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anDreas Vesalius

De Humani corporis Fabrica libri septem

the Fabric of the Human Body


Danie l H. G ar r i s on M alcol M H. Ha s t an annotated translation of the 1543 and 1555 editions

CONTENTS

1555

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Three Forms of Joint 13 : Enarthrosis 13 Arthrodia 14 When Nature Formed Arthrodia 14 Ginglymus 14 When Nature Formed Ginglymus 14 In What Ways Double Joints Are Formed 14 Gomphosis 15 : Suture 15 Harmonia Symphysis 16 Substances That Aid the Union of Bones: Ligaments 16 Flesh: Syssarcosis 16 Cartilage: Synchondrosis 16 Bones That Are Joined with the Aid of No Substance 16 Some Major Disagreements in This Chapter with the Opinions of Galen 16 Appendix: Ginglymus (the Hinge Joint; 1555 Version) Why Nature Sometimes Joined Two Bones with Several Joints

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5
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 he  S Truc T ur e ofThe he Ad: T Why  IT  I S S hApe dA S IT I S , Andh oW  M Any  confIgur ATI on S IThA S  17 The Head Was Formed for the Sake of the Eyes 18 How Nature Protected the Eyes 18 The Brain Is Located in the Head for the Sake of the Eyes, and the Other Senses on Account of the Brain 18 The Natural Shape of the Head 19 First, Second, and Third Unnatural Shapes 19 Fourth Unnatural Shape 19 Other Variations 19 AppendixA: Natural Shapes of the Skull (1555 Version) AppendixB: Variant Shapes of the Head (End; Expanded 1555 Version)

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CHAPTER

The Heads of Men Do Not Always Differ from Those of Women Sutureless Heads Differences in Bones of Old, Young, and Juvenile Persons Sutures in Unnatural Heads The Scaly Seams of the Temples The Sutures Are Visible Also inside the Skull Why Squamous Agglutinations Do Not Resemble the Other Sutures Sutures Already Accounted For The Suture Surrounding the Eighth Bone of the Head Sutures between the Head and Other Bones Extensions of the Lambdoid Suture The Edge of the Cuneiform Bone In What Places the Suture around the Cuneiform Bone Occurs On a Passage in Galens De ossibus, and on the Suture between the Frontal Bone, the Bones of the Maxilla, and Others The Borders of the Vertex Bones The Borders of the Frontal Bone The Softest and Least Dense Part of the Skull The Borders of the Occipital Bone The Thickest Point of the Occiput Capitula of the Occipital Bone The Circumference of the Temporal Bones Mammillary Processes The Cavity of the Temporal Bone The Process Resembling a Writers Stylus The Jugal Process of the Temporal Bone The Cuneiform Bone The Cuneiform Bone Is Not Perforated like a Sponge The Winglike Processes The Eighth Bone of the Head A Bone inside the Canine Skull AppendixA: Why the Entire Brain Is Surrounded by Bones, and Why These Vary and Are Connected Chiey by Sutures (1555 Version)  AppendixB: On the Occurrence of Cohesive Squamous Joints Instead of Sutures (1555 Version) Appendixc: The Cuneiform or Sphenoid Bone (1555 Version) The Nature of the Middle Region of the Cuneiform Bone (1555 Version) Appendixd: A Cartilage or Bone in the Brain (1555 Version)

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32 33 33 33 33 34 34 34 34 34 34 35 36 36 36 37 37 37 38 38 38 38 38 39 39 41 41

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o n  The  e I ghT Bone S ofThehe Ad And  The  SuT ur e Sconnec TIn g The M  20 25 What Kind of Dwelling Nature Prepared for the Brain Why the Skull Is Not Made of Solid Bone The Use of Sutures Sutures of the Naturally Shaped Head The Coronal, Lambdoid, and Sagittal Sutures 26 26 26 26 26 31 31 31 32 32

CHAPTER

7
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 nTheJug Al Bone ,And o TheBone Sr e S e MB lIn gAro ck  ouTcroppIn g  Names Are Assigned to Certain Areas of Bone As If They Were Entirely Separate

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1555

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1 5 43

1555

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The Jugal Bone The Use of the Jugal Bone How Nature Made Provision for the Temporal Muscles The Mansorius Muscle Originates at the Jugal Bone The Bones Resembling a Rocky Outcropping

33 33 33 33 33

42 42 42 43

91

AppendixA: First Two Paragraphs

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91

of the Narrative Section (1555 Version) What Part of the Skull Is Called the Upper Maxilla Why It Consists of Many Bones, Both Light and Hollow AppendixB: How to Distinguish the Maxillary Bones (1555 Version)

49 49 49 49

1555

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1 5 43

CHAPTER

8
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CHAPTER

10
43 43 43 44 44 44 44 44 54 54 54 55 55 55 55 55

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The Cavity Made for the Organ of Hearing, and the Foramina Extending into It Nerves from the Fifth Pair to the Organ of Hearing The Anvil-Like Ossicle The Ossicle That Is Not unlike a Small Hammer Comparison of the Second Ossicle to the Femoral Bone The Use of Ossicles of the Organ of Hearing Marcus Antonius Genua and Wolfgang Hervort, Chiey Responsible for My Undertaking and Completion of This Work Appendix: First 32 Lines of the Chapter 8 Narrative (1555 Version)

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CHAPTER

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 n The Te e Th ,WhI chAr e Al S o o counTe dA S Bone S  Key to the Figure of the Present Eleventh Chapter, and Its Characters The Teeth Have Sensation The Distinction between Teeth and the Other Bones The Number of Teeth The Canines Molars How Teeth Are Fixed in the Jaws Roots of the Teeth The Number of Teeth Sometimes Varies Wisdom Teeth (Genuini dentes) Hollow Space in Teeth Dental Epiphyses

