]. The blood uses as a vehicle [39] the
thin watery refuse which it had taken up to the liver from the intestines. This
refuse, accompanying the blood thus
far and ascending together with it into the vena cava, renders a signal service
to it in these narrow passages. For since, thus far, this refuse aids the blood in the function of a prompt
distribution, it is also suitable for
this refuse to carry off whatever overabundant supply of itself [the refuse] the blood does not require and to purge
the blood of that which would be a
burden.
This office of purgation is most fitly
performed by the kidneys, one each on either side of the vena cava and very
close to the liver. They quickly draw the greater part of the serous humor
of the liver toward themselves and strain it from the blood [40]. In order at they may accomplish this more
handily, a notable vein and likewise an artery are extended to the kidney; the kidney receives the serous blood into a
membranous sinus which is broad and
hollow and divided into many offshoots concealed by the sub, stance of the kidney and covered over with a
double tunic [41]. By its function the urine is expelled and led off into
another sinus which is pro, longed as
the urinary passage constructed like a vein [42]; this urine is going to be carried to the bladder.
The bladder, situated at the posterior region of the pubic
bone, gradually receives
the urine [43]. Shaped like a rotund flask, it is formed of its own
simple and sinewy tunic, interwoven with a threefold type of fibers, ready to be distended or contracted [44]. Another
membrane is drawn over it from the peritoneum or the membrane of the
abdomen, which is the covering and
protection of the organs thus far mentioned. Single passageways from each of the kidneys are carefully inserted in
the posterior portion of the bladder
not far from its neck. This collects the urine only so long until it troubles man either by its abundance or its
quality; then it is completely voided
by the opening of the muscle which surrounds the neck of the bladder in
circular fashion [45].
The blood, purified by this operation, is distributed through
the branches of the vena cava or its rivulets over the entire body in order
that the separate parts may drain from the blood that which is proper to
them; changing and applying it to themselves, they then convert it to their
own nourishment.
Finally, also, they drive off the refuse of this concoction from themselves by their own functions.
The series of
the vena cava is for the most part as follows: while it is located in the posterior region of
the liver, it sends forth branches from its own
anterior aspect distributed in a numerous series to the gibbous part of the liver. Then ascending and perforating the
transverse septum and the pericardium,
it sends two offshoots to the septum [46]. At the level of the right auricle of the heart, the vena cava opens
toward the right ventricle with an
opening wider than the circular width of the vena cava elsewhere. From the posterior region of its implantation
(unless you prefer to say rising [47], a
vein proceeds surrounding the base of the heart in the manner of a crown and
sending little branches downward along the upper surface of the heart [48]. The vena cava, rising
upward from the heart, there where it
pierces the pericardium, sends off from the right side, the azygous
vein, which nourishes the eight,
more commonly lower, intervals of the ribs on both sides.
In the throat. the vena cava is divided
into two parts [49], sending veins from its anterior region to the pectoral bone and to the membranes
dividing the thorax, and creeping through the upper part of the abdomen
[50]. From the root of the one branch of the division into two parts in the throat
arises a notable vein running above
the first rib to the armpit [51 ] but
first sending into the cavity of the thorax a branch which disappears in
the three upper intervals of the ribs of
its side [52], and another
branch through the transverse processes of
the cervical vertebrae all the way to the skull [53], and another
spread out in the posterior part of the thorax near the root of the neck [54]
The present vein, having meanwhile,
passed out of the thorax, here sends
forth the shoulder vein [humerariam uenam] [55] and a branch to the muscles spread over the anterior region of the thorax [56];
then, hastening on into the armpit, it sends another to the posterior region
of the thorax and the hollow of the
scapula [57], and then another to
the side of the thorax [58].
