1911 Encyclopædia Britannica/Anatomy
ANATOMY (Gr. ἀνατομή, from ἀνα-τέμνειν, to cut up), literally dissection or cutting asunder, a term always used to denote the study of the structure of living things; thus there is animal anatomy (zootomy) and vegetable anatomy (phytotomy). Animal anatomy may include the study of the structure of different animals, when it is called comparative anatomy or animal morphology, or it may be limited to one animal only, in which case it is spoken of as special anatomy. From a utilitarian point of view the study of Man is the most important division of special anatomy, and this human anatomy may be approached from different points of view. From that of the medical man it consists of a knowledge of the exact form, position, size and relationship of the various structures of the human body in health, and to this study the term descriptive or topographical human anatomy is given, though it is often, less happily, spoken of as Anthropotomy. An accurate knowledge of all the details of the human body takes years of patient observation to gain and is possessed by only a few. So intricate is man’s body that only a small number of professional human anatomists are complete masters of all its details, and most of them specialize on certain parts, such as the brain, viscera, &c.; contenting themselves with a good working knowledge of the rest. Topographical anatomy must be learned by each person for himself by the repeated dissection and inspection of the dead human body. It is no more a science than a pilot’s knowledge is, and, like that knowledge, must be exact and available in moments of emergency.
From the morphological point of view, however, human anatomy is a scientific and fascinating study, having for its object the discovery of the causes which have brought about the existing structure of Man, and needing a knowledge of the allied sciences of embryology or ontogeny, phylogeny and histology.
Pathological or morbid anatomy is the study of diseased organs, while sections of normal anatomy, applied to various purposes, receive special names such as medical, surgical, gynaecological, artistic and superficial anatomy. The comparison of the anatomy of different races of mankind is part of the science of physical anthropology or anthropological anatomy. In the present edition of this work the subject of anatomy is treated systematically rather than topographically. Each anatomical article contains first a description of the structures of an organ or system (such as nerves, arteries, heart, &c.), as it is found in Man; and this is followed by an account of the development or embryology and comparative anatomy or morphology, as far as vertebrate animals are concerned; but only those parts of the lower animals which are of interest in explaining Man’s structure are here dealt with. The articles have a twofold purpose; first, to give enough details of man’s structure to make the articles on physiology, surgery, medicine and pathology intelligible; and, secondly, to give the non-expert inquirer, or the worker in some other branch of science, the chief theories on which the modern scientific groundwork of anatomy is built.
The following separate anatomical articles will be found under their own headings:—
History of Anatomy
In tracing the history of the origin of anatomy, it may be justly said that more learning than judgment has been displayed. Some writers claim for it the highest antiquity, and pretend to find its first rudiments alternately in the animal sacrifices of the shepherd kings, the Jews and other ancient nations, and in the art of embalming as practised by the Egyptian priests. Even the descriptions of wounds in the Iliad have been supposed adequate to prove that in the time of Homer mankind had distinct notions of the structure of the human body. Of the first it may be said that the rude information obtained by the slaughter of animals for sacrifice does not imply profound anatomical knowledge; and those who adduce the second as evidence are deceived by the language of the poet of the Trojan War, which, distinguishing certain parts by their ordinary Greek epithets, as afterwards used by Hippocrates, Galen and all anatomists, has been rather too easily supposed to prove that the poet had studied systematically the structure of the human frame.
With not much greater justice has the cultivation of anatomical knowledge been ascribed to Hippocrates, who, because he is universally allowed to be the father of medicine, has also been thought to be the creator of the science of anatomy. Of the seven individuals of the family of the Heracleidae who bore this celebrated name, the second, who was the son of Heraclides and Phenarita, and grandson of the first Hippocrates. Hippocrates, was indeed distinguished as a physician of great observation and experience, and the first who appreciated the value of studying accurately the phenomena, effects and terminations of disease. It does not appear, however, notwithstanding the vague and general panegyrics of J. Riolan, Bartholin, D. le Clerc, and A. Portal, that the anatomical knowledge of this illustrious person was either accurate or profound. Of the works ascribed to Hippocrates, five only are genuine. Most of them were written either by subsequent authors of the same name, or by one or other of the numerous impostors who took advantage of the zealous munificence of the Ptolemies, by fabricating works under that illustrious name. Of the few which are genuine, there is none expressly devoted to anatomy; and of his knowledge on this subject the only proofs are to be found in the exposition of his physiological opinions, and his medical or surgical instructions. From these it appears that Hippocrates had some accurate notions on osteology, but that of the structure of the human body in general his ideas were at once superficial and erroneous. In his book on injuries of the head, and in that on fractures, he shows that he knew the sutures of the cranium and the relative situation of the bones, and that he had some notion of the shape of the bones in general and of their mutual connexions. Of the muscles, of the soft parts in general, and of the internal organs, his ideas are confused, indistinct and erroneous. The term φλἑψ he seems, in imitation of the colloquial Greek, to have used generally to signify a blood-vessel, without being aware of the distinction of vein and artery; and the term ἀρτηρία, or air-holder, is restricted to the windpipe. He appears to have been unaware of the existence of the nervous chords; and the term nerve is used by him, as by Grecian authors in general, to signify a sinew or tendon. On other points his views are so much combined with peculiar physiological doctrines, that it is impossible to assign them the character of anatomical facts; and even the works in which these doctrines are contained are with little probability to be ascribed to the second Hippocrates. If, however, we overlook this difficulty, and admit what is contained in the genuine Hippocratic writings to represent at least the sum of knowledge possessed by Hippocrates and his immediate descendants, we find that he represents the brain as a gland, from which exudes a viscid fluid; that the heart is muscular and of pyramidal shape, and has two ventricles separated by a partition, the fountains of life—and two auricles, receptacles of air; that the lungs consist of five ash-coloured lobes, the substance of which is cellular and spongy, naturally dry, but refreshed by the air; and that the kidneys are glands, but possess an attractive faculty, by virtue of which the moisture of the drink is separated and descends into the bladder. He distinguishes the bowels into colon and rectum (ὀ ἀρχός).
The knowledge possessed by the second Hippocrates was transmitted in various degrees of purity to the descendants and pupils, chiefly of the family of the Heracleidae, who succeeded him. Several of these, with feelings of grateful affection, appear to have studied to preserve the written memory of his instructions, and in this manner to have contributed to form part of that collection of treatises which have long been known to the learned world under the general name of the Hippocratic writings. Though composed, like the genuine remains of the physician of Cos, in the Ionian dialect, all of them differ from these in being more diffuse in style, more elaborate in form, and in studying to invest their anatomical and medical matter with the fanciful ornaments of the Platonic philosophy. Hippocrates had the merit of early recognizing the value of facts apart from opinions, and of those facts especially which lead to general results; and in the few genuine writings which are now extant it is easy to perceive that he has recourse to the simplest language, expresses himself in terms which, though short and pithy, are always precise and perspicuous, and is averse to the introduction of philosophical dogmas. Of the greater part of the writings collected under his name, on the contrary the general character is verboseness, prolixity and a great tendency to speculative opinions. For these reasons, as well as for others derived from internal evidence, while the Aphorisms, the Epidemics and the works above mentioned, bear distinct marks of being the genuine remains of Hippocrates, it is impossible to regard the book Περίφύσιος ἁνθρὡπου as entirely the composition of that physician; and it appears more reasonable to view it as the work of some one of the numerous disciples to whom the author had communicated the results of his observation, which they unwisely attempted to combine with the philosophy of the Platonic school and their own mysterious opinions.
Among those who aimed at this distinction, the most fortunate in the preservation of his name is Polybus, the son-in-law of the physician of Cos. This person, who must not be confounded with the monarch of Corinth, immortalized by Sophocles in the tragic story of Oedipus, is represented as a Polybus.recluse, severed from the world and its enjoyments, and devoting himself to the study of anatomy and physiology, and to the composition of works on these subjects. To him has been ascribed the whole of the book on the Nature of the Child and most of that On Man; both physiological treatises interspersed with anatomical sketches. His anatomical information, with which we are specially concerned, appears to have been rude and inaccurate, like that of his preceptor. He represents the large vessels of the body as consisting of four pairs; the first proceeding from the head by the back of the neck and spinal cord to the hips, lower extremities and outer ankle; the second, consisting of the jugular vessels (αὶ σφαγἰτιδες), proceeding to the loins, thighs, hams and inner ankle; the third proceeding from the temples by the neck to the scapula and lungs, and thence by mutual intercrossings to the spleen and left kidney, and the liver and right kidney, and finally to the rectum; and the fourth from the fore-part of the neck to the upper extremities, the fore-part of the trunk, and the organs of generation.
This specimen of the anatomical knowledge of one of the most illustrious of the Hippocratic disciples differs not essentially from that of Syennesis, the physician of Cyprus, and Diogenes, the philosopher of Apollonia, two authors for the preservation of whose opinions we are indebted to Aristotle. They may be admitted as representing the state of anatomical knowledge among the most enlightened men at that time, and they only show how rude and erroneous were their ideas on the structure of the animal body. It may indeed, without injustice, be said that the anatomy of the Hippocratic school is not only erroneous, but fanciful and imaginary in often substituting mere supposition and assertion for what ought to be matter of fact. From this censure it is impossible to exempt even the name of Plato himself, for whom some notices in the Timaeus on the structure of the animal body, as taught by Hippocrates and Polybus, have procured a place in the history of the science.
Amidst the general obscurity in which the early history of anatomy is involved, only two leading facts may be admitted with certainty. The first is, that previous to the time of Aristotle there was no accurate knowledge of anatomy; and the second, that all that was known was derived Aristotle.from the dissection of the lower animals only. By the appearance of Aristotle this species of knowledge, which was hitherto acquired in a desultory and irregular manner, began to be cultivated systematically and with a definite object; and among the services which the philosopher of Stagira rendered to mankind, one of the greatest and most substantial is, that he was the founder of Comparative Anatomy, and was the first to apply its facts to the elucidation of zoology. The works of this ardent and original naturalist show that his zootomical knowledge was extensive and often accurate; and from several of his descriptions it is impossible to doubt that they were derived from frequent personal dissection. Aristotle, who was born 384 years before the Christian era, or in the first year of the 99th Olympiad, was at the age of thirty-nine requested by Philip to undertake the education of his son Alexander. During this period it is said he composed several works on anatomy, which, however, are now lost. The military expedition of his royal pupil into Asia, by laying open the animal stores of that vast and little-known continent, furnished Aristotle with the means of extending his knowledge, not only of the animal tribes, but of their structure, and of communicating more accurate and distinct notions than were yet accessible to the world. A sum of 800 talents, and the concurrent aid of numerous intelligent assistants in Greece and Asia, were intended to facilitate his researches in composing a system of zoological knowledge; but it has been observed that the number of instances in which he was thus compelled to trust to the testimony of other observers led him to commit errors in description which personal observation might have enabled him to avoid.