CHAPTER

9
36 36 38 39 39 39 39 39 40 40 40 41 41 42 46 46 48 48 48 50 50 51 52 52 52

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 n  The  T We lve B one S of o The  uppe r M A xIll A , IncludIn g  The B one S of  The  n o S e  Index of the First Figure of the Ninth Chapter and Its Characters Index of the Second Figure and Its Characters Why the Maxilla Consists of Several Bones, Both Hollow and Light Structural System of the Maxillary Bones Brief Enumeration of the Bones of the Maxilla How Many Bones Make Up the Eye Socket The First Bone of the Maxilla The Second Maxillary Bone Third Maxillary Bone Fourth Maxillary Bone The Fifth Bone of the Maxilla The Sixth Bone of the Maxilla There Are in All Twelve Bones of the Upper Maxilla Not Everything Thus Far Stated in This Chapter Fits the Opinions of Galen; Some Items Are Enumerated at the End of the Chapter

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84 84 85 85 86 86 87 88 88 89

CHAPTER

12
47 59 59

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o n The f or A MInAofThehe Ad  AndTheuppe r M A xIll A 

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Why a Description of the Foramina Is Undertaken 47

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BOOK

 n  The  o S S I cle S  ThATe nTe rup on o The  con S Truc TI on  ofTheorg An  of  he Ar In g  33

onTheloWe r M A xIll A  Man Has the Shortest Jaw The Human Jaw Is Made Virtually from a Single Bone Two Processes on Both Sides of the Maxilla Picture of the Special Cartilage in the Joint of the Maxillae Foramina of the Maxilla Alveoli of the Teeth Breadth, Thinness, Depressions, and Rough Spots in the Posterior Area of the Jaw

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ON THE BONE RESEMBLING T H E G R E E K U P S I L O N


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K E Y TO F I G U R E S A N D C H A R AC T E R S SET FORTH HERE The first figure of the present chapter represents the anterior face of the bone [corpus ossis hyoidei] resembling the letter [Greek upsilon], together with its lesser or more elevated sides [cornua minora] and the ossicles which are connected to them as far as the processes of the temporal bones that are shaped in the fashion of a stylus [processus styloidei]. The second figure shows the posterior region of the bone resembling an , along with the more elevated ribs [cornua]; but for the moment we have not drawn those ossicles which extend to the processes that resemble a stylus and are drawn in the previous figure.

A, B, C 1 Larger and middle ossicle [corpus] of the hyoid bone, visible on its anterior side. A and B indicate the protuberant region of this surface. In between these characters appears the particular *. tubercle of this region, marked *. C indicates the transversely elongated depression discernible in the superior part of this middle ossicle. D 2 Posterior side of the larger ossicle [corpus], depressed and concave. E, F 1, 2 Lower sides [cornua majora] of the hyoid bone, which with the middle ossicle represent a figure like an . G 1, 2 Joint of the lower side [cornu majus] with the broader and larger ossicle of the hyoid bone.

H 1, 2 Apex of the lower side, which is attached to the process of the laryngeal cartilage that resembles a shield [cornu superius cartilaginis thyroideae]. I, K 1, 2 Upper sides [cornua minora] of the hyoid bone, considerably thinner and more smoothly rounded than the lower ones. L, M, N 1 Three ossicles, very often joined to the upper sides [cornua minora]. Besides the fifth plate of the muscles at the letter L , several earlier illustrations of the twelfth chapter of the second book at A , B, C , and D further represent the hyoid bone.

F I R S T F I GU R E

S E CO N D F I GU R E

01

02

An earlier version of this chapter was published in Medical History 37.1 (1993), pp. 336. Neither of these gures illustrates a typically human hyoid bone a notable departure for a book which stresses human as opposed to animal anatomy. The left hyoid bone shown above (g.1) has a canine feature in the chain of narrow ossicles (K , L , M , N) that extend in the dog to the styloid bone (in the human, this connec-

tion is made by the stylohyoid ligament). The right hyoid bone (g.2) represents the posterior aspect of the same bone with L , M , N removed. Its lesser horns (I, K) appear nearly the same length as the greater horns (E , F ), whereas in humans the lesser horns have only a fraction of the mass and length of the greater, and are altogether dierent in shape. Vesalius is described as using the larynx of an ox and of some other animals

in a 1540 anatomy lecture at Bologna because, he said, in the hanged [human] subjects we cannot see the larynxes, for they are destroyed by the noose, but they are however quite dierent [in man and in animals] (Eriksson, 1959, p. 285). The illustrations in this chapter appear to blend human and animal anatomy.

03

04

Lat. ut plurimum, perhaps more often than not; see preceding note. Possibly, these are nontypical, ossied portions of ligamentum stylohyoideum; more likely, this gure reects features of the canine hyoid bone and apparatus, in which the cornu minus is connected to the pars tympanica and vagina processus styloidei by a series of ossicles (L = epihyoid, M = stylohyoid, N = tympanohyoid), unlike the ligamentum stylohyoideum of the human. An error in both editions; these illustrations appear in Ch. 21, Bk. II.

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113

L OC AT ION A ND NA M E S OF T HE H YOID BONE


laced before the most prominent part of the larynx is a bone taken collectively for the sake of unity, but constructed of many different ossicles; some call it 5 from the shape of the letter , others more succinctly ; those without experience in dissection, misled by this term, have translated it in Galen as the bone resembling a pig.6 This bone is named elsewhere [lambda-shaped] from the look of the letter ; translators deceived by this name have become accustomed to render it as the lambda-like suture of the head (C, D in gs. 3 and 4, Ch. 6; B in the 3rd skeleton). But I for my part have recently removed errors of this sort from a version of Galen which both Italy and Germany published in Latin. Herophilus7 is also said to have called this bone [companion], perhaps because it is located next to the tongue, or the larynx, or the jaws, just as in the organs serving generation he calls certain items , the varicose companion [i.e. spermatic duct] (from to in gs. 22 and 23, Bk. V), and (, B in the same gures), the glandular companion.8 Moreover, there are some who, because it is located in the throat, have called it the .9 I have made it my practice throughout to name this the bone resembling an , or more succinctly the hyoid.