The remaining branch of the trunk split
into two parts in the throat is again divided into two unequal
branches. Of these, the inner and more slender one forms the internal jugular
vein. It enters the skull, with two offshoots passing to the dural membrane of the brain. The outer branch sends an
offshoot from its outer side; from this the humeral vein [humeralis
uena] is derived [59]. It goes upward, forming the superficial jugular, running in various ways up to the fauces, and distributed to the tongue, the larynx, the palate, the face, the temples, and
the vertex and entering the skull
with three veins.
The humeral vein, before it is carried
under the clavicle and the acromion into the arm,
extends a branch to the posterior region of the neck [60] and another
to the gibbous part of the scapula. Another branch goes to the upper region
of the acromion [61], and a second creeps
under the skin, following along the outer side of the anterior muscle of those
which flex the elbow [62]; bringing forth slender shoots to the skin, it
divides in front of the elbow joint.
Sometimes one branch lies deeper and soon disappears, passing to the elbow joint. Another runs obliquely
under the skin to the middle of the
bend of the elbow [63] to meet with the branch of the axillary
vein and to form one vein in common
with it [64]. A third passes under the
skin along the radius to the posterior aspect of the forearm, finally to the root of the wrist near the end of the ulna [65];
it mingles there with the offshoot of
the axillary vein and rises to the outer side of the
little finger and the ring finger [66].
The axillary vein lies hidden in the armpit and sends a branch
to the skin covering the anterior region of
the arm toward the inner aspect. It presents an offshoot to the heads of the muscles which extend the elbow and
another at almost the middle of their
length [67]. Then the axillary vein sends another offshoot, with the fourth nerve that proceeds to the arm, along
the posterior aspect of the arm up to
the exterior region of the forearm [68]. It is soon cut into two veins, one of which sinks completely into the
depths in its entire length,
continually accompanied by an artery [69]. This vein passes through the
middle of the bend of the elbow joint; before it reaches the middle of the length of the forearm, it is cut
into two offshoots, one of which
stretches along the radius [70], the
other along the ulna toward the wrist [71].
Here it is again split into offshoots [72],
distributed to the inner region of the
fingers in such a way that it offers two twigs to each of them; one shoot,
extending to the external region of the hand, is distributed between the first 'internode
of the thumb and the metacarpal bone supporting
the index finger.
Extending under the skin all the way, the other branch from
the axillary vein [73] is divided
into two branches near the elbow joint. One of these branches
runs obliquely toward the bend of the elbow joint and merges with the branch of the humeral
vein which is composed of those two middle veins,
forming a common vein with it [74]. Running
obliquely downward along the radius,
this is divided into two offshoots like the letter Y in the external region of the forearm. One of these runs
for the most part to the external
region of the middle finger; the other runs to the thumb and index finger and sends an offshoot into the internal
region of the hand to mingle with the small branches encircling the
sacred hill of Venus [75]. The other branch from the axillary
vein formed by the division near the elbow joint sends various offshoots to the internal region of the forearm [76].
In association with these branches, a vein often occurs arising from the other
branch constituting a common vein which the axillary
sends forth. These offshoots come
close together in various ways at times; again, they separate in turn and are interwoven in the skin in the inner aspect
of the forearm. Finally they creep forward to the skin of the internal
part of the hand. The more outstanding
offshoot of this branch extends to the ulna and sends offshoots in similar fashion into the external region of the
forearm. It merges with the branch of the shoulder vein [humerariae]
near the root of the wrist as that
branch runs to the little finger and the ring finger.
A part of the vena cava runs downward below the liver. It
sends a branch from the left side to the fatty tunic of the left kidney and
the region contiguous to it [77]. Then a large vein is
borne to each of the kidneys. From the
superior aspect of the vein seeking the right kidney (which vessel frequently
originates higher than the vein belonging to the left kidney), an offshoot approaches the fatty tunic of the right
kidney [78]. From the inferior aspect of that vein which passes to the
left kidney, a seminal vein arises;
the right seminal vein originates much lower down from the trunk of the vena cava [79]. Further, where the vena
cava lies upon the lumbar vertebrae,
it gives offshoots to the latter in clusters which finally disappear into the nearby muscles and sides of the abdomen [80].