The first three books of the History of Animals, a treatise consisting of ten books, and the four books on the Parts of Animals, constitute the great monument of the Aristotelian Anatomy. From these we find that Aristotle was the first who corrected the erroneous statements of Polybus, Syennesis and Diogenes regarding the blood-vessels, which they made, as we have seen, to arise from the head and brain. These he represents to be two in number, placed before the spinal column, the larger on the right, the smaller on the left, which, he also remarks, is by some called aorta (ἀορτἠ), the first time we observe that this epithet occurs in the history. Both he represents to arise from the heart, the larger from the largest upper cavity, the smaller or aorta from the middle cavity, but in a different manner and forming a narrower canal. He also distinguishes the thick, firm and more tendinous structure of the aorta from the thin and membranous structure of vein. In describing the distribution of the latter, however, he confounds the vena cava and pulmonary artery, and, as might be expected, he confounds the ramifications of the former with those of the arterial tubes in general. While he represents the lung to be liberally supplied with blood, he describes the brain as an organ almost destitute of this fluid. His account of the distribution of the aorta is wonderfully correct. Though he does not notice the coeliac, and remarks that the aorta sends no direct branches to the liver and spleen, he had observed the mesenteric, the renal and the common iliac arteries. It is nevertheless singular that though he remarks particularly that the renal branches of the aorta go to the substance and not the pelvis (κοιλία) of the kidney, he appears to mistake the ureters for branches of the aorta. Of the nerves (νευρἀ) he appears to have the most confused notions. Making them arise from the heart, which he says has nerves (tendons) in its largest cavity, he represents the aorta to be a nervous or tendinous vein (νευρὠδης φλέψ). By and by, afterwards saying that all the articulated bones are connected by nerves, he makes them the same as ligaments.
He distinguishes the windpipe or air-holder (ἀρτηρία) from the oesophagus, because it is placed before the latter, because food or drink passing into it causes distressing cough and suffocation, and because there is no passage from the lung to the stomach. He knew the situation and use of the epiglottis, seems to have had some indistinct notions of the larynx, represents the windpipe to be necessary to convey air to and from the lungs, and appears to have a tolerable understanding of the structure of the lungs. He repeatedly represents the heart, the shape and site of which he describes accurately, to be the origin of the blood-vessels, in opposition to those who made them descend from the head; yet, though he represents it as full of blood and the source and fountain of that fluid, and even speaks of the blood flowing from the heart to the veins, and thence to every part of the body, he says nothing of the circular motion of the blood. The diaphragm he distinguishes by the name διάζωμα, and ύπόζωμα. With the liver and spleen, and the whole alimentary canal, he seems well acquainted. The several parts of the quadruple stomach of the ruminating animals are distinguished and named; and he even traces the relations between the teeth and the several forms of stomach, and the length or brevity, the simplicity or complication of the intestinal tube. Upon the same principle he distinguishes the jejunum (ἠ νῆστις), or the empty portion of the small intestines in animals (τὸ ἒντερον λεπτὀν), the caecum (τυφλόν τι καὶ ὂγκωδες), the colon (τὸ κὣλον), and the sigmoid flexure (στενὠτερον καὶ εἰλιγμἑνον). The modern epithet of rectum is the literal translation of his description of the straight progress (εύθύ) of the bowel to the anus (πρωκτός). He knew the nasal cavities and the passage from the tympanal cavity of the ear to the palate, afterwards described by B. Eustachius. He distinguishes as “partes similares” those structures, such as bone, cartilage, vessels, sinews, blood, lymph, fat, flesh, which, not confined to one locality, but distributed throughout the body generally, we now term the tissues or textures, whilst he applies the term “partes dissimilares” to the regions of the head, neck, trunk and extremities.
Next to Aristotle occur the names of Diocles of Carystus and Praxagoras of Cos, the last of the family of the Asclepiadae. The latter is remarkable for being the first who distinguished the arteries from the veins, and the author of the opinion that the former were air-vessels.
Hitherto anatomical inquiry was confined to the examination of the bodies of brute animals. We have, indeed, no testimony of the human body being submitted to examination previous to the time of Erasistratus and Herophilus; and it is vain to look for authentic facts on this point before the Alexandrian school.foundation of the Ptolemaic dynasty of sovereigns in Egypt. This event, which, as is generally known, succeeded the death of Alexander, 320 years before the Christian era, collected into one spot the scattered embers of literature and science, which were beginning to languish in Greece under a weak and distracted government and an unsettled state of society. The children of her divided states, whom domestic discord and the uncertainties of war rendered unhappy at home, wandered into Egypt, and found, under the fostering hand of the Alexandrian monarchs, the means of cultivating the sciences, and repaying with interest to the country of Thoth and Osiris the benefits which had been conferred on the infancy of Greece by Thales and Pythagoras. Alexandria became in this manner the repository of all the learning and knowledge of the civilized world; and while other nations were sinking under the effects of internal animosities and mutual dissensions, or ravaging the earth with the evils of war, the Egyptian Greeks kept alive the sacred flame of science, and preserved mankind from relapsing into their original barbarism. These happy effects are to be ascribed in an eminent degree to the enlightened government and liberal opinions of Ptolemy Soter, and his immediate successors Philadelphus and Euergetes. The two latter princes, whose authority was equalled only by the zeal with which they patronized science and its professors, were the first who enabled physicians to dissect the human body, and prevented the prejudices of ignorance and superstition from compromising the welfare of the human race. To this happy circumstance Herophilus and Erasistratus are indebted for the distinction of being known to posterity as the first anatomists who dissected and described the parts of the human body. Both these physicians flourished under Ptolemy Soter, and probably Ptolemy Philadelphus, and were indeed the principal supports of what has been named in medical history the Alexandrian School, to which their reputation seems to have attracted numerous pupils. But though the concurrent testimony of antiquity assigns to these physicians the merit of dissecting the human body, time, which wages endless war with the vanity and ambition of man, has dealt hardly with the monuments of their labours. As the works of neither have been preserved, great uncertainty prevails as to the respective merits of these ancient anatomists; and all that is now known of their anatomical researches is obtained from the occasional notices of Galen, Oribasius and some other writers. From these it appears Erasistratus. that Erasistratus recognized the valves of the heart, and distinguished them by the names of tricuspid and sigmoid; that he studied particularly the shape and structure of the brain, and its divisions, and cavities, and membranes, and likened the convolutions to the folds of the jejunum; that he first formed a distinct idea of the nature of the nerves, which he made issue from the brain; and that he discovered lymphatic vessels in the mesentery, first in brute animals, and afterwards, it is said, in man. He appears also to have distinguished the nerves into those of sensation and those of motion.
Of Herophilus it is said that he had extensive anatomical knowledge, acquired by dissecting not only brutes but human bodies. Of these he probably dissected more than any of his predecessors or contemporaries. Devoted to the assiduous cultivation of anatomy, he appears Herophilus.to have studied with particular attention those parts which were least understood. He recognized the nature of the pulmonary artery, which he denominates arterious vein; he knew the vessels of the mesentery, and showed that they did not go to the vena portae, but to certain glandular bodies; and he first applied the name of twelve-inch or duodenum (δωδεκαδἀκτυλος) to that part of the alimentary canal which is next to the stomach. Like Erasistratus, he appears to have studied carefully the configuration of the brain; and though, like him, he distinguishes the nerves into those of sensation and those of voluntary motion, he adds to them the ligaments and tendons. A tolerable description of the liver by this anatomist is preserved in the writings of Galen. He first applied the name of choroid or vascular membrane to that which is found in the cerebral ventricles; he knew the straight venous sinus which still bears his name; and to him the linear furrow at the bottom of the fourth ventricle is indebted for its name of calamus scriptorius.
The celebrity of these two great anatomists appears to have thrown into the shade for a long period the names of all other inquirers; for, among their numerous and rather celebrated successors in the Alexandrian school, it is impossible to recognize a name which is entitled to distinction in the history of anatomy. In a chasm so wide it is not uninteresting to find, in one who combined the characters of the greatest orator and philosopher of Rome, the most distinct traces of attention to anatomical knowledge. Cicero, in his treatise De Natura Deorum, in a short sketch of physiology, such as it was taught by Aristotle and his disciples, introduces various anatomical notices, from which the classical reader may form some idea of the state of anatomy at that time. The Roman orator appears to have formed a pretty distinct idea of the shape and connexions of the windpipe and lungs; and though he informs his readers that he knows the alimentary canal, he omits the details through motives of delicacy. In imitation of Aristotle, he talks of the blood being conveyed by the veins (venae), that is, blood-vessels, through the body at large; and, like Praxagoras, of the air inhaled by the lungs being conveyed through the arteries.
Aretaeus, though chiefly known as a medical author, makes some observations on th e lung and the pleura, maintains the glandular structure of the kidney, and describes the anastomoses or communications of the capillary extremities of the vena cava with those of the portal vein.
The most valuable depository of the anatomical knowledge of these times is the work of Celsus, one of the most judicious medical authors of antiquity. He left, indeed, no express anatomical treatise; but from the introductions to the 4th and 8th books of his work, De Medicina, with incidental Celsus.remarks in the 7th, the modern reader may form very just ideas of his anatomical attainments. From these it appears that Celsus was well acquainted with the windpipe and lungs and the heart; with the difference between the windpipe and oesophagus (stomachus), which leads to the stomach (ventriculus); and with the shape, situation and relations of the diaphragm. He enumerates also the principal facts relating to the situation of the liver, the spleen, the kidneys and the stomach. He appears, however, to have been unaware of the distinction of duodenum or twelve-inch bowel, already admitted by Herophilus, and represents the stomach as directly connected by means of the pylorus with the jejunum or upper part of the small intestine.