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terior surface, it is concave. On the anterior, it is indented on top as in an elongated depression because the shape is suitable for it, and because of the muscles and ligaments attached to it. For into the upper depression are implanted the third and fourth muscles (R in the 4th table of muscles) [mm. mylohyoidei] peculiar to this bone; on the protuberance visible in this location, at the sides which are somewhat impressed in the area where it swells, the rst two muscles [mm. sternohyoidei] peculiar to this bone make their insertion (S, T in the 4th table of muscles; the other muscles of this bone are Q [musculus stylohyoideus] and V [musculus omohyoideus]). From the hollow of the posterior side, the rst two muscles [radix linguae] that move the tongue have their principal origin (DD in gs. 1 and 2, Ch. 19, Bk. II). Moreover, because the hyoid is convex on the outside but hollow inside, the muscles are also conveniently placed farther from the path of injuries coming from the outside. This larger ossicle [corpus ossis hyoidei], positioned slightly above the larynx, may be found by touch, but its sides [cornua] are a little more deeply hidden. With this wider ossicle, two others [cornua minora, cc. majora] are united on each side. One of these is lower, the other higher.

Bk. 1 Ch. 6 Fig. 3, 4 Bk. 1 Skeleton 3

Bk. 5 Fig. 22, 23

Bk. 1 Ch. 13 Fig. 1, 2

Bk. 2 Table 4

Bk. 2 Ch. 19 Fig. 1, 2

L OW ER SIDE S OF T HE H YOID BONE


The lower ossicle [cornu majus] is somewhat shorter and broader than the upper [cornu minus] (one is E, F in gs. 1 and 2, the other I, K), and is connected to no other bone than the side (G in gs. 1 and 2) of the middle, wider ossicle of the hyoid bone, to which it is rmly attached by cartilage and cartilaginous ligament over a noteworthy breadth. The end of this bone (H in gs. 1 and 2) is joined [ligamentum thyrohyoideum laterale] to the superior process [cornu superius] of the laryngeal cartilage that looks like a shield [cartilago thyroidea] (A, B in gs. 3 and 4, Ch. 38). We rightly call this lower ossicle or side, together
Bk. 1 Ch. 38 Fig. 3, 4

MIDDL E OS SICL E OF T HE H YOID BONE


The human has this bone quite differently constructed than the quadrupeds which until now we have dissected,0 and it is the broadest ossicle of the hyoid bone (A, B, *, C in g.1, D in g.2), convex on the outside and jutting forward with its own protuberance; but inside, or on the pos-

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

05

06

A fanciful compound unattested in LSJ or the TLG medical canon, combined from short u and - -like, presumably because it is shaped like the Greek letter. An additional element could be , on high, because it is situated above the larynx, high on the neck. Because, in Greek, hys or sus means pig; but there may also be a note of irony in this false etymology as Galens description of the larynx is based in part on pig anatomy. See May, 1968, p. 352, n. 32.

07

Herophilus of Chalcedon (4th3rd cent. BC), the most important of the Greek anatomists in Alexandria who dissected human cadavers, is frequently cited by Galen. His contributions to nomenclature are noteworthy for their use of visual comparisons. The word generally means companion, or bystander, and is applied to the twin spermatic ducts as well as the hyoid bone conceived as the companion to the larynx; see May, 1968, p. 26.

08 09

For which see Galen, De usu partium 4.190.3. (May, 1968, p. 644). A variant reading for , or larynx, translated by LSJ as , i.e. the windpipe or pharynx, but not in the sense suggested here, pharynxbone. The word is Hippocratic (De anatome 1.1); see also Galen, De libris propriis liber 19.28.1, PseudoGalen, Introductio seu medicus 14.721.5, Aretaeus (2nd cent. AD), De causis et signis acutorum morborum 1.7.14, 2.2.1.3, and Atius Amidenus (6th cent. AD), Iatricorum liber 2.92.24.

10

11

Vesalius handwritten comments on the 1555 edition delete this portion of the sentence. The 1555 edition adds: We call these the sides of the hyoid bone with Avicenna, in his chapter On the Throat. Avicenna (9801037) is the Arabian physician and philosopher whose Canon of Medicine had been considered authoritative since 1100, appearing in at least 60 complete or partial Latin editions between 1500 and 1674; see Siraisi (1987).

Bk. 5 Ch. 15 Fig. 25

224

On the Carpus
We shall add an index explaining the six figures above together with their characters1 on the following page.

The first two figures apply not only to the present chapter but also to the three following, in which the parts of the hand are also explained. We shall call what Hippocrates named 2 the top or end of the hand, that is, the part which lies between the forearm and the farthest [distalis] tip of the fingers and which we divide into carpus, metacarpus, and fingers.3 By hand, Hippocrates meant whatever comes between the scapulae and the end of the fingers and is subdivided into arm, forearm, and hand. Thus, the first figure of this chapter shows the inner [palmaris] surface of the bones of the hand. the second includes the outer [dorsalis] surface of the same bones, appropriately drawn. The four subsequent figures are peculiar to this chapter and represent only the eight carpal bones in various aspects. the one identified as third shows the inner [palmaris] surface of the eight wrist bones, all together in place. the fourth has the same bones drawn from their outer [dorsalis] aspect. the fifth includes the upper part [p. proximalis] of the wrist bones, where they are articulated to the forearm. the sixth displays the lower surface [pars distalis] of the wrist bones, to which the first bone of the thumb [os metacarpale I] and the four metacarpal bones [ossa metacarpalia IIV] are attached. The index of characters will be as follows. 1, 2, 3, 4, 5, 6, 7, 8 These eight numerals designate the eight bones of the carpus in all six of the present figures, if all were seen on the surface in which the wrist presents itself. Each bone is always identified with its own number, and in this way shows its name. We shall call the first bone [os scaphoideum] that which is marked 1, the second [os lunatum] the one marked 2 . Thus, 1, 2 , 3, and 4 mark the upper [proximalis] row of the eight wrist bones, these being the four higher or nearest to the forearm. 5, 6, 7, and 8 indicate the lower [distalia] bones, which are conterminous with the metacarpus.4