The most outstanding of these are those
which arise from the vena cava where it divides into two equal trunks [81]
above the union of the os
sacrum and the lumbar vertebrae.
Both the right and left trunks send some offshoots to the foramina of
the os sacrum [82].
Each trunk is divided into two branches, of which the inner [83] sends an offshoot which ends
in the muscles occupying the posterior regions of the iliac and sacral bones [84]. Another offshoot goes to the bladder and penis [85]; in women it extends to the uterus in the form of many smaller shoots [86].
That which is left of this branch anastomoses with
the external branch and is led through the
foramen of the pubic bone to the thigh [87], where it sends offshoots to the skin and muscles occupying the inner
femoral region. Proximal to the knee
joint, it ends, joining its terminus with the branch of another vein which extends to the leg, as I shall soon
describe.
The external
branch [88] of the left trunk of the vena
cava, when it is about to pass through the groin to the thigh, sends to the
peritoneum an offshoot which terminates in the lower region of the abdomen up
to the umbilicus [89]. Extending downward upon the thigh, the external
branch sends a shoot to the skin of
the pubis and to the hillocks of the female pudenda [90]. It sends a
notable vein under the skin through the internal aspect of the thigh, knee, and
leg as far as the end of the toes [91]; in its progress it distributes
other branches here and there to the skin. Another vein is also sent under the skin to the anterior
region of the hip joint [92]. Itself
more deeply submerged among the muscles, the trunk [93] sends an offshoot to the muscles located in the external
region of the thigh and to the skin [94];
it sends another offshoot to the muscles
which appropriate to themselves the
inner and anterior region of the thigh [95]. With this offshoot is joined
the end of that vein which descended through the foramen of the pubic bone. Thence the large vein [93]
winds back to the posterior part of the thigh and sends offshoots to the
muscles of that region; from these
offshoots little branches extend to the skin, upward and downward as far as the calf.
This large vein is divided into two trunks between the lower
heads of the femur.
The lesser outer one extends to the fibula [96]; from it, in addition to small
branches extending to the anterior aspect of the knee [97], a branch is separated which proceeds posteriorly under the skin covering the external region of the leg and which is
variously divided toward the upper
part of the toes [98]. That portion
of it which remains hidden higher up
among the muscles extending toward the external region of the fibula runs past the middle of the length of the leg. The
inner of the two trunks is quite
large [99]; along the inner region
of the tibia, it sends a branch spread
out posteriorly under the skin as far as the toes.
Another branch is sent forth, somewhat
hidden through the calf and stretching as far as the heel. Especially worthy of note concerning this
trunk is the fact that it extends to the muscles which occupy the
posterior aspect of the leg. It sends a
branch from its anterior aspect down through the membranous ligament which binds the fibula to the tibia. The branch
hidden under the anterior muscles which surround the tibia extends to the upper
part of the foot [100].
The vein itself, running down along the
posterior part and thence sending shoots to the skin and the contiguous
muscles, finally enters the lower portion of the foot between heel and tibia and is
there distributed to the muscles and toes in such a way that two offshoots
are sent to each toe.
GENERAL INTERPRETATION
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N
THIS and the following chapters, the physiology departs sufficiently from
modern concepts and is so dispersed through the text that it seems appropriate to
bring it together in brief abstracts. To these are joined such remarks of
general nature as may refer to the subject and yet find no specific place in
the serial notes.
The Vesalian
discussion of blood and bile is an effort to bring to the prevailing humoral theory of physiology and pathology some degree of anatomical
specificity. The theory, which probably originated with primitive man, was
used in Vedic medicine, proclaimed to the West by Hippocrates,
"proved" by Galen, and held in good repute until the time of Virchow. It is not surprising to find that, in the main, Vesalius accepts it; his position is to carry forward the
efforts of Erasistratus to take it out of the realm
of metaphysical speculation.