The 7th and 8th books, which are devoted to the consideration of those diseases which are treated by manual operation, contain sundry anatomical notices necessary to explain the nature of the diseases or mode of treatment. Of these, indeed, the merit is unequal; and it is not wonderful that the ignorance of the day prevented Celsus from understanding rightly the mechanism of the pathology of hernia. He appears, however, to have formed a tolerably just idea of the mode of cutting into the urinary bladder; and even his obstetrical instructions show that his knowledge of the uterus, vagina and appendages was not contemptible. It is in osteology, however, that the information of Celsus is chiefly conspicuous. He enumerates the sutures and several of the holes of the cranium, and describes at great length the superior and inferior maxillary bones and the teeth. With a good deal of care he describes the vertebrae and the ribs, and gives very briefly the situation and shape of the scapula, humerus, radius and ulna, and even of the carpal and metacarpal bones, and then of the different bones of the pelvis and lower extremities. He had formed a just idea of the articular connexions, and is desirous to impress the fact that none is formed without cartilage. From his mention of many minute holes (multa et tenuia foramina) in the recess of the nasal cavities, it is evident that he was acquainted with the perforated plate of the ethmoid bone; and from saying that the straight part of the auditory canal becomes flexuous and terminates in numerous minute cavities (multa et tenuia foramina diducitur), it is inferred by Portal that he knew the semicircular canals.
Though the writings of Celsus show that he cultivated anatomical knowledge, it does not appear that the science was much studied by the Romans; and there is reason to believe that, after the decay of the school of Alexandria, it languished in neglect and obscurity. It is at least certain that the appearance of Marinus during the reign of Nero is mentioned by authors as an era remarkable for anatomical inquiry, and that this person is distinguished by Galen as the restorer of a branch of knowledge which had been before him suffered to fall into undeserved neglect. From Galen also we learn that Marinus gave an accurate account of the muscles, that he studied particularly the glands, and that he discovered those of the mesentery. He fixed the number of nerves at seven; he observed the palatine nerves, which he rated as the fourth pair; and described as the fifth the auditory and facial, which he regards as one pair, and the hypoglossal as the sixth.
Not long after Marinus appeared Rufus (or Ruffus) of Ephesus, a Greek physician, who in the reign of Trajan was much attached to physiology, and as a means of cultivating this science studied Comparative Anatomy and made sundry experiments on living animals. Of the anatomical writings of Rufus.this author there remains only a list or catalogue of names of different regions and parts of the animal body. He appears, however, to have directed attention particularly to the tortuous course of the uterine vessels, and to have recognized even at this early period the Fallopian tube. He distinguishes the nerves into those of sensation and those of motion. He knew the recurrent nerve. His name is further associated with the ancient experiment of compressing in the situation of the carotid arteries the pneumogastric nerve, and thereby inducing insensibility and loss of voice.
Of all the authors of antiquity, however, none possesses so just a claim to the title of anatomist as Claudius Galenus, the celebrated physician of Pergamum, who was born about the 130th year of the Christian era, and lived under the reigns of Hadrian, the Antonines, Commodus and Galen.Severus. He was trained by his father Nicon (whose memory he embalms as an eminent mathematician, architect and astronomer) in all the learning of the day, and initiated particularly into the mysteries of the Aristotelian philosophy. In an order somewhat whimsical he afterwards studied philosophy successively in the schools of the Stoics, the Academics, the Peripatetics and the Epicureans. When he was seventeen years of age, his father, he informs us, was admonished by a dream to devote his son to the study of medicine; but it was fully two years after that Galen entered on this pursuit, under the auspices of an instructor whose name he has thought proper to conceal. Shortly after he betook himself to the study of anatomy under Satyrus, a pupil of Quintus, and of medicine under Stratonicus, a Hippocratic physician, and Aeschrion, an empiric. He had scarcely attained the age of twenty when he had occasion to deplore the loss of the first and most affectionate guide of his studies; and soon after he proceeded to Smyrna to obtain the anatomical instructions of Pelops, who, though mystified by some of the errors of Hippocrates, is commemorated by his pupil as a skilful anatomist. After this he appears to have visited various cities distinguished for philosophical or medical teachers; and, finally, to have gone to Alexandria with the view of cultivating more accurately and intimately the study of anatomy under Heraclianus. Here he remained till his twenty-eighth year, when he regarded himself as possessed of all the knowledge then attainable through the medium of teachers. He now returned to Pergamum to exercise the art which he had so anxiously studied, and received, in his twenty-ninth year, an unequivocal testimony of the confidence which his fellow-citizens reposed in his skill, by being intrusted with the treatment of the wounded gladiators; and in this capacity he is said to have treated wounds with success which were fatal under former treatment. A seditious tumult appears to have caused him to form the resolution of quitting Pergamum and proceeding to Rome at the age of thirty-two. Here, however, he remained only five years; and returning once more to Pergamum, after travelling for some time, finally settled in Rome as physician to the emperor Commodus. The anatomical writings ascribed to Galen, which are numerous, are to be viewed not merely as the result of personal research and information, but as the common depository of the anatomical knowledge of the day, and as combining all that he had learnt from the several teachers under whom he successively studied with whatever personal investigation enabled him to acquire. It is on this account not always easy to distinguish what Galen had himself ascertained by personal research from that which was known by other anatomists. This, however, though of moment to the history of Galen as an anatomist, is of little consequence to the science itself; and from the anatomical remains of this author a pretty just idea may be formed both of the progress and of the actual state of the science at that time.
The osteology of Galen is undoubtedly the most perfect of the departments of the anatomy of the ancients. He names and distinguishes the bones and sutures of the cranium nearly in the same manner as at present. Thus, he notices the quadrilateral shape of the parietal bones; he distinguishes the squamous, the styloid, the mastoid and the petrous portions of the temporal bones; and he remarks the peculiar situation and shape of the sphenoid bone. Of the ethmoid, which he omits at first, he afterwards speaks more at large in another treatise. The malar he notices under the name of zygomatic bone; and he describes at length the upper maxillary and nasal bones, and the connexion of the former with the sphenoid. He gives the first clear account of the number and situation of the vertebrae, which he divides into cervical, dorsal and lumbar, and distinguishes from the sacrum and coccyx. Under the head Bones of the Thorax, he enumerates the sternum, the ribs (αί πλευραί), and the dorsal vertebrae, the connexion of which with the former he designates as a variety of diarthrosis. The description of the bones of the extremities and their articulations concludes the treatise.
Though in myology Galen appears to less advantage than in osteology, he nevertheless had carried this part of anatomical knowledge to greater perfection than any of his predecessors. He describes a frontal muscle, the six muscles of the eye and a seventh proper to animals; a muscle to each ala nasi, four muscles of the lips, the thin cutaneous muscle of the neck, which he first termed platysma myoides or muscular expansion, two muscles of the eyelids, and four pairs of muscles of the lower jaw—the temporal to raise, the masseter to draw to one side, and two depressors, corresponding to the digastric and internal pterygoid muscles. After speaking of the muscles which move the head and the scapula, he adverts to those by which the windpipe is opened and shut, and the intrinsic or proper muscles of the larynx and hyoid bone. Then follow those of the tongue, pharynx and neck, those of the upper extremities, the trunk and the lower extremities successively; and in the course of this description he swerves so little from the actual facts that most of the names by which he distinguishes the principal muscles have been retained by the best modern anatomists. It is chiefly in the minute account of these organs, and especially in reference to the minuter muscles, that he appears inferior to the moderns.
The angiological knowledge of Galen, though vitiated by the erroneous physiology of the times and ignorance of the separate uses of arteries and veins, exhibits, nevertheless, some accurate facts which show the diligence of the author in dissection. Though, in opposition to the opinions of Praxagoras and Erasistratus, he proved that the arteries in the living animal contain not air but blood, it does not appear to have occurred to him to determine in what direction the blood flows, or whether it was movable or stationary. Representing the left ventricle of the heart as the common origin of all the arteries, though he is misled by the pulmonary artery, he nevertheless traces the distribution of the branches of the aorta with some accuracy. The vena azygos also, and the jugular veins, have contributed to add to the confusion of his description, and to render his angiology the most imperfect of his works.
In neurology we find him to be the author of the dogma that the brain is the origin of the nerves of sensation, and the spinal cord of those of motion; and he distinguishes the former from the latter by their greater softness or less consistence. Though he admits only seven cerebral pairs, he has the merit of distinguishing and tracing the distribution of the greater part of both classes of nerves with great accuracy. His description of the brain is derived from dissection of the lower animals, and his distinctions of the several parts of the organ have been retained by modern anatomists. His mode of demonstrating this organ, which indeed is clearly described, consists of five different steps. In the first the bisecting membrane—i.e. the falx (μῆνιγξ διχοτομοῦσα)—and the connecting blood-vessels are removed; and the dissector, commencing at the anterior extremity of the great fissure, separates the hemispheres gently as far as the torcular, and exposes a smooth surface (τὴν χὡραν τυλὠδη πως ζούσαν), the mesolobe of the moderns, or the middle band. In the second he exposes by successive sections the ventricles, the choroid plexus and the middle partition. The third exhibits the pineal body (σῶμα κωνοειδές) or conarium, concealed by a membrane with numerous veins, meaning that part of the plexus which is now known by the name of velum interpositum, and a complete view of the ventricles. The fourth unfolds the third ventricle (τὶς ἅλλη τρἰτη κοιλἰα), the communication between the two lateral ones, the arch-like body (σῶμα ψαλιδοειδἐς) fornix, and the passage from the third to the fourth ventricle. In the fifth he gives an accurate description of the relations of the third and fourth ventricle, of the situation of the two pairs of eminences, nates (γλουτἀ) and testes (διδυμἰα or ὅρχεις), the scolecoid or worm-like process, anterior and posterior, and lastly the linear furrow, called by Herophilus calamus scriptorius.
In the account of the thoracic organs equal accuracy may be recognized. He distinguishes the pleura by the name of inclosing membrane (ὐμὴν ὑπεζωκὠς, membrana succingens), and remarks its similitude in structure to that of the peritoneum, and the covering which it affords to all the organs. The pericardium also he describes as a membranous sac with a circular basis corresponding to the base of the heart and a conical apex; and after an account of the tunics of the arteries and veins, he speaks shortly of the lung, and more at length of the heart, which, however, he takes some pains to prove not to be muscular, because it is harder, its fibres are differently arranged, and its action is incessant, whereas that of muscle alternates with the state of rest; he gives a good account of the valves and of the vessels; and notices especially the bony ring formed in the heart of the horse, elephant and other large animals.