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F I R S T F I GU R E

The four metacarpal bones are marked in the first and second figures;5 there is no reason not to name them by the number written on them unless one prefers to name them for the finger they support, and which they precede. a, B, C 1, 2 Three bones of the thumb [pollex] which we also call internodes.6 D, e, F 1, 2 Three bones of the index finger [index]; the same system applies to the other fingers as well.7 G 3, 6 Depression [facies articularis, basis metacarpalis I] of the fifth carpal bone [os trapezium], and surface to which the first bone [os metacarpale I] of the thumb is articulated. We measure the length of this depression transversely a, b. 6 from a to b in the sixth figure. The inc. 6 ternal [medialis] surface is marked c , d. 4, 6 the external [lateralis] d, which is also visible in the fourth figure. h 3, 4, 6 Surface [facies articularis] of the sixth carpal bone [os trapezoideum] to which the metacarpal bone supporting the index finger [index] is attached; on h. 3, 4, 6 the fifth bone, h marks the place
1, 2

I, II, III, IIII

[facies articularis, basis metacarpalis II] which the same metacarpal bone also touches. K 3, 4, 6 Place [facies] on the seventh wrist bone [os capitatum] to which the metacarpal bone supporting the middle finger [digitus medius] is attached. In k. 3, 4, 6 the same figures, k marks the place [facies articularis, basis metacarpalis III] where this metacarpal touches the sixth wrist bone. L 3, 4, 6 Place on the eighth carpal bone [os hamatum] to which the metacarpal bone [os metacarpale IV] leading to the ring finger [digitus anularis] is attached. M 3, 4, 6 Place on the eighth carpal bone to which the metacarpal bone [os metacarpale V] supporting the little finger [digitus minimus] is articulated.

As in the preceding chapter, Vesalius presents his illustrations with the proximal end down, contrary to the practice of his own time (e.g. Canano, Musculorum humani corporis picturata dissectio, c. 1541) and contrary to modern convention. In the text, however, the orientation is reversed: proximal bones are upper, and distal bones lower. Or more accurately , in On Fractures 9.2. In the 1543 Fab-

rica, Vesalius summa manus for hand imitates Galens , employed because Gk. can mean the arm or the hand and arm combined (LSJ II). Galen explains this usage at the beginning of Ch. 2 in Bk. 3 of De anatomicis administrationibus. The Latin term is something of an affectation, as manus is not ambiguous in the same way as the Greek term. Here as elsewhere in the 1555 edition, Vesalius substitutes manus for

summa manus. Vesalius digression on nomenclature was also deleted from this point in the later edition, and moved (with revisions) to the beginning of the narrative section. See n. 14 below. Brachiale & postbrachiale ac digitos. On the lack of a Latin word for wrist or adjectives based on Gk. karpos, see n. 2, Ch. 24. In all figures except the 4th, the number 5 has been engraved backward. The 1555 edition omits all

5 6

but the first sentence of this section. The 1555 edition omits all that follows in this section. Os metacarpale I, phalanx proximalis, ph. distalis. Vesalius follows Galen in calling the first metacarpal the first phalanx of the thumb, while the other metacarpal bones are numbered IIIII for the four fingers. Phalanx proximalis, ph. media, ph. distalis.

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225

Bk. 5 Ch. 15 Fig. 25

T H I R D F I GU R E

Bk. 5 Ch. 15 Fig. 25

S E CO N D F I GU R E
Bk. 5 Ch. 15 Fig. 25

F O U R T H F I GU R E

Bk. 5 Ch. 15 Fig. 25

n 1, 2 Ossicle [os sesamoideum] leaning against the outer side of the articulation of the eighth carpal bone to the metacarpal bone, by which the little finger is supported. O 2 [1], 3, 6 Process of the eighth carpal bone [hamulus ossis hamati] protruding into the inner area of the carpus. p 2 [1], 3, 6 Process [tuberculum ossis trapezii] of the fifth carpal bone from which originates the transverse ligament [retinaculum musculorum flexorum] that makes its insertion into the process of the eighth bone marked O; it is covered by tendons from the forearm8 that go to the inner area of the hand. Q 2 Upper epiphysis [basis metacarpalis II] of the metacarpal bone that supports the index finger [index]; it is articulated to the carpus [os trapezium, os trapezoideum].

r 2 Lower epiphysis [caput] of the metacarpal bone leading to the index finger, which forms the head that enters the depression of the first bone [phalanx proximalis] of the index finger.9 s 1, 2 Interval between the metacarpal bone leading to the index finger and the one that supports the middle finger. The same system of epiphyses and intervals holds for the other metacarpal bones. t 1, 2 In the first figure, the inner of two sesamoid bones placed before the inside of the second thumb joint is marked; in the second figure, the outer. V V 1 Two sesamoid ossicles placed in front of the joint of the index finger.10 X X 1 A single sesamoid ossicle, or rather like a mustard seed, placed upon the second joint of the index finger.11 Y1 A single sesamoid ossicle, located on the third joint of the thumb.12 In the remaining fingers, the system is the same as with the index finger, though we have not shown the sesamoid ossicle of the second and third joints.13

Bk. 5 Ch. 15 Fig. 25

F I F T H F I GU R E

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

S I X T H F I GU R E

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

9 10 11

Musculus flexor digitorum superficialis, tendines; m. flexor digitorum profundus, tendines; m. flexor pollicis longus, tendo 1555: And which is much more easily seen than the upper. The V on the left of this pair was recut in the 1555 edition. Xs were recut below the 1st and 2nd interphalangeal joints in the

1555 edition, and the legend was rewritten as follows: The lower X marks the sesamoid ossicle placed before the second joint of the index finger; the upper marks the ossicle given to the third joint of the index finger. The arrangement of these ossicles is the same in the other digits.

12

13

Y is not visible at the interphalangeal joint of the thumb in either edition of the Fabrica, and the 1555 edition omits this entry altogether. In the hand, sesamoid bones embedded in tendons are found only on the palmar surface of the joints. Two (medial and lateral) are constant at the metacarpophalangeal joint of the thumb; one is fre-

quently present at the metacarpophalangeal joint of the little finger and the index finger. Occasionally, sesamoid bones are found at the metacarpophalangeal joints of the middle and ring fingers, and at the interphalangeal joints of the thumb and index fingers (Gray, 1995, p. 736).