Vesalius believes that
the mesenteric vessels carry material absorbed from the intestines to the
liver (via the portal vein). Blood is formed in the liver and enters the circulation
through the hepatic vein. In the liver is obtained a refuse which consists of two parts,
comparable to the flowers (or supernatant scum) and lees (or dregs) of wine.
The thicker is the black bile, which is sent back through the portal vein to
the spleen; no effort is made to explain this two-way flow in the portal vein
(intestine to liver and liver to spleen). It is not difficult to understand the
"black bile" (atra bilis, melancholia) of the splenic
vein when one remembers that the blood coming from the spleen actually contains
a high concentration of hemoglobin breakdown pigments. Anything in
the black bile not usable by the spleen is sent (via the left gastroepiploic vein?) to the stomach.
The thinner decoction of the
liver is the yellow bile, which is sent to the gall bladder. While Vesalius has some doubt as to the role of the gall bladder
as a storage organ, he recognizes that bile is the "physiological
laxative," acting as an irritant (through its "biting quality")
to increase intestinal motility.
The noncellular
component of blood leaving the liver contains some waste material, which is carried
to the inferior vena cava and then to the kidneys for excretion. In a later chapter Vesalius states that the two kidneys have slightly
different functions with respect to this excretion; he thereby accounts for
the difference in right and left internal spermatic veins and explains the
method by which erotic activity and formation of seminal fluid are stimulated
by its acrid quality.
The blood is now freed from all
useless or harmful substances and is distributed to all parts of the body by
the veins. The various tissues extract from blood useful substances and return
to it their own refuse from metabolism.
Phlegm, the fourth humor, is mentioned only in passing; the
account of its origin is contained in a later chapter. • -
The only authority named in the
Epitome,* Plato, is cited in this chapter in connection with the discussion of
the liver. While the exact source is not given, I believe it to be the Timaeus. This dialogue, while starting with cosmogony,
mathematics, and astronomy, devotes its last third to anatomy, physiology, and
pathology. Without doubt Vesalius is as
familiar with the content as he is with the work of Hippocrates, Aristotle, and
Galen. Plato believes the soul is tripartite, with special regions of the body as the
seat of each part. The head, being spherical and most perfect in shape, is the seat
of reason and intellect, the most perfect part of the soul. It is above the other seats of
soul-portions, and hence reason is placed in a dominant position. The breast is the
seat of the nobler passions; it is not to be identified with the head, and hence the neck
has been interposed. The diaphragm divides the nobler soul from the coarser base
soul, with its bodily appetites and sensuality, seated in the abdomen. The liver has a
degree of control over this last in that: (a) it contains "bitter,"
which it uses to restrain the cravings; (b) it contains
"sweet," to he discharged when desires conform to reason; (c) it is
like a mirror, smooth and bright (note the pathologist's phrase,
"smooth, moist, and glistening""), and may thus reflect the
thoughts.
In the
Symposium of Plato, the myth of the Charioteer and the two horses is thought to
be an allegorical statement of this theory of the soul.
The reader
interested in the history of medical concepts will, if not already familiar
with the Timaeus, find much delight in reading it.
* With the
exception of a passing mention of Galen in the section on regional anatomy. 51
NOTES
1. BY Aristotelian teaching (as in De Generation Animalium), the
semen of the male is a pure secretion containing the soul principle, while the
catamenia is a female semen lacking
this principle. Introduction of the soul principle to the secretion of the
female results in conception and formation of the embryo.
2. The "path"
itself is the lumen, and the two tunics the mucosa and the muscularis adventitia.
3. Trachea;
"rough" because of its cartilage rings, "artery" because it
is an air passage.
4. The same two layers as in note 2, plus the serosa, a reflection of the peritoneum.
5. The acid chyme.
6. This is a brief statement of
the fact that not all of the intestine is in a broad mesentery but in a
number of places becomes almost retroperitoneal.
7. The cecum,
"blind," as in a "blind alley" or cul-de-sac. The appendix vermiformis is the part here designated in particular
as blind.