The description of the abdominal organs, and of the kidneys and urinary apparatus, is still more minute, and in general accurate. Our limits, however, do not permit us to give any abstract of them; and it is sufficient in general to say that Galen gives correct views of the arrangement of the peritoneum and omentum, and distinguishes accurately the several divisions of the alimentary canal and its component tissues. In the liver, which he allows to receive an envelope from the peritoneum, he admits, in imitation of Erasistratus, a proper substance or parenchyma, interposed between the vessels, and capable of removal by suitable dissection. His description of the organs of generation is rather brief, and is, like most of his anatomical sketches, too much blended with physiological dogmas.
This short sketch may communicate some idea of the condition of anatomical knowledge in the days of Galen, who indeed is justly entitled to the character of rectifying and digesting, if not of creating, the science of anatomy among the ancients. Though evidently confined, perhaps entirely by the circumstances of the times, to the dissection of brute animals, so indefatigable and judicious was he in the mode of acquiring knowledge, that many of his names and distinctions are still retained with advantage in the writings of the moderns. Galen was a practical anatomist, and not only describes the organs of the animal body from actual dissection, but gives ample instructions for the proper mode of exposition. His language is in general clear, his style as correct as in most of the authors of the same period, and his manner is animated. Few passages in early science are indeed so interesting as the description of the process for demonstrating the brain and other internal organs which is given by this patient and enthusiastic observer of nature. To some it may appear absurd to speak of anything like good anatomical description in an author who writes in the Greek language, or anything like an interesting and correct manner in a writer who flourished at a period when taste was depraved or extinct and literature corrupted—when the philosophy of Antoninus and the mild virtues of Aurelius could do little to soften the iron sway of Lucius Verus and Commodus; but the habit of faithful observation in Galen seems to have been so powerful that in the description of material objects, his genius invariably rises above the circumstances of his age. Though not so directly connected with this subject, it is nevertheless proper to mention that he appears to have been the first anatomist who can be said, on authentic grounds, to have attempted to discover the uses of organs by vivisection and experiments on living animals. In this manner he ascertained the position and demonstrated the action of the heart; and he mentions two instances in which, in consequence of disease or injury, he had an opportunity of observing the motions of this organ in the human body. In short, without eulogizing an ancient author at the expense of critical justice, or commending his anatomical descriptions as superior to those of the moderns, it must be admitted that the anatomical writings of the physician of Pergamum form a remarkable era in the history of the science; and that by diligence in dissection and accuracy in description he gave the science a degree of importance and stability which it has retained through a lapse of many centuries.
The death of Galen, which took place at Pergamum in the seventieth year of his age and the 200th of the Christian era, may be regarded as the downfall of anatomy in ancient times. After this period we recognize only two names of any celebrity in the history of the science—those of Soranus and Oribasius, with the more obscure ones of Meletius and Theophilus, the latter the chief of the imperial guard of Heraclius.
Soranus, who was an Ephesian, and flourished under the emperors Trajan and Hadrian, distinguished himself by his researches on the female organs of generation. He appears to have dissected the human subject; and this perhaps is one reason why his descriptions of these parts are more copious and more accurate than those of Galen, who derived his knowledge from the bodies of the lower animals. He denies the existence of the hymen, but describes accurately the clitoris. Soranus the anatomist must be distinguished from the physician of that name, who was also a native of Ephesus.
Oribasius, who was born at Pergamum, is said to have been at once the friend and physician of the emperor Julian, and to have contributed to the elevation of that apostate to the imperial throne. For this he appears to have suffered the punishment of a temporary exile under Valens and Oribasius.Valentinian; but was soon recalled, and lived in great honour till the period of his death (387). By le Clerc, Oribasius is regarded as a compiler; and indeed his anatomical writings bear so close a correspondence with those of Galen that the character is not altogether groundless. In various points, nevertheless, he has rendered the Galenian anatomy more accurate; and he has distinguished himself by a good account of the salivary glands, which were overlooked by Galen.
To the same period generally is referred the Anatomical Introduction of an anonymous author, first published in 1618 by Lauremberg, and afterwards by C. Bernard. It is to be regarded as a compilation formed on the model of Galen and Oribasius. The same character is applicable to the treatises of Meletius and Theophilus.
The decline indicated by these languid efforts soon sank into a state of total inactivity; and the unsettled state of society during the latter ages of the Roman empire was extremely unfavourable to the successful cultivation of science. The sanguinary conflicts in which the southern countries of Europe were repeatedly engaged with their northern neighbours between the 2nd and 8th centuries tended gradually to estrange their minds from scientific pursuits; and the hordes of barbarians by which the Roman empire was latterly overrun, while they urged them to the necessity of making hostile resistance, and adopting means of self-defence, introduced such habits of ignorance and barbarism, that science was almost universally forgotten. While the art of healing was professed only by some few ecclesiastics or by itinerant practitioners, anatomy was utterly neglected; and no name of anatomical celebrity occurs to diversify the long and uninteresting period commonly distinguished as the dark ages.
Anatomical learning, thus neglected by European nations, is believed to have received a temporary cultivation from the Asiatics. Of these, several nomadic tribes, known to Europeans under the general denomination of Arabs and Saracens, had gradually coalesced under various Arabian Physicians.leaders; and by their habits of endurance, as well as of enthusiastic valour in successive expeditions against the eastern division of the Roman empire, had acquired such military reputation as to render them formidable wherever they appeared. After a century and a half of foreign warfare or internal animosity, under the successive dynasties of the Omayyads and Abbasids, in which the propagation of Islam was the pretext for the extinction of learning and civilization, and the most remorseless system of rapine and destruction, the Saracens began, under the latter dynasty of princes, to recognize the value of science, and especially of that which prolongs life, heals disease and alleviates the pain of wounds and injuries. The caliph Mansur combined with his official knowledge of Moslem law the successful cultivation of astronomy; but to his grandson Mamun, the seventh prince of the line of the Abbasids, belongs the merit of undertaking to render his subjects philosophers and physicians. By the directions of this prince the works of the Greek and Roman authors were translated into Arabic; and the favour and munificence with which literature and its professors were patronized speedily raised a succession of learned Arabians. The residue of the rival family of the Omayyads, already settled in Spain, was prompted by motives of rivalry or honourable ambition to adopt the same course; and while the academy, hospitals and library of Bagdad bore testimony to the zeal and liberality of the Abbasids, the munificence of the Omayyads was not less conspicuous in the literary institutions of Cordova, Seville and Toledo.
Notwithstanding the efforts of the Arabian princes, however, and the diligence of the Arabian physicians, little was done for anatomy, and the science made no substantial acquisition. The Koran denounces as unclean the person who touches a corpse; the rules of Islam forbid dissection; and whatever their instructors taught was borrowed from the Greeks. Abu-Bekr Al-Rasi, Abu-Ali Ibn-Sina, Abul-Qasim and Abul Walid ibn Rushd, the Rhazes, Avicenna, Abulcasis and Averroes of European authors, are their most celebrated names in medicine; yet to none of these can the historian with justice ascribe any anatomical merit. Rhazes has indeed left descriptions of the eye, of the ear and its meatus, and of the heart; and Avicenna, Abul-Qasim and Averroes give anatomical descriptions of the parts of the human body. But of these the general character is, that they are copies from Galen, sometimes not very just, and in all instances mystified with a large proportion of the fanciful and absurd imagery and inflated style of the Arabian writers. The chief reason of their obtaining a place in anatomical history is, that by the influence which their medical authority enabled them to exercise in the European schools, the nomenclature which they employed was adopted by European anatomists, and continued till the revival of ancient learning restored the original nomenclature of the Greek physicians. Thus, the cervix, or nape of the neck, is nucha; the oesophagus is meri; the umbilical region is sumen or sumac; the abdomen is myrach; the peritoneum is siphac; and the omentum, zirbus.
From the general character now given justice requires that we except Abdallatif, the annalist of Egyptian affairs. This author, who maintains that it is impossible to learn anatomy from books, and that the authority of Galen must yield to personal inspection, informs us that the Moslem doctors did not neglect opportunities of studying the bones of the human body in cemeteries; and that he himself, by once examining a collection of bones in this manner, ascertained that the lower jaw is formed of one piece; that the sacrum, though sometimes composed of several, is most generally of one; and that Galen is mistaken when he asserts that these bones are not single.
The era of Saracen learning extends to the 13th century; and after this we begin to approach happier times. The university of Bologna, which, as a school of literature and law, was already celebrated in the 12th century, became, in the course of the following one, not less School of Bologna.distinguished for its medical teachers. Though the misgovernment of the municipal rulers of Bologna had disgusted both teachers and students, and given rise to the foundation of similar institutions in Padua and Naples, —and though the school of Salerno, in the territory of the latter, was still in high repute,—it appears, from the testimony of M. Sarti, that medicine was in the highest esteem in Bologna, and that it was in such perfection as to require a division of its professors into physicians, surgeons, physicians for wounds, barber-surgeons, oculists and even some others. Notwithstanding these indications of refinement, however, anatomy was manifestly cultivated rather as an appendage of surgery than a branch of medical science; and according to the testimony of Guy de Chauliac, the cultivation of anatomical knowledge was confined to Roger of Parma, Roland, Jamerio, Bruno, and Lanfranc or Lanfranchi of Milan; and this they borrowed chiefly from Galen.
In this state matters appear to have proceeded with the medical school of Bologna till the commencement of the 14th century, when the circumstance of possessing a teacher of originality enabled this university to be the agent of as great an improvement in medical science as she had already Mondino.effected in jurisprudence. This era, indeed, is distinguished for the appearance of Mondino (Mundinus), under whose zealous cultivation the science first began to rise from the ashes in which it had been buried. This father of modern anatomy, who taught in Bologna about the year 1315, quickly drew the curiosity of the medical profession by well-ordered demonstrations of the different parts of the human body. In 1315 he dissected and demonstrated the parts of the human body in two female subjects; and in the course of the following year he accomplished the same task on the person of a single female. But while he seems to have had sufficient original force of intellect to direct his own route, J. Riolan accuses him of copying Galen; and it is certain that his descriptions are corrupted by the barbarous leaven of the Arabian schools, and his Latin defaced by the exotic nomenclature of Avicenna and Rhazes. He died, according to G. Tiraboschi, in 1325.