ON THE CARPUS

226

T HE C A R PUS IS C ONS T RUC T ED OF EIGH T BONE S DIF F ER ING F ROM E ACH O T HER IN SH A PE4
HE GREEKS call the part of the hand (V to Z in the skeletal gures; 18 in all the gures of this chapter) that is articulated to the forearm ; we call it brachiale in imitation of Celsus.5 It is constructed of eight bones separated in a double row. In people of mature years, these bones are hard and small, not porous inside, and lled with a slight amount of marrow like the epiphyses, not altogether lacking in marrow.6 This is particularly so in the larger of these bones, as they are all of different size, shape, and location, nor is there one in the lot which at all resembles another: each one has some feature by which it can readily be distinguished from the others. But varied though they be, they are so harmoniously tted to each other, and attain such a unity of composition, that their number is not very easy to discover. For unless you cut away the very strong cartilaginous ligaments [articulationes carpi] ( in the 8th table of muscles, l in the 12th table) with which they are covered, as well as the membranes, and carefully scrape them off, they will all appear to be a single one,7 or like Celsus you will believe they consist of an uncertain number.8

Bk. 1 Skeletons 1+

Bk. 1 Ch. 25 Fig. 1+

Bk. 2 Table 8

Bk. 2 Table 12

these surfaces are bound by ligaments;0 above (g. 5), where the bones [ossa carpi proximalis] are joined to the forearm [radius, ulna], they are smooth and coated with cartilage, just as they are below (g.6) [ossa carpi distalis], where they are joined to the metacarpal bones [ligamenta carpometacarpalia dorsalia/palmaria] and the rst bone of the thumb [articulatio carpometacarpalis pollicis]. Indeed, where the bones touch each other they are not everywhere rough and uneven or covered with ligaments, but smoothly tted depressions are carved in all of them, lined with smooth, slippery cartilage, and they receive the tubercles or heads of the other bones, which are likewise smooth and covered with cartilage. Ligaments [ll. intercarpalia dorsalia, ll. intercarpalia palmaria, ll. intercarpalia interossea] or membranes come between none of the carpal bones except in the spaces [interossea] between the bones of the lower row [ossa carpi distalis], where a small amount of cartilaginous ligament scarcely worth noticing intervenes as if at a point, and where the lower bones are not so closely packed together as the upper.

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Bk. 1 Ch. 25 Fig. 2

W H Y T HER E A R E T WO ROW S OF C A R PA L BONE S


Nature constructed this justly, fashioning two rows of wrist bones particularly because the upper row [ossa carpi proximalis] (14 in nearly all the gures) needed to be joined to the forearm in quite a different way than the lower row [ossa carpi distalis] (58 in all gures) needed to be joined to the metacarpus and the rst bone of the thumb. The carpus is articulated to these as separate and distinct bones, while it articulates with the forearm as to a single bone, so that the bones of the upper row are rightly articulated with each other more closely and intimately than the bones of the lower row, and without the intervention of any body. Anatomists believe this is the chief reason for the large number of wrist bones, adding as a secondary

Bk. 1 Ch. 25 Fig. 3, 4

Bk. 1 Ch. 25 Fig. 5

W HER E T HE C A R PUS IS C OV ER ED W I T H L IG A M EN T S , A ND W HER E BY C A RT IL AGE


They are all (compare gs. 1 and 2, then the 3rd to the 4th) bound together (but not, as some think, fused) by these sinewy and cartilaginous bonds, forming two complete surfaces: convex on the outside [dorsalis], as much as is useful to the hand, and hollow on the inside [palmaris], as concave as is convenient for this part of the hand.9 Only

Bk. 1 Ch. 25 Fig. 6

Bk. 5 Ch. 15 Fig. 25

14
Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

The following some of it transferred from the beginning of the 1543 figure legend is added to the beginning of the 1555 narrative: The part which we vulgarly call the brachium when we say that man is endowed with arms and legs, meaning everything from the scapula to the end of the fingers and the tips of the nails, was called the hand (or rather ) by Hippocrates and often by Galen. What is called the manus by nearly all the Latins, and which we measure from the lowest end of the forearm and the loose joint attaching the hand to the forearm out to the end of the fingers, was called by Hippocrates , as if to say the farthest or end hand. This distinction, however fitting for the

15

16 17

Greeks, cannot be of much use for those writing in Latin. We shall divide the hand only into wrist, metacarpus, and digits, and give each its own chapter. In the present we shall describe the part which is articulated to the forearm, etc. See n. 1, Ch. 24, and Celsus 8.1.2022, where manus and prima palmae pars are named as the location of the carpal bones. Brachiale does not occur in Celsus and is unattested in the OLD except in the sense of bracelet, armlet. 1555: as has been thought by some. Paraphrased from Galen, De usu partium 3.121.11ff.: these bones are fitted together so skilfully as to

18

19

leave nothing wanting for accuracy and perfection. In the first place, although no one of the eight carpal bones greatly resembles any other in shape or size, they nevertheless achieve such close union in their articulations that it is hard to tell how many of them there are. In fact, unless you carefully scrape away the ligaments and strip off the protecting membranes, you will think they are all one bone. (tr. May, 1968, p. 131). Celsus 8.1.21: The first part of the palm consists of many minute bones of which the number is uncertain (Loeb tr. by W.G. Spencer, p. 489). Cf. Galen, De usu partium 3.121.20ff.: the carpusis concave on its inner side as much as is suit-

20

21

22

able for the hand and convex on its outer side to the extent that this too is advantageous (tr. May, 1968, pp. 131f.). L. radiocarpale dorsale, l. radiocarpale palmare; l. ulnocarpale palmare; l. carpi radiatum; l. collaterale carpi ulnare, l. collaterale carpi radiale. Simplified as follows in 1555: where the bones touch each other they have smooth depressions and heads covered with slippery cartilage, by which they are articulated to each other. The final clause is rewritten in the 1555 version: so that this difference of articulation must also be considered the chief reason for the large number of carpal bones.