8. The
sigmoid colon.
9. Intestinum rectum.
10. The mesenteric vessels,
within the two sheets of serosa making up the
mesentery. The glands are mesenteric lymph nodes.
11. "Suck
out": compare the observation of H. S. Wells, Am. J. Physiol.,
XCIX (1931), 209, that the osmotic pressure here is enough to balance a negative
intra-intestinal pressure of 8 to 26 cm of normal saline solution.
While we would not say "suck," the concept of some of the absorptive
mechanism is suggested.
12. In correction of a standing
anatomical error of the time, probably deriving from dissection of
lower mammals.
13. "Ministering to it" via the portal venous
system.
14. The many impressions on the surface of the liver.
15. The Galenic concept of the nature of liver parenchyma.
16. The tunica
serosa-Glisson's capsule.
17. From the left vagus and the
sympathetic (celiac plexus) via the hepatic plexus.
18. The Timaeus; see general
interpretation to this chapter; also Republic 439a-440.
19. The intralobular veins join to
form the hepatic vein. 20. Gall bladder; cystic vein.
21. Pyloric vein.
22. Right gastroepiploic vein.
23. "The upper membrane" is the
anterior portion of the gastrocolic fold.
24. Successively, the gastrohepatic, gastrolienal, and lienorcnal "ligaments" or portions of the omentum.
25. The superior mesenteric vein.
26. Pancreaticoduodenal vein; the pancreas. 27. The
coronary vein. 28. The lienal (splenic)
vein.
29. The
inferior mesenteric and left colic veins. 30. The short gastric veins.
31. The left gastroepiploic; the vein is "notable" because of
its part in the relation, ship of spleen to stomach (see
text and general interpretation).
32. That is, it has a broad side and an opposing sharp border.
33. The capsule
is formed by a reflection of the dorsal mesogastrium.
34. See Chap. II, note 41.
35. The bile ducts and hepatic duct.
36. See Chap.
II, note 41. To bring the sentence on the gall bladder up to date, one would have
only to say that "the professors of anatomy are convinced but the professors of
physiology doubt, etc." The words which have been exchanged over just such
controversies as this are those which prompted Truthful James to remark:
I hold it not
quite wise in any scientific gent
To say another
is an acs, at least to all intent.
-BRET
HARTE, "The Society upon the Stanislaus"
37. Note the
recognition of the laxative function of the bile salts.
38. The confluence of the hepatic
arterial and portal venous blood into the central veins and
thence via the hepatic vein to the vena cava.
39. Vehicle, in the (present)
pharmaceutical sense of a fluid "carrier" for the active constituents.
40. The liver effluent blood
contains wastes for excretion by the kidney; for example, the liver is a
prime source of urea, one of the discards of protein metabolism.
41. The outer "tunic"
was the peripelvic tissue; the inner, the kidney
pelvis and calyces.
42. Ureter.
43. Observe
the contrast in Vesalius' expressions of rate of
activity: blood "rushes" "quickly" in speaking of liver
and kidney circulation in the two preceding paragraphs, but urine is
secreted "gradually." Vesalius performed a
number of physiologic observations as well as anatomies. (Lamhert, "The Physiology of Vesalius,"
Bull.
44. Nerve: a connective tissue sheet like
an aponeurosis; see Chap. II, note 1.
45. Chap. IT, note 50. The detrusor muscle and the sphincters.
46. The inferior phrenic
veins.
47. Using the Aristotelian idea
of a vena caval origin at the heart, rather than the Galenic concept of a hepatic origin.
48. Great
cardiac vein and especially the coronary sinus. 49. The innominate
veins.
50. Internal
mammary and superior phrenic veins. 51. Axillary vein.
52. Highest intercostal vein. 53. Vertebral vein.
54. Superficial cervical vein. From this point in
the description of the veins of the upper extremity, it has not proved possible
to identify every vessel with certainty. This
is due partly to the considerable variability of even larger veins in this
region and partly to obscurities in
description and form of outline. In consequence, only the vessels which seem most certainly identified are
noted. SS. Cephalic vein.