Mondino divides the body into three cavities (ventres), the upper containing the animal members, as the head, the lower containing the natural members, and the middle containing the spiritual members. He first describes the anatomy of the lower cavity or the abdomen, then proceeds to the middle or thoracic organs, and concludes with the upper, comprising the head and its contents and appendages. His general manner is to notice shortly the situation and shape or distribution of textures or membranes, and then to mention the disorders to which they are subject. The peritoneum he describes under the name of siphac, in imitation of the Arabians, the omentum under that of zirbus, and the mesentery or eucharus as distinct from both. In speaking of the intestines he treats first of the rectum, then the colon, the left or sigmoid flexure of which, as well as the transverse arch and its connexion with the stomach, he particularly remarks; then the caecum or monoculus, after this the small intestines in general under the heads of ileum and jejunum, and latterly the duodenum, making in all six bowels. The liver and its vessels are minutely, if not accurately, examined; and the cava, under the name chilis, a corruption from the Greek κοίλη, is treated at length, with the emulgents and kidneys. His anatomy of the heart is wonderfully accurate; and it is a remarkable fact, which seems to be omitted by all subsequent authors, that his description contains the rudiments of the circulation of the blood. “Postea vero versus pulmonem est aliud orificium venae arterialis, quae portat sanguinem ad pulmonem a corde; quia cum pulmo deserviat cordi secundum modum dictum, ut ei recompenset, cor ei transmittit sanguinem per hanc venam, quae vocatur vena arterialis; est vena, quia portat sanguinem, et arterialis, quia habet duas tunicas; et habet duas tunicas, primo quia vadit ad membrum quod existit in continuo motu, et secundo quia portat sanguinem valde subtilem et cholericum.” The merit of these distinctions, however, he afterwards destroys by repeating the old assertion that the left ventricle ought to contain spirit or air, which it generates from the blood. His osteology of the skull is erroneous. In his account of the cerebral membranes, though short, he notices the principal characters of the dura mater. He describes shortly the lateral ventricles, with their anterior and posterior cornua, and the choroid plexus as a blood-red substance like a long worm. He then speaks of the third or middle ventricle, and one posterior, which seems to correspond with the fourth; and describes the infundibulum under the names of lacuna and emboton. In the base of the organ he remarks, first, two mammillary caruncles, the optic nerves, which he reckons the first pair; the oculomuscular, which he accounts the second; the third, which appears to be sixth of the moderns; the fourth; the fifth, evidently the seventh; a sixth, the nervus vagus; and a seventh, which is the ninth of the moderns. Notwithstanding the misrepresentations into which this early anatomist was betrayed, his book is valuable, and has been illustrated by the successive commentaries of Alessandro Achillini, Jacopo Berengario and Johann Dryander (1500–1560).
Matthew de Gradibus, a native of Gradi, a town in Friuli, near Milan, distinguished himself by composing a series of treatises on the anatomy of various parts of the human body (1480). He is the first who represents the ovaries of the female in the correct light in which they were subsequently regarded by Nicolas Steno or Stensen (1638–1687).
Objections similar to those already urged in speaking of Mondino apply to another eminent anatomist of those times. Gabriel de Zerbis, who flourished at Verona towards the conclusion of the 15th century, is celebrated as the author of a system in which he is obviously more anxious to astonish his readers by the wonders of a verbose and complicated style than to instruct by precise and faithful description. In the vanity of his heart he assumed the title of Medicus Theoricus; but though, like Mondino, he derived his information from the dissection of the human subject, he is not entitled to the merit either of describing truly or of adding to the knowledge previously acquired. He is superior to Mondino, however, in knowing the olfactory nerves.
Eminent in the history of the science, and more distinguished than any of this age in the history of cerebral anatomy, Achillini of Bologna (1463–1512), the pupil and commentator of Mondino, appeared at the close of the 15th century. Though a follower of the Arabian school, the assiduity with Achillini.which he cultivated anatomy has rescued his name from the inglorious obscurity in which the Arabian doctors have in general slumbered. He is known in the history of anatomical discovery as the first who described the two tympanal bones, termed malleus and incus. In 1503 he showed that the tarsus consists of seven bones; he rediscovered the fornix and the infundibulum; and he was fortunate enough to observe the course of the cerebral cavities into the inferior cornua, and to remark peculiarities to which the anatomists of a future age did not advert. He mentions the orifices of the ducts, afterwards described by Thomas Wharton (1610–1673). He knew the ileo-caecal valve; and his description of the duodenum, ileum and colon shows that he was better acquainted with the site and disposition of these bowels than any of his predecessors or contemporaries.
Not long after, the science boasts of one of its most distinguished founders. Berengario, commonly called Berenger of Carpi, in the Modenese territory, flourished at Bologna at the beginning of the 16th century. In the annals of medicine his name will be remembered not only as the most Berenger.zealous and eminent in cultivating the anatomy of the human body, but as the first physician who was fortunate enough to calm the alarms of Europe, suffering under the ravages of syphilis, then raging with uncontrollable virulence. In the former character he surpassed both predecessors and contemporaries; and it was long before the anatomists of the following age could boast of equalling him. His assiduity was indefatigable; and he declares that he dissected above one hundred human bodies. He is the author of a compendium, of several treatises which he names Introductions (Isagogae), and of commentaries on the treatise of Mondino, in which he not only rectifies the mistakes of that anatomist, but gives minute and in general accurate anatomical descriptions.
He is the first who undertakes a systematic view of the several textures of which the human body is composed; and in a preliminary commentary he treats successively of the anatomical characters and properties of fat, of membrane in general (panniculus), of flesh, of nerve, of villus or fibre (filum), of ligament, of sinew or tendon, and of muscle in general. He then proceeds to describe with considerable precision the muscles of the abdomen, and illustrates their site and connexions by woodcuts which, though rude, are spirited, and show that anatomical drawing was in that early age beginning to be understood. In his account of the peritoneum he admits only the intestinal division of that membrane, and is at some pains to prove that Gentilis Fulgineus, who justly admits the muscular division also, is in error. In his account of the intestines he is the first who mentions the vermiform process of the caecum; he remarks the yellow tint communicated to the duodenum by the gall-bladder; and he recognizes the opening of the common biliary duct into the duodenum (quidam porus portans choleram). In the account of the stomach he describes the several tissues of which that organ is composed, and which he represents to be three, and a fourth from the peritoneum; and afterwards notices the rugae of its villous surface. He is at considerable pains to explain the organs of generation in both sexes, and gives a long account of the anatomy of the foetus. He was the first who recognized the larger proportional size of the chest in the male than in the female, and conversely the greater capacity of the female than of the male pelvis. In the larynx he discovered the two arytenoid cartilages. He gives the first good description of the thymus; distinguishes the oblique situation of the heart; describes the pericardium, and maintains the uniform presence of pericardia liquor. He then describes the cavities of the heart; but perplexes himself, as did all the anatomists of that age, about the spirit supposed to be contained. The aorta he properly makes to arise from the left ventricle; but confuses himself with the arteria venalis, the pulmonary vein, and the vena arterialis, the pulmonary artery. His account of the brain is better. He gives a minute and clear account of the ventricles, remarks the corpus striatum, and has the sagacity to perceive that the choroid plexus consists of veins and arteries; he then describes the middle or third ventricle, the infundibulum or lacuna of Mondino, and the pituitary gland; and lastly, the passage to the fourth ventricle, the conarium or pineal gland, and the fourth or posterior ventricle itself, the relations of which he had studied accurately. He rectifies the mistake of Mondino as to the olfactory or first pair of nerves, gives a good account of the optic and others, and is entitled to the praise of originality in being the first observer who contradicts the fiction of the wonderful net and indicates the principal divisions of the carotid arteries. He enumerates the tunics and humours of the eye, and gives an account of the internal ear, in which he notices the malleus and incus.
Italy long retained the distinction of giving birth to the first eminent anatomists in Europe, and the glory she acquired in the names of Mondino, Achillini, Berenger and N. Massa, was destined to become more conspicuous in the labours of R. Columbus, G. Fallopius and Eustachius. While French school.Italy, however, was thus advancing the progress of science, the other nations of Europe were either in profound ignorance or in the most supine indifference to the brilliant career of their zealous neighbours. The 16th century had commenced before France began to acquire anatomical distinction in the names of Jacques Dubois, Jean Fernel and Charles Etienne; and even these celebrated teachers were less solicitous in the personal study of the animal body than in the faithful explanation of the anatomical writings of Galen. The infancy of the French school had to contend with other difficulties. The small portion of knowledge which had been hitherto diffused in the country was so inadequate to eradicate the prejudices of ignorance, that it was either difficult or absolutely impossible to procure human bodies for the purposes of science; and we are assured, on the testimony of A. Vesalius and other competent authorities, that the practical part of anatomical instruction was obtained entirely from the bodies of the lower animals. The works of the Italian anatomists were unknown; and it is a proof of the tardy communication of knowledge that, while the structure of the human body had been taught in Italy for more than a century by Mondino and his followers, these anatomists are never mentioned by Etienne, who flourished long after.
Such was the aspect of the times at the appearance of Jacques Dubois (1478–1555), who, under the Romanized name of Jacobus Sylvius, according to the fashion of the day, has been fortunate in acquiring a reputation to which his researches do not entitle him. For the name of Dubois the history Dubois.of anatomy, it is said, is indebted to his inordinate love of money. At the instance of his brother Francis, who was professor of eloquence in the college of Tournay at Paris, he devoted himself to the study of the learned languages and mathematics; but discovering that these elegant accomplishments do not invariably reward their cultivators with the goods of fortune, Dubois betook himself to medicine. After the acquisition of a medical degree in the university of Montpellier, at the ripe age of fifty-one Dubois returned to Paris to resume a course of anatomical instruction. Here he taught anatomy to a numerous audience in the college of Trinquet; and on the departure of Vidus Vidius for Italy was appointed to succeed that physician as professor of surgery to the Royal College. His character is easily estimated. With greater coarseness in his manners and language than even the rude state of society in his times can palliate, with much varied learning and considerable eloquence, he was a blind, indiscriminate and irrational admirer of Galen, and interpreted the anatomical and physiological writings of that author in preference to giving demonstrations from the subject. Without talent for original research or discovery himself, his envy and jealousy made him detest every one who gave proofs of either. We are assured by Vesalius, who was some time his pupil, that his manner of teaching was calculated neither to advance the science nor to rectify the mistakes of his predecessors. A human body was never seen in the theatre of Dubois; the carcases of dogs and other animals were the materials from which he taught; and so difficult even was it to obtain human bones, that unless Vesalius and his fellow-students had collected assiduously from the Innocents and other cemeteries, they must have committed numerous errors in acquiring the first principles. This assertion, however, is contradicted by J. Riolan, and afterwards by K. P. J. Sprengel and T. Lauth, the last of whom decidedly censures Vesalius for this ungrateful treatment of his instructor. It is certain that opportunities of inspecting the human body were by no means so frequent as to facilitate the study of the science. Though his mention of injections has led some to suppose him the discoverer of that art, he appears to have made no substantial addition to the information already acquired; and the first acknowledged professor of anatomy to the university of Paris appears in history as one who lived without true honour and died without just celebrity. He must not be confounded with Franciscus Sylvius (de le Boe), who is mentioned by F. Ruysch and M. V. G. Malacarne as the author of a particular method of demonstrating the brain.