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227

reason that it is difficult to hurt; they believe the wrist is made more resistant to injury because it is composed of many bones that break the force of objects that strike it by giving way, as we observe that a spear or arrow has more trouble penetrating loose targets than those that are taut. At the same time, we notice that this strength and abundance of bones was constructed by Nature not least for a countless variety of motions of the hand. I shall now endeavor to explain what depressions and outgrowths the wrist bones have.4

NA M E S OF T HE C A R PA L BONE S
Four bones are located in the upper [proximalis] part of the carpus, in the row that faces the forearm. To these we shall assign appropriate names according to the order in which they are arranged, always naming the rst [os scaphoideum] (1 in the rst ve gures) the bone that constitutes the inner [lateral] side of the upper row; second [os lunatum] (2 in the same gures), the one that follows this and is more distant from the inside; third [os triquetrum] (3 in the same gures), the one that is closest to the second toward the outside [medial]; and fourth [os pisiforme] (4 in the same gures [gs. 1, 3, 5, and 6]), the one that occupies the outermost side.5 Similarly, we shall name the four bones of the lower [distalis] row (58 in all gures) the fth, sixth, seventh, and eighth, and in this fashion we shall approach the account of the individual bones. The rst, second, and third are very strongly and closely joined together and linked in a single row as if they were a single bone, forming the upper area of the carpus in such a way that they are smoothly articulated into the depression [facies articularis carpalis] of the radius and ulna as if they were the head of a single long, wide bone. The rst [os scaphoideum] and the second [os lunatum] are placed in a depression (x, y in gs. 1 and 8, Ch. 24) carved in the epiphysis of the radius; the third [os triquetrum] leans against

the cartilage [discus articularis] (T in gs. 13, and 8, Ch. 24) which we have written begins at the radius and chiey separates the ulna from the carpus. But the outer side of the third bone also comes into contact with the sharp process [p. styloideus ulnae] (R in gs. 1, 2, 5, and 10, Ch. 24) of the epiphysis of the ulna when we incline the hand to the outside.6 At the same time, this third bone does not have a depression visually distinguishable in man that is made especially for the sharp process and lined with cartilage, since the process itself protrudes only along the side of the depression where the carpus is contained, acting in the same way as the brows of the other depressions, including the apex ( in gs. 1, 2, and 7, Ch. 24) of the epiphysis of the radius in this area.7 This is readily decided even by touch if, when the hand is bent to the inside, one tries to insert the tip of the thumb of the other hand between the carpus and the ulna. Therefore the rst three carpal bones are so joined together on their upper [proximalis] surface, and so protrude, that they make up, as it were, a single head of the wrist, smooth and covered with cartilage, by which it is articulated to the forearm and is moved in many vigorous motions as if formed of a single large bone.8

Bk. 1 Ch. 25 Fig. 1+

Bk. 1 Ch. 25 Fig. 3, 5, 6

Bk. 1 Ch. 24 Fig. 1, 8

Bk. 1 Ch. 24 Fig. 2, 3

Bk. 1 Ch. 24 Fig. 5, 10

PEC U L I A R I T IE S CL A I M ED BY T HE FOU RT H BONE


The fourth carpal bone [os pisiforme] (there is no need to identify the bones in the margin hereafter, as the numbers are obvious in nearly all the gures of this chapter) does not touch the ulna, but on its upper surface it admits the portion of the ligament of this joint [ligamentum ulnocarpale palmare] which originates from the sharp process [p. styloideus] of the epiphysis of the ulna. The tendon [musculus exor carpi ulnaris, tendo] ( in the 4th table of muscles) of the muscle which is reckoned the lower of those exing the wrist is attached to the upper surface of the fourth bone. From its lower surface, the muscle [m. abducBk. 1 Ch. 24 Fig. 7

Bk. 2 Table 4

118

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

23

See Galen, De usu partium 3.125.16ff.: to protect the [carpal] system completely, it was better for it to consist of many bones, and further, of bones just as hard as they are; for by yielding at the joints to objects striking against them, they break the force of the blows. It is in just this way that a dart or spear or any other weapon of the sort pierces a stretched hide more easily than one not under

24 25

tension, because the one offers resistance and the other by yielding a little deadens the force of the blows falling upon it. (tr. May, 1968, p. 133). This sentence is omitted from the 1555 edition. In the anatomical position favored by modern convention, the hand is down with the palm facing forward, making Vesalius outer (medial) side the little finger side, and his inner side the lateral or thumb side.

26 27

Adduction or ulnar deviation. Vesalius point is that the styloid process of the ulna is not articular, as Galen had stated in De usu partium 3.133 and elsewhere (see n. 56, Ch. 24), but functions only as a structure corresponding to the styloid process of the radius, helping to contain the wrist bones within the articular capsule formed by the radius and ulna.

28

Cf. Galen, De usu partium 3.129.1719: It was necessary for [the bones of the carpus] to be almost like one bone, since they must act as one in articulating with the forearm and in taking part in many vigorous movements. (tr. May, 1968, p. 135). This sentence is omitted from the 1555 Fabrica.

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

SECOND SKELETON

324

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Bk. 5 Ch. 15 Fig. 25

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Bk. 5 Ch. 15 Fig. 25

330

INDE x OF CHAR AC TER S PL ACED ON THE THREE FIgURES REPRESENTINg THE ENTIRE SKELE TON1 The same characters are generally inscribed on each of the three preceding figures2 (which I call the complete figures), though if one of them is peculiar to only one figure, it will readily be noticed from the number which I shall now append to each character in the Index, where for the most part I have endeavored simply to write the names of the bones,3 placing first those which I chiefly use in the main body of my text, then the greek names, and after that the Latin names (if there are any others) accepted by the most approved authors, so that the order of names here will have some significance. Hebrew names will follow these, but also a few that are still Arabic, almost all taken from a Hebrew translation of Avicenna with the aid of a prominent physician and close friend of mine, Lazarus Hebraeus de Frigeis (with whom I am accustomed to work on Avicenna).4 I thought it proper to add a Latin transliteration to those names, because most of them occur in Arabic books translated into Latin.5 Similarly, other words that occur often in Latin translations of the Arabic will for good reason be placed next, along with names which are read in the scholastic doctors (as they love to be called) and in the medical handbooks of our time.