56. Anterior pectoral vein.
57. Subscapular vein.
58. Lateral thoracic vein.
59. Subclavian, axillary, and
brachial (in succession). 60. Transverse cervical vein. 61. Acromial and deltoid veins. 62. Basilic
vein.
63. Median cubital vein.
64. Median antibrachial vein. 65. Accessory cephalic vein.
66. The most medial of the dorsal metacarpal veins, from the
dorsal venous network. 67. Humeral circumflex and muscular rami.
68. Deep brachial vein, with the radial nerve (Chap. V, note 71). 69. Ulnar vein.
70. Dorsal interosseous vein. 71. Volar interosseous vein.
72. Superficial volar arch. 73. Radial
vein.
74. Anastomosis
with the superficial circulation, especially the median antibrachial
vein.
75. The deep volar, with an offshoot
to the thenar eminence.
76. The venous
anastomosis around the elbow joint, and the cutaneous and muscular rami.
77. Left
suprarenal vein; the subsequent account differs from the modern in two main points:
(a) Modern texts show the right suprarenal as a branch of the inferior vena cava; Vesalius just reverses this. (b) Modern texts place the
left renal higher than the right; again this is reversed in the Epitome.
78. Right suprarenal vein.
79. The
internal spermatic veins. 80. Lumbar veins.
81. The common
iliac veins. 82. Lateral sacral veins.
83. Hypogastric vein.
84. Gluteal veins.
85. Internal pudendal and vesical veins.
86. Uterine veins and venous plexuses of pelvic viscera.
87. Obturator vein; Vesalius must
have followed a branch to an anastomosis with some of
the superficial veins of the thigh, perhaps an accessory saphenous.
88. External iliac vein.
89. Deep epigastric
vein.
90.
Superficial external pudendal vein. 91. Great saphenous vein. 92. Superficial circumflex iliac vein. 93. Femoral
vein.
94. Lateral circumflex femoral vein.
95. Deep
femoral vein, especially the medial femoral circumflex branch as the anastomotic channel.
96. Peroneal
vein.
97. Genicular
veins.
98. Small saphenous
vein. 99. Posterior tibial vein. 100. Anterior
tibia) vein.
CONCERNING
THE ORGANS WHICH MINISTER
TO THE PROPAGATION OF THE SPECIES
CHAPTER VI
I N THE beginning, the Author of the human fabric
fashioned two human beings for the conservation of the species in such a way
that the male should furnish the primary principle of the infant, the female
indeed should fitly conceive it and should nourish the little child arising
from this principle as she would nourish some member of her own body [1 ] until the
child should become stronger and could be given forth into the air which
surrounds us. Both male and female received instruments suitable for
these functions and peculiar to them alone. To these organs was imparted so
great a power and attraction of delight in the generative art that the
living creatures are incited by this power, and whether or not they are young
or foolish or devoid of reason, they fall to the task of propagating the
species not otherwise than if they were the wisest of beings.
The male
possesses two testes covered by skin which is here called scrotum,
surrounded with a fleshy membrane [2), and formed of a white, con, tinuous substance quite peculiar to them. A strong membrane contains
this substance, growing very close to it in circular fashion and receiving the
insertion and connection of those parts which are near the testis,
constituting a
covering belonging to each of the testes [3].
Joined to this one is another covering
proper [4] to the testis and growing forth
from the peritoneum where the latter
offers a path for the seminal vessels. Thence grows forth the membrane containing those vessels with the
testis; it is at no point fused to
the testis nor even to the seminal vessels (except where they escape from the great cavity of the peritoneum). This tunic is
attached with its fleshy part only to
the lower region of the testis; we consider this the muscle of the testis
[5].