Almost coeval may be placed Charles Etienne (1503–1564), a younger brother of the celebrated printers, and son to Henry, who Hellenized the family name by the classical appellation of Stephen (Στέφανος). It is uncertain whether he taught publicly. But his tranquillity was disturbed, Etienne.and his pursuits interrupted, by the oppressive persecutions in which their religious opinions involved the family; and Charles Etienne drew the last breath of a miserable life in a dungeon in 1564, Etienne, though sprung of a family whose classical taste has been their principal glory, does not betray the same servile imitation of the Galenian anatomy with which Dubois is charged. He appears to have been the first to detect valves in the orifice of the hepatic veins. He was ignorant, however, of the researches of the Italian anatomists; and his description of the brain is inferior to that given sixty years before by Achillini. His comparison of the cerebral cavities to the human ear has persuaded F. Portal that he knew the inferior cornua, the hippocampus and its prolongations; but this is no reason for giving him that honour to the detriment of the reputation of Achillini, to whom, so far as historical testimony goes, the first knowledge of this fact is due. The researches of Etienne into the structure of the nervous system are, however, neither useless nor inglorious; and the circumstance of demonstrating a canal through the entire length of the spinal cord, which had neither been suspected by contemporaries nor noticed by successors till J. B. Senac (1693–1770) made it known, is sufficient to place him high in the rank of anatomical discoverers.
The French anatomy of the 16th century was distinguished by two circumstances unfavourable to the advancement of the science—extravagant admiration of antiquity, with excessive confidence in the writings of Galen, and the general practice of dissecting principally the bodies of the lower animals. Vesalius.Both these errors were much amended, if not entirely removed, by the exertions of a young Fleming, whose appearance forms a conspicuous era in the history of anatomy. Andreas Vesalius, (1514–1564), a native of Brussels, after acquiring at Louvain the ordinary classical attainments of the day, began at the age of fourteen to study anatomy under the auspices of Dubois. Though the originality of his mind soon led him to abandon the prejudices by which he was environed, and take the most direct course for attaining a knowledge of the structure of the human frame, he neither underrated the Galenian anatomy nor was indolent in the dissection of brute animals. The difficulties, however, with which the practical pursuit of human anatomy was beset in France, and the dangers with which he had to contend, made him look to Italy as a suitable field for the cultivation of the science; and in 1536 we find him at Venice, at once pursuing the study of human anatomy with the utmost zeal, and requested, ere he had attained his twenty-second year, to demonstrate publicly in the university of Padua. After remaining here about seven years, Vesalius went by express invitation to Bologna, and shortly afterwards to Pisa; and thus professor in three universities, he appears to have carried on his anatomical investigations and instructions alternately at Padua, Bologna and Pisa, in the course of the same winter. It is on this account that Vesalius, though a Fleming by birth and trained originally in the French school, belongs, as an anatomist, to the Italian, and may be viewed as the first of an illustrious line of teachers by whom the anatomical reputation of that country was in the course of the 16th century raised to the greatest eminence.
Vesalius is known as the first author of a comprehensive and systematic view of human anatomy. The knowledge with which his dissections had furnished him proved how many errors were daily taught and learned under the broad mantle of Galenian authority; and he perceived the necessity of a new system of anatomical instruction, divested of the omissions of ignorance and the misrepresentations of prejudice and fancy. The early age at which he effected this object has been to his biographers the theme of boundless commendation; and we are told that he began at the age of twenty-five to arrange the materials he had collected, and accomplished his task ere he had completed his 28th year.
Soon after this period we find him invited as imperial physician to the court of Charles V., where he was occupied in the duties of practice and answering the various charges which were unceasingly brought against him by the disciples of Galen. After the abdication of Charles he continued at court in great favour with his son Philip II. To this he seems to have been led principally by the troublesome controversies in which his anatomical writings had involved him. It is painful to think, however, that even imperial patronage bestowed on eminent talents does not ensure immunity from popular prejudice; and the fate of Vesalius will be a lasting example of the barbarism of the times, and of the precarious tenure of the safety even of a great physician. On the preliminary circumstances authors are not agreed; but the most general account states that when Vesalius was dissecting, with the consent of his kinsmen, the body of a Spanish grandee, it was observed that the heart still gave some feeble palpitations when divided by the knife. The immediate effects of this outrage to human feelings were the denunciation of the anatomist to the Inquisition; and Vesalius escaped the severe treatment of that tribunal only by the influence of the king, and by promising to perform a pilgrimage to the Holy Land. He forthwith proceeded to Venice, from which he sailed with the Venetian fleet, under James Malatesta, for Cyprus. When he reached Jerusalem, he received from the Venetian senate a message requesting him again to accept the Paduan professorship, which had become vacant by the death of his friend and pupil Fallopius. His destiny, however, which pursued him fast, suffered him not again to breathe the Italian air. After struggling for many days with the adverse winds in the Ionian Sea, he was wrecked on the island of Zante, where he quickly breathed his last in such penury that unless a liberal goldsmith had defrayed the funeral charges, his remains must have been devoured by beasts of prey. At the time of his death he was scarcely fifty years of age.
To form a correct estimate of the character and merits of Vesalius, we must not compare him, in the spirit of modern perfection, with the anatomical authors either of later times or of the present day. Whoever would frame a just idea of this anatomist must imagine, not a bold innovator without academical learning, not a genius coming from a foreign country, unused to the forms and habits of Catholic Europe, nor a wild reformer, blaming indiscriminately everything which accorded not with his opinion; but a young student scarcely emancipated from the authority of instructors, whose intellect was still influenced by the doctrines with which it had been originally imbued,—a scholar strictly trained in the opinions of the time, living amidst men who venerated Galen as the oracle of anatomy and the divinity of medicine,—exercising his reason to estimate the soundness of the instructions then in use, and proceeding, in the way least likely to offend authority and wound prejudice, to rectify errors, and to establish on the solid basis of observation the true elements of anatomical science. Vesalius has been denominated the founder of human anatomy; and though we have seen that in this career he was preceded with honour by Mondino and Berenger, still the small proportion of correct observation which their reverence for Galen and Arabian doctrines allowed them to communicate, will not in a material degree impair the original merits of Vesalius. The errors which he rectified and the additions which he made are so numerous, that it is impossible, in such a sketch as the present, to communicate a just idea of them.
Besides the first good description of the sphenoid bone, he showed that the sternum consists of three portions and the sacrum of five or six; and described accurately the vestibule in the interior of the temporal bone. He not only verified the observation of Etienne on the valves of the hepatic veins, but he described well the vena azygos, and discovered the canal which passes in the foetus between the umbilical vein and the vena cava, since named ductus venosus. He described the omentum, and its connexions with the stomach, the spleen and the colon; gave the first correct views of the structure of the pylorus; remarked the small size of the caecal appendix in man; gave the first good account of the mediastinum and pleura and the fullest description of the anatomy of the brain yet advanced. He appears, however, not to have understood well the inferior recesses; and his account of the nerves is confused by regarding the optic as the first pair, the third as the fifth and the fifth as the seventh.
The labours of Vesalius were not limited to the immediate effect produced by his own writings. His instructions and examples produced a multitude of anatomical inquirers of different characters and varied celebrity, by whom the science was extended and rectified. Of these we cannot speak in detail; but historical justice requires us to notice shortly those to whose exertions the science of anatomy has been most indebted.
The first that claims attention on this account is Bartolomeo Eustachi of San Severino, near Salerno, who though greatly less fortunate in reputation than his contemporary Vesalius, divides with him the merit of creating the science of human anatomy. He extended the knowledge Eustachius.of the internal ear by rediscovering and describing correctly the tube which bears his name; and if we admit that G. F. Ingrassias anticipated him in the knowledge of the third bone of the tympanal cavity, the stapes, he is still the first who described the internal and anterior muscles of the malleus, as also the stapedius, and the complicated figure of the cochlea. He is the first who studied accurately the anatomy of the teeth, and the phenomena of the first and second dentition. The work, however, which demonstrates at once the great merit and the unhappy fate of Eustachius is his Anatomical Engravings, which, though completed in 1552, nine years after the impression of the work of Vesalius, the author was unable to publish. First communicated to the world in 1714 by G. M. Lancisi, afterwards in 1744 by Cajetan Petrioli, again in 1744 by B. S. Albinus, and subsequently at Bonn in 1790, the engravings show that Eustachius had dissected with the greatest care and diligence, and taken the utmost pains to give just views of the shape, size and relative position of the organs of the human body.
The first seven plates illustrate the history of the kidneys and some of the facts relating to the structure of the ear. The eighth represents the heart, the ramifications of the vena azygos, and the valve of the vena cava, named from the author. In the seven subsequent plates is given a succession of different views of the viscera of the chest and abdomen. The seventeenth contains the brain and spinal cord; and the eighteenth more accurate views of the origin, course and distribution of the nerves than had been given before. Fourteen plates are devoted to the muscles.
Eustachius did not confine his researches to the study of relative anatomy. He investigated the intimate structure of organs with assiduity and success. What was too minute for unassisted vision he inspected by means of glasses. Structure which could not be understood in the recent state, he unfolded by maceration in different fluids, or rendered more distinct by injection and exsiccation. The facts unfolded in these figures are so important that it is justly remarked by Lauth, that if the author himself had been fortunate enough to publish them, anatomy would have attained the perfection of the 18th century two centuries earlier at least. Their seclusion for that period in the papal library has given celebrity to many names which would have been known only in the verification of the discoveries of Eustachius.