These are no less carefully to be considered than names received from the Latin authors. Bone is called by the greeks, os by the Latins, and by the Hebrews , hezem. Cartilage is , hascechusim. It will be convenient for us to begin the names of the bones with those of the head or skull, which the greeks call , , , , . Many call the entire area of the bones of the head that surround the brain made of eight bones6 calva, cerebri galea, and the like. Others so name only the area covered with hair. Its circle is called and ; tkek hamoah, chederath hamoach; theca case and olla jar of the head, testa shell of the head, and scutella pan of the head, asoan. The sutures with which the bones of the head are joined together are generally called , scelavim; senan, direzan, adoren, complosa7 clapped together. A 2, 3 Coronal suture, ; hachlilii, chascthii; arcualis arcuate, sutura puppis.8 B 2, 3 The suture [s. lambdoidea] resembling the greek capital , , and from its resemblance to ; lambdii; laude, hypsili, sutura prorae.9

C3

Sagittal suture, , . Suture running along the longitude of the head like a shaft, spit, or rod. checii, scefodii. Called nervalis especially when joined to the coronal suture; the place [bregma] is called zeudech, particularly by Mesu.10 D 2, 3 This joint [sutura squamosa], not resembling a true suture, is named with its mate, the sutures joined to each other like scales, , temporal, squamiform, chelaphiim, cortical, mendosae false sutures. The remaining sutures of the skull11 do not have their own names. As they are such, I need not return to them again at greater length. 2, 3 This bone [os parietale], together with its mate, is called the bone of the vertex, and likewise of the 12 or . There are some who call them the bones of the sinciput; hezem hachodchod; nervalia, paria, arcualia; others call them iugalia and parietal bones, a name by which some call the temporal bones; the bones of reason or cogitation. 1, 2, 3 Frontal bone, , called by some the bone of the sinciput; hezem hamezzech, the coronal, os puppis of the head, the os inverecundum shameless bone, the bone of common sense.

166

1 2

1555: together with the various names of the bones. 1555: in which the complete structure of the bones is represented. These skeletons may be compared to the three which constitute the latter half of Vesalius Tabulae anatomicae published in Venice, April 1538. The 1538 figure legends, printed on the same sheets as the woodcut figures, are a similar attempt to provide a greek, Latin, Arabic, and Hebrew nomenclature. But the 1538 figures are less profusely marked, with only 55 items marked in all three. See Singer and Rabin, 1946, pp. 1844 for an extensive commentary on the 1538 nomenclature. Saunders and OMalley (1950, p. 84) note rightly that the Fabrica s skeletal figures, probably of a 17- or 18-year-old male, contain errors of proportion. For example, the thorax is too short, the lumbar spine is too long, and the entire torso is proportionally short. As already noted (see n. 3, Ch. 14, and n. 59, Ch. 16), several of the spinal curves are missing, perhaps reflecting the practice of threading the vertebrae over a rigid iron bar improperly bent to demonstrate curvature during

3 4

articulation of a skeleton, but due also to Vesalius ide fixe about spinal curvature (see n. 42 and 49, Ch. 39). The result is that with the loss of the spinal curves the ribs are too horizontal and the normal anterior pelvic tilt is lessened. Although the ratio of the tibia to the femur is nearly normal, the upper extremity is proportionately too long for the axial skeleton, with the bones of the forearm proportionately too long for the humerus, and the upper extremity is not typically proportionate to the lower extremity. 1555: but without explaining how they work. On attempts to identify Lazaro de Frigeis, see OMalley, 1964, p. 120. Singer and Rabin (1946, pp. lxxvi lxxvii) note that de Frigeis access to a 1491 Hebrew translation of Avicenna is an important factor distinguishing the Semitic vocabulary in the Fabrica from what was provided in the Tabulae of 1538. There is no reason to believe that Vesalius himself had more than a sketchy acquaintance with the Hebrew alphabet or any real knowledge of Semitic languages. See Etziony (1945, 1946; a detailed

study of the Hebrew terminology used by Vesalius), Fck (1955), Dannenfeldt (1955), Pines (1965), Brugman and Schrder (1979), Katchen (1984), and grafton (1993, vol. 1). For Hebrew and Arabic medical nomenclature, see Hyrtl (1879). In this translation, we offer occasional translations of the Latin terms; but a complete account of the greek, Hebrew, Arabic, and Latin nomenclature, such as the one noted above (n. 2) by Singer and Rabin, is beyond the scope of this commentary. The Hebrew words and their transliterations present their own difficulties: (1) de Frigeis knowledge of Hebrew and Arabic may have been sketchy; (2) the transcriber was unfamiliar with Hebrew; and (3) the typesetter, also unfamiliar with Hebrew, made numerous typographical errors. In this version, we have tried only to achieve a degree of consistency between the Hebrew and its transliteration, and where possible to give the correct Hebrew spelling. We are grateful to Ahuvia Kahane and Mira Balberg for their assistance in this task.

7 8

9 10

11

12

Os frontale (1), os parietale (2), os occipitale (1), os sphenoidale (1), os temporale (2), and os ethmoidale, lamina cribrosa (1; Vesalius 8th bone of the head). The 1555 edition describes the skull differently: as it occurs in cemeteries, or is commonly represented otherwise. Like arcualis below, this meaning is postclassical. Stern suture, so called because it is arched like the curved stern of a sailing ship. The same attributive is given to the frontal bone ( below). Another nautical metaphor, the prow suture. Johannes Mesu the Elder (Yannn ibn Msawayh, d. 857), a collector and translator into Arabic of the greek medical classics; a Christian hospital director in Baghdad, he was also known as Janus Damascenus. 1555: and all their structures. The second edition also omits the last sentence of this item. Bregma: the intersection of the sagittal and coronal sutures.