The seminal vessels consist of one vein
and one artery on each side. The vein which seeks the right testis grows forth
from the anterior region of the trunk of the vena cava below the place of origin of the veins
which extend to the kidneys. But that vein
which is offered to the left testis is believed to take its origin from the lower aspect of the vein which
approaches the left kidney [6] for the
reason that it may not carry the pure blood to the testis in the manner of the right vein but rather the serous
blood, which by its salty and acrid quality
may bring about an itching for the emission of the semen. Both arteries take their origin from the great artery a
little below the right seminal vein;
the right-hand one, climbing over on the trunk of the vena cava, joins the right vein, reaching the testis together with
this vein. It is complexly intertwined
with the vein before it reaches the testis and forms a body showing many dilatations [7]. This body is inserted with its base in the superior region of the testis, offering small
branches to the innermost covering of the testis [8]. The body is distributed through the manifold
substance of the testis which changes
this benign blood and spirit by its own innate faculty into semen not
otherwise than the substance of the liver changes the thick juice carried there from the intestines into blood.
The semen, when it is created, is received by a strong vessel
like a worm growing
in the posterior region of the testis and complexly intertwined like a tendril [9]. This vessel, round like a nerve, rises upward to the great cavity of the peritoneum along that path by which the
seminal vein and artery descended [10]. Turning downward to the pubic bone, it reaches
the posterior region of the bladder,
to which a vessel bearing the semen from the left testis also runs. This vessel is attached to the right one [11 ] and together with it is inserted into the root of the neck of the bladder in the
glandulous body covering the neck [ 12].
For the semen and for the urine there arises a common channel
which is led slightly downward and again bends back upward to the joining of
the pubic bones outside, lying under the bodies which constitute the penis.
There issues forth on either side of the pubic bone a nerve and a
round and sinewy body which is seen to
be very funguslike within and full of blood [13].
United and fused together, they constitute
the penis; by the aid of its substance
it provides for its erection and enlargement when it is about to inject the semen into the uterus. Otherwise, when there
is no need for its full length, it
is flaccid and slender. For the satisfactory use of Venus, it swells in its apex in the manner of an acorn [14];
it is furnished with a skin by which it can be covered and uncovered [ 15 ].
The female possesses a uterus, dedicated
to receiving the semen and to containing the fetus. The uterus lies
between the bladder and the rectum and, like the bladder, is suitably
formed with a fundus and neck [vagina] [16] adapted for stretching and
relaxing, intertwined with loose membranes and
with some fleshy fibers (by the assistance of which the uterus is voluntarily moved somewhat). It is joined at its sides
to the peritoneum [17]t just
as the mesentery contains the intestines. The shape of its fundus
is not completely round but flattened in front and behind, obtuse above,
and showing two blunt angles (one on each side) which resemble the immature
horns on the foreheads of calves [
18]. In the fundus of the uterus is a simple sinus [19] corresponding very closely to the shape of the
fundus; ending in an orifice and constricting and relaxing itself by a natural force alone
and not by the conscious will of the female, it projects like the glans penis into the cavil, of
the neck of the uterus [vagina]. The fundus of the uterus consists 4-a simple intrinsic tunic notably thick in non-pregnant women so that it
can be stretched to a remarkable
extent in the uterus of women who are with child. Another tunic is drawn over this one; it takes its origin from
the peritoneum. The neck of the
uterus [vagina] is round and smooth; in the non, gravid uterus it is not particularly distended, not
much smaller than the fundus itself. It
receives the insertion of the neck of the bladder [urethra] and is furnished at its orifice with leathery
pieces of flesh and hillocks or wings
[20].
On each side of the-uterus lies one testis to which vessels extend in
exactly the same way as in males [21]. Here, however, it happens that only the middle part of the seminal vein and artery is sent
to the testis; the other part is interwoven in the fundus
of the uterus [22]. The vessel carries a thin and very scanty and watery semen from the female testis; it is inserted into
the obtuse angle of the side of the
uterus. Veins and likewise arteries in a very rich series interweave the
uterus, in addition to those mentioned before; they issue from those distributions of the vessels
which are formed below the junction
of the os sacrum and the lowest lumbar vertebra [23].