M. R. Columbus and G. Fallopius were pupils of Vesalius. Columbus, as his immediate successor in Padua, and afterwards as professor at Rome, distinguished himself by rectifying and improving the anatomy of the bones; by giving correct accounts of the shape and cavities of the heart, of Columbus.the pulmonary artery and aorta and their valves, and tracing the course of the blood from the right to the left side of the heart; by a good description of the brain and its vessels, and by correct understanding of the internal ear, and the first good account of the ventricles of the larynx.
Fallopius, who, after being professor at Pisa in 1548, and at Padua in 1551, died at the age of forty, studied the general anatomy of the bones; described better than heretofore the internal ear, especially the tympanum and its osseous ring, the two fenestrae and their communication with Fallopius.the vestibule and cochlea; and gave the first good account of the stylo-mastoid hole and canal, of the ethmoid bone and cells, and of the lacrymal passages. In myology he rectified several mistakes of Vesalius. He also devoted attention to the organs of generation in both sexes, and discovered the utero-peritoneal canal which still bears his name.Osteology nearly at the same time found an assiduous cultivator in Giovanni Filippo Ingrassias (1545–1580), a learned Sicilian physician, who, in a skilful commentary on the osteology of Galen, corrected numerous mistakes. He gave the first distinct account of the true configuration of the sphenoid Ingrassias.and ethmoid bones, and has the merit of first describing (1546) the third bone of the tympanum, called stapes, though this is also claimed by Eustachius and Fallopius.
The anatomical descriptions of Vesalius underwent the scrutiny of various inquirers. Those most distinguished by the importance and accuracy of their researches, as well as the temperate tone of their observations, were Julius Caesar Aranzi (1530–1589), anatomical professor for thirty-two Aranzi.years in the university of Bologna, and Constantio Varoli, physician to Pope Gregory XIII. To the former we are indebted for the first correct account of the anatomical peculiarities of the foetus, and he was the first to show that the muscles of the eye do not, as was falsely imagined, arise from the dura mater but from the margin of the optic hole. He also, after considering the anatomical relations of the cavities of the heart, the valves and the great vessels, corroborates the views of Columbus regarding the course which the blood follows in passing from the right to the left side of the heart. Aranzi is the first anatomist who describes distinctly the inferior cornua of the ventricles of the cerebrum, who recognizes the objects by which they are distinguished, and who gives them the name by which they are still known (hippocampus); and his account is more minute and perspicuous than that of the authors of the subsequent century. He speaks at large of the choroid plexus, and gives a particular description of the fourth ventricle, under the name of cistern of the cerebellum, as a discovery of his own.
Italy, though rich in anatomical talent, has probably few greater names than that of Constantio Varoli (b. 1543) of Bologna. Though he died at the early age of thirty-two, he acquired a reputation not inferior to that of the most eminent of his contemporaries. He is now known chiefly as the Varolius.author of an epistle, inscribed to Hieronymo Mercuriali, on the optic nerves, in which he describes a new method of dissecting the brain, and communicates many interesting particulars relating to the anatomy of the organ. He observes the threefold division of the inferior surface or base, defines the limits of the anterior, middle and posterior eminences, as marked by the compartments of the skull, and justly remarks that the cerebral cavities are capacious, communicate with each other, extending first backward and then forward, near the angle of the pyramidal portion of the temporal bone, and that they are folded on themselves, and finally lost above the middle and inferior eminence of the brain. He appears to have been aware that at this point they communicate with the exterior or convoluted surface. He recognized the impropriety of the term corpus callosum, seems to have known the communication called afterwards foramen Monroianum, and describes the hippocampus more minutely than had been previously done.
Among the anatomists of the Italian school, as a pupil of Fallopius, Eustachius and U. Aldrovandus, is generally enumerated Volcher Coiter (b. 1534) of Groningen. He distinguished himself by accurate researches on the cartilages, the bones and the nerves, recognized the value of morbid anatomy, and made experiments on living animals to ascertain the action of the heart and the influence of the brain.
The Frutefull and Necessary Briefe Worke of John Halle (1565) and The Englisheman’s Treasure by Master Thomas Vicary (1586), English works published at this time, are tolerable compilations from former authors, much tinged by Galenian and Arabian distinctions. A more valuable compendium than either is, however, that of John Banister (1578), entitled The Historie of Man, from the most approved Anathomistes in this Present Age.
The celebrity of the anatomical school of Italy was worthily maintained by Hieronymo Fabricio of Acquapendente, who, in imitation of his master Fallopius, laboured to render anatomical knowledge more precise by repeated dissections, and to illustrate the obscure by researches on the Fabricius.structure of animals in general. In this manner he investigated the formation of the foetus, the structure of the oesophagus, stomach and bowels, and the peculiarities of the eye, the ear and the larynx. The discovery, however, on which his surest claims to eminence rest is that of the membranous folds, which he names valves, in the interior of veins. Several of these folds had been observed by Fernel, Sylvius and Vesalius; and in 1547 G. B. Canani observed those of the vena azygos; but no one appears to have offered any rational conjecture on their use, or to have traced them through the venous system at large, until Fabricius in 1574, upon this hypothesis, demonstrated the presence of these valvular folds in all the veins of the extremities.
Fabricius, though succeeded by his pupil Julius Casserius of Placenza, may be regarded as the last of that illustrious line of anatomical teachers by whom the science was so successfully studied and taught in the universities of Italy. The discoveries which each made, and the errors which their successive labours rectified, tended gradually to give anatomy the character of a useful as well as an accurate science, and to pave the way for a discovery which, though not anatomical but physiological, is so intimately connected with correct knowledge of the shape and situation of parts, that it exercised the most powerful influence on the future progress of anatomical inquiry. This was the knowledge of the circular motion of the blood—a fact which though obscurely conjectured by Aristotle, Nemesius, Mondino and Berenger, and partially taught by Servetus, Columbus, Andreas Caesalpinus and Fabricius, it was nevertheless reserved to William Harvey fully and satisfactorily to demonstrate.
Mondino believed that the blood proceeds from the heart to the lungs through the vena arterialis or pulmonary artery, and that the aorta conveys the spirit into the blood through all parts of the body. This doctrine was adopted with little modification by Berenger, who further demonstrated the existence and operation of the tricuspid valves in the right ventricle, and of the sigmoid valves at the beginning of the pulmonary artery and aorta, and that there were only two ventricles separated by a solid impervious septum. These were afterwards described in greater detail by Vesalius, who nevertheless appears not to have been aware of the important use which might be made of this knowledge. It was the Spaniard Michael Servet or Servetus (born in 1509, burnt in 1553) who in his treatise Servetus. De Trinitatis Erroribus, published at Haguenau in 1531, first maintained the imperiousness of the septum, and the transition of the blood by what he terms an unknown route, namely, from the right ventricle by the vena arteriosa (pulmonary artery) to the lungs, and thence into the arteria venosa or pulmonary vein and left auricle and ventricle, from which, he adds afterwards, it is conveyed by the aorta to all parts of the body.
Though the leading outlines, not only of the pulmonary or small but even of the great circulation, were sketched thus early by one who, though a philosopher, was attached to the church, it was only in his work De Re Anatomica, published at Venice in 1559, that Columbus formally and distinctly announced the circular course of the blood as a discovery of his own; and maintained, in addition to the imperiousness of the septum, the fact that the arteria venalis (pulmonary vein) contains, not air, but blood mixed with air brought from the lungs to the left ventricle of the heart, to be distributed through the body at large.
Soon after, views still more complete of the small or pulmonary circulation were given by Andreas Caesalpinus (1519–1603) of Arezzo, who not only maintained the analogy between the structure of the arterious vein or pulmonary artery and the aorta, and that between the venous artery or Caesalpinus.pulmonary veins and veins in general, but was the first to remark the swelling of veins below ligatures, and to infer from it a refluent motion of blood in these vessels. The discoveries of Aranzi and Eustachius in the vessels of the foetus tended at first to perplex and afterwards to elucidate some of these notions.
At length it happened that, between the years 1598 and 1600, a young Englishman, William Harvey, pursuing his anatomical studies at Padua under Fabricius, learnt from that anatomist the existence of the valves in the veins of the extremities, and undertook to ascertain the use of these Harvey.valves by experimental inquiry. It is uncertain whether he learnt from the writings of Caesalpinus the fact observed by that author of the tumescence of a vein below the ligature, but he could not fail to be aware, and indeed he shows that he was aware, of the small circulation as taught by Servetus and Columbus. Combining these facts already known, he, by a series of well-executed experiments, demonstrated clearly the existence, not only of the small, but of a general circulation from the left side of the heart by the aorta and its subdivisions, to the right side by the veins. This memorable truth was first announced in the year 1619.
It is unnecessary here to consider the arguments and facts by which Harvey defended his theory, or to notice the numerous assaults to which he was exposed, and the controversies in which his opponents wished to involve him. It is sufficient to say that, after the temporary ebullitions of spleen and envy had subsided, the doctrine of the circular motion of the blood was admitted by all enlightened and unprejudiced persons, and finally was universally adopted as affording the most satisfactory explanation of many facts in anatomical structure which were either misunderstood or entirely overlooked. The inquiries to which the investigation of the doctrine gave rise produced numerous researches on the shape and structure of the heart and its divisions, of the lungs, and of the blood-vessels and their distribution. Of this description were the researches of Nicolas Steno on the structure of the heart, the classical work of Richard Lower, the dissertation of J. N. Pechlin, the treatise of Raymond Vieussens, the work of Marcello Malpighi on the structure of the lungs, several sketches in the writings of John Mayow, and other treatises of less moment. Systematic treatises of anatomy began to assume a more instructive form, and to breathe a more philosophical spirit. The great work of Adrian Spigelius, which appeared in 1627, two years after the death of the author, contains indeed no proof that he was aware of the valuable generalization of Harvey; but in the institutions of Caspar Bartholinus, as republished and improved by his son Thomas in 1651, the anatomical descriptions and explanations are given with reference to the new doctrine. A still more unequivocal proof of the progress of correct anatomical knowledge was given in the lectures delivered by Peter Dionis, at the Jardin Royal of Paris, in 1673 and the seven following years, in which that intelligent surgeon gave most accurate demonstrations of all the parts composing the human frame, and especially of the heart, its auricles, ventricles and valves, and the large vessels connected with it and the lungs. These demonstrations, first published in 1690, were so much esteemed that they passed through seven editions in the space of thirty years, and were translated into English.