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SKELE TON S
1, 2, 3 Process [p. mastoideus] of the temporal bone resembling the nipple of a breast: , mamillaris, hezem potmii. E 2, 3 Bone [os sphenoidale] compared to a wedge, ; it is defined by galen 17 (even though it scarcely touches the palate), . Cuneiform bone18 of the palate, basillare (though they also so name the occipital bone),19 moscau hamoach; baxillare, paxillum, os colatorii, os cribratum, cavilla though they call the talus the same thing. 2 Area of the skull which we call stony, lapidosa [os temporale, pars petrosa]. 2 Processes of the sphenoid bone resembling bats wings; , hezzem chenaphii.20 F 1, 2, 3 This area [arcus zygomaticus, commonly named the zygoma], and its mate on the other side, is called the jugal bones: , , 21; hazamoth hazogh. Bones of a pair and paria are names they also assign to the bones of the temples: handles of the temporal bones, [pars squamosa, processus zygomaticus] arcualia ossa.22 We have written no character on the twelve bones of the upper maxilla23 because they lack separate names, though the septum of the nostrils [vomer] is called by some the os cristae.24 Also, the upper maxilla [maxilla] is called 25 and mandibula, halechi hahelion.

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2, 3 Bone of the occiput [os occipitale] or occipitium, ,13 hezem


hahoreph; laude os, pyxis bone,14 prow bone, memory bone. There are some who also call it the basilar bone15 (because it makes up a large portion of the head), even though this name is elsewhere given to the cuneiform bone [os sphenoidale]. 2, 3 This bone [os temporale] and its mate are the bones of the temples, , , . Some also call them stone-like:16 , lapidea, lapidosa; hazedahim, azzamoth haauniim; bone of the ears, even though the name could be applied to the two ossicles [ossicula auditoria] going into the construction of the organ of hearing, , *. 2 marked and * on the pedestal upon which the second figure rests its elbows, where [incus] marks the ossicle like an anvil or a molar, and * [malleus] the one that we compare to a little hammer or femoral bone. Since these ossicles were unknown to ancient professors of Anatomy, it is little wonder that they are also lacking in names. The bones of the temples are called by some those of the tympae, the mendosa or false bones, parietal, the hard or armalia bones. 2 Process [p. styloideus] in the temporal bone resembling a stylus or needle: , , , , calcar capitis; chemo marhezz ; os calaminum reed-like bone, saggitale, clavale, acuale.

G 1, 2, 3 These names are also given to the lower maxilla [mandibula], marked G in the three figures, which the translator of Haly Abbas specifically names the throat, faux.26 As a rule, sixteen teeth , scinaiim are affixed in each jaw, of which the four middle or anterior ones are called incisorii [dentes incisivi]; , , , , risorii or laughing teeth, quaterii; hamechatechim, quadrupli. They27 call the two middle teeth by themselves the duales. The tooth closest to the incisors on each side is called the caninus or dog tooth; there are therefore two canines [dentes canini] in each jaw; ; chelauiim or metalehoth; the biting teeth, mordentes; some also have called these risorii or laughing teeth. The five following these on each side are called grinders, molares;28 , ; molares, maxillares, paxillares29. Cicero30 and others call genuini those that generally grow after puberty; by the greeks, they are called , , ; by our people they are called teeth of sense and wisdom31 and cayseles; naghuid; neguegidi, nanged, alhalm. The Hebrews call the molars tochanoh.

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

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13 14 15

16 17

18

Inion: protuberantia occipitalis externa. A pyxis is a small box for medicines. Os basilare; in English, basilar means pertaining to the base, particularly of the skull. In modern anatomy, the basilaris cranii is a composite of the numerous bones which serve as a supportive floor and form the axis of the whole skull (Dorland, 1994). Vesalius explanation may be an attempt to link the work with gk. basilikos, royal, because it makes up a large portion of the head. The Latin term is not given in the OLD. Os temporale, pars petrosa. Bone at the palate, e.g. in De usu partium 3.934.4 (May, 1968, p. 547). galen does not distinguish between the palatine and sphenoid bones. E in the basis cranii externa in fig.2 is the ala vomeris.

19

20

21

22

Os occipitale, pars basilaris, which articulates with os sphenoidale, corpus at the sphenooccipital synchondrosis. This character is visible only in the skull lying on the pedestal in both editions. The 1555 edition adds and , neither of which is attested in LSJ or the medical writers in TLg. The 1555 edition adds the following: The bone of the head numbered eighth [os ethmoidale] compared to a sieve or strainer and by some to a sponge, for that reason called and and popularly named cristatum, crested appears nowhere in these three plates representing the entire structure of the bones, since it occurs only in the inner space of the skull, as shown in the eighth figure of the sixth chapter at A , B,

23

24

25

26

A . But perhaps, because it forms the septum of the nostrils [lamina perpendicularis ossis ethmoidalis] outside the space mentioned, one might argue that it is seen to a degree. Consisting of the concha nasalis inferior (2), os lacrimale (2), os nasale (2), maxilla (2), os zygomaticum (2), os palatinum (2), and vomer (1). This qualification is omitted from the 1555 edition because of the addition recorded in n. 22 above. The 1555 edition adds (attested in Hippocrates, Epidemiorum libri, and elsewhere in 5thcent. greek) and (unattested in this sense in LSJ). Usually a plural, fauces, in classical Latin. Haly Abbas was the name by which Europeans knew 'Al ibn al-'Abbs al-Majs (d. c. 994), author of Kamil al-sinaa altibbiya, The Complete Medical Art, which

27 28 29

30

31

was twice translated into Latin: by Constantine the African (fl. 1080) under the title Liber pantegni, and by Stephen of Antioch in 1127 as the Liber regius. Best known as the Pantegni, it came to occupy a place in European medical literature second only to Avicennas Canon. See Vivian Nutton in Conrad et al., 1995, pp. 113f., and Bynum and Porter, 1993a, pp. 700f. Substitute barbarians in the 1555 edition. Dentes praemolares (2), dd. molares (3). 1555 adds mensales, table teeth (perhaps because they are relatively flat-topped). See n. 15, Ch. 11 on Ciceros nomenclature in De natura deorum of the cheek teeth for all the molars. 1555 adds: of intellect, serotini or late-coming, and aetatem complentes, age-completing.

Bk. 5 Ch. 15 Fig. 25

Bk. 5 Ch. 15 Fig. 25

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