These vessels serve for nourishing the
fetus and for the re-creation of the. innate heat.
The fetus, contained in the uterus, is covered with three involucra. One of these is commonly called the secundine ["afterbirth"], because it surrounds only
the fetus like a wide belt and is notably thick and blackish like the spleen [24]; this is joined to the uterus and receives the vessels extending thereto. By means of it, those vessels which are
presently gathered within it are inserted into the umbilicus by two
veins and the same number of arteries, and at
last with one vein to the liver [25]. Two arteries [26] extend to the offshoots of the great artery as these are about
to descend through the apertures of
the pubic bones. The second envelope, collecting the fetal urine between itself and the third envelope, is a
membrane embracing the entire fetus
in the image of a sausage [27]. The
urine is carried by a special channel (28) from the upper aspect of the bladder into this cavity so that, the
urine of the fetus being contained within this membrane, the fetus is not
injured by its acidity. The third
envelope is a very thin membrane and is for this reason also called agnina,
lamblike, by the masters of dissection [29]. It covers the fetus very
closely; finally it keeps the perspiration of the fetus [ 30] between itself and the skid of the fetus, smeared, as it were, with a yellowish scum [31 ].
When the fetus is given forth into the
light of day, it sucks the milk as its own nourishment from the breasts,
untaught by anyone. The breasts have their location in the chest and are
furnished with nipples; they are built up of a glandulous material which,
by an innate force, converts the blood brought to them by the veins into
milk.
THE END OF THE ENUMERATION OF ALL THE PARTS WHICH OCCUR
in the fabric of the human body, as far as possible most briefly and in
their
completeness set down; the following
pages contain the delineation
of these same parts, to be examined in
the order we
prescribed at the outset.
GENERAL INTERPRETATION
VESALIUS' ideas on reproductive physiology are
Aristotelian in origin. The substances from which the embryo is formed. are
"genital semen" and "menstrual blood." The former is
formed by the testes from the blood coming to them in a manner similar to that
in which the liver creates blood from the food brought to it. In addition to the
menstrual blood, the female also forms a thin watery semen in the ovaries which
is carried to the uterus.
The chapter appears to be the
least adequate of the various sections in the Epitome. Much anatomy is not
described. The significance of the clitoris was at first missed by Vesalius and later denied (after having been pointed out by Fallopius). The vagina goes by the name of "cervix
(neck) of the uterus," and the "fundus of
the uterus' is equivalent to the entire uterine mass. The uterine tubes
are not described. Fugitive sheets published by Vesalius
only a few years before the printing of the Epitome represent the
uterus as bearing horns. The section on fetal membranes is not written from the
standpoint of human anatomy.
The Epitome does not describe the
various male and female reproductive organs in terms of direct homology,
although implications are often present. Additional data may be drawn from
the manikin-plates, where the reproductive systems have been represented in such
a way that homologizing is apparent. From such sources the following table of
homologues in the Epitome is offered; it is subject, of course, to possible
revision and addition by future translators of the Fabrica.
MALE FEMALE
Testis Ovary-"testis"
Epididymis Pampiniform plexus of vein
Ductus (vas) deferens Portion of
ovarian artery
Prostate gland Fundus of uterus Body of uterus
Corpora cavernosa
(urethrae et penis) Cervix
of uterus (modern terminology) Vagina-
Clans penis 'neck of the
uterus"-and labia
Prepuce minora
NOTES
1.
THAT is, as if it were an organ of the mother; the independence of maternal and
fetal
circulation was not known.
2. The dartos tunic.
3. Tunica albuginea.
4. Tunica vaginalis proprius.
5. The cremaster
muscle, lying on the internal spermatic fascia (tunica vaginalis
communis).
6. See Chap. III, note 79.
7. Pampiniform plexus.
8. The septula, which radiate from the mediastinum
testis to the tunica albuginea.