The progress of anatomical discovery continued in the meantime to advance. In the course of the 16th century Eustachius, in studying minutely the structure of the vena azygos, had recognized in the horse a white vessel full of watery fluid, connected with the internal jugular vein, on the left side of the vertebral column, corresponding accurately with the vessel since named thoracic duct. Fallopius also described vessels belonging to the liver distinct from arteries and veins; and similar vessels appear to have been noticed by Nicolaus Massa (1499–1569). The nature and properties of these vessels were, however, entirely unknown. On the 23rd of July 1622 Gaspar Aselli, professor of anatomy at Pavia, while engaged in demonstrating Aselli. the recurrent nerves in a living dog, first observed numerous white delicate filaments crossing the mesentery in all directions; and though he took them at first for nerves, the opaque white fluid which they shed quickly convinced him that they were a new order of vessels. The repetition of the experiment the following day showed that these vessels were best seen in animals recently fed; and as he traced them from the villous membrane of the intestines, and observed the valves with which they were liberally supplied, he inferred that they were genuine chyliferous vessels. By confounding them with the lymphatics, he made them proceed to the pancreas and liver—a mistake which appears to have been first rectified by Francis de le Boe. The discovery of Aselli was announced in 1627; and the following year, by means of the zealous efforts of Nicolas Peiresc, a liberal senator of Aix, the vessels were seen in the person of a felon who had eaten copiously before execution, and whose body was inspected an hour and a half after. In 1629 they were publicly demonstrated at Copenhagen by Simon Pauli, and the same year the thoracic duct was observed by Jacques Mentel (1599–1670) for the first time since it was described by Eustachius. Five years after (1634), John Wesling, professor of anatomy and surgery at Venice, gave the first delineation of the lacteals from the human subject, and evinced more accurate knowledge than his predecessors of the thoracic duct and the lymphatics. Nathaniel Highmore in 1637 demonstrated unequivocally the difference between the lacteals and the mesenteric veins; and though some perplexity was occasioned by the discovery of the pancreatic duct by Christopher Wirsung, this mistake was corrected by Thomas Bartholinus; and the discovery by Jean Pecquet in 1647 of the common trunk of the lacteals and lymphatics, and of the course which the chyle follows to reach the blood, may be regarded as the last of the series of isolated facts by the generalization of which the extent, distribution and uses of the most important organs of the animal body were at length developed.
To complete the history of this part of anatomical science one step yet remained—the distinction between the lacteals and lymphatics, and the discovery of the termination of the latter order of vessels. The honour of this discovery is divided between George Joyliffe (1621–1658), an English Joyliffe.anatomist, and Olaus Rudbeck (1630–1702), a young Swede. The former, according to the testimony of Francis Glisson and Thomas Wharton, was aware of the distinct existence of the lymphatics in 1650, and demonstrated them as such in 1652. It is nevertheless doubtful whether he knew them much before the latter period; and it is certain that Rudbeck observed the lymphatics of the large intestines, and traced them to glands, on the 27th of January 1651, after he had, in the course of 1650, made various erroneous conjectures regarding them, and, like others, attempted to trace them to the liver. The following year he demonstrated them in presence of Queen Christina, and traced them to the thoracic duct, and the latter to the subclavian vein. Their course and distribution were still more fully investigated by Thomas Bartholinus, Wharton, J. Swammerdam and G. Blaes, the last two of whom recognized the existence of valves; while Antony Nuck of Leiden, by rectifying various errors of his predecessors, and adding several new and valuable observations, rendered this part of anatomy much more precise than formerly.
After this period anatomists began to study more minutely the organs and textures. Francis Glisson distinguished himself by a minute description of the liver (1654), and a clearer account of the stomach and intestines, than had yet been given. Thomas Wharton investigated the structure of the glands with particular care; and though rather prone to indulge in fanciful generalization, he developed some interesting views of these organs; while Walter Charlton (1619–1707), who appears to have been a person of great genius, though addicted to hypothesis, made some good remarks on the communication of the arteries with the veins, the foetal circulation and the course of the lymphatics. But the circumstance which chiefly distinguished the history of anatomy at the beginning of the 17th century was the appearance Willis. of Thomas Willis (1621–1675), who rendered himself eminent not only by good researches on the brain and nerves, but by many judicious observations on the structure of the lungs, the intestines, the blood-vessels and the glands. His anatomy of the brain and nerves is so minute and the elaborate, and abounds so much in new information, that the reader is struck by the immense chasm between the vague and meagre notices of his predecessors and the ample and correct descriptions of Willis. This excellent work, however, is not the result of his own personal and unaided exertions; and the character of Willis derives additional lustre from the candid avowal of his obligations to Sir Christopher Wren and Thomas Millington, and, above all, to the diligent researches of his fellow-anatomist Richard Lower.
Willis was the first who numbered the cranial nerves in the order in which they are now usually enumerated by anatomists. His observation of the connexion of the eighth pair with the slender nerve which issues from the beginning of the spinal cord is known to all. He remarked the parallel lines of the mesolobe, afterwards minutely described by Felix Vicq d'Azyr (1748–1794). He seems to have recognized the communication of the convoluted surface of the brain and that between the lateral cavities beneath the fornix. He described the corpora striata and optic thalami; the four orbicular eminences, with the bridge, which he first named annular protuberance; and the white mammillary eminences, behind the infundibulum. In the cerebellum he remarks the arborescent arrangement of the white and grey matter, and gives a good account of the internal carotids, and the communications which they make with the branches of the basilar artery.
About the middle of the 17th century R. Hooke and Nehemiah Grew employed the simple microscope in the minute examination of plants and animals; and the Dutch philosopher A. Leeuwenhoek with great acuteness examined microscopically the solids and fluids of the body, recognized the presence of scales in the cuticle, and discovered the corpuscles in the blood and milk, and the spermatozoa in the seminal fluid. The researches of Malpighi also tended greatly to improve the knowledge of minute Malpighi. structure. He gave the first distinct ideas on the organization of the lung, and the mode in which the bronchial tubes and vessels terminate in that organ. By the microscope he traced the transition of the arteries into the veins, and saw the movements of the blood corpuscles in the capillaries. He endeavoured to unfold, by dissection and microscopic observation, the minute structure of the brain. He studied the structure of bone, he traced the formation and explained the structure of the teeth; and his name is to this day associated with the discovery of the deeper layer of the cuticle and the Malpighian bodies in the spleen and kidney. In these difficult inquiries the observations of Malpighi are in general faithful, and he may be regarded as the founder of histological anatomy.
Nicolas Steno, or Stensen, described with accuracy (1660) the lacrymal gland and passages, and rediscovered the parotid duct. L. Bellini studied the structure of the kidneys, and described the tongue and tonsils with some care; and Charles Drelincourt laboured to investigate the changes effected on the uterus by impregnation, and to elucidate the formation of the foetus. The science might have derived still greater advantages from the genius of Regnier de Graaf, who investigated with accuracy the structure of the pancreas and of the organs of generation in both sexes, had he not been cut off at the early age of thirty-two. Lastly, Wepfer, though more devoted to morbid anatomy, made, nevertheless, some just observations on the anatomical disposition of the cerebral vessels, the glandular structure of the liver, and the termination of the common duct in the duodenum.
The appearance of Frederic Ruysch, who was born in 1638, became professor of anatomy at Amsterdam in 1665 and died in that city in 1731, gave a new impulse to anatomical research, and tended not only to give the science greater precision, but to extend its limits in every direction. Ruysch.The talents of Ruysch are said to have been developed by accident. To repel the audacious and calumnious aspersions with which Louis de Bils attacked de le Boe and van Horne, Ruysch published his tract on the valves of the lymphatics, which completely established his character as an anatomist of originality and research. This, however, is the smallest of his services to the science. The art of injecting, which had been originally attempted by Eustachi and Varoli, and was afterwards rudely practised by Glisson, Bellini and Willis, was at length carried to greater perfection by de Graaf and Swammerdam, the former of whom injected the spermatic vessels with mercury and variously coloured liquors; while the latter, by employing melted wax with other ingredients, made the first approach to the refinements of modern anatomy. By improving this idea of using substances which, though solid, may be rendered fluid at the period of injecting, Ruysch carried this art to the highest perfection.
By the application of this happy contrivance he was enabled to demonstrate the arrangement of minute vessels in the interior of organs which had escaped the scrutiny of previous anatomists. Scarcely a part of the human body eluded the penetration of his syringe; and his discoveries were proportionally great. His account of the valves of the lymphatics, of the vessels of the lungs, and their minute structure; his researches on the vascular structure of the skin, of the bones, and their epiphyses, and their mode of growth and union; his observations on the spleen, the glans penis, the clitoris, and the womb impregnated and unimpregnated, were but a limited part of his anatomical labours. He studied the minute structure of the brain; he demonstrated the organization of the choroid plexus; he described the state of the hair when affected with Polish plait; he proved the vascular structure of the teeth; he injected the dura mater, the pleura, the pericardium and peritoneum; he unfolded the minute structure of the conglomerate glands; he investigated that of the synovial apparatus placed in the interior of the joints; and he discovered several curious particulars relating to the lacteals, the lymphatics and the lymphatic glands.
Meanwhile, H. Meibomius rediscovered (1670) the palpebral glands, which were known to Casserius; Swammerdam studied the action of the lungs, described the structure of the human uterus, and made numerous valuable observations on the coeca and pancreatoid organs of fishes; and Th. Kerckring laid the foundation of a knowledge of the process of ossification. John Conrad Brunner, in the course of experiments on the pancreas, discovered (1687) the glands of the duodenum named after him, and J. Conrad Peyer (1677–1681) described the solitary and agminated glands of the intestinal canal. Leonard Tassin, distinguished for original observation, rendered the anatomical history of the brain more accurate than heretofore, and gave particular accounts of the intestinal tube, the pancreatic duct and the hepatic ligaments (1678).
That France might not be without participation in the glory of advancing the progress of anatomical knowledge, the names of Joseph Guichard Duverney and Vieussens are commemorated with distinction. Duverney, born in 1648, and first introduced into public life in 1676 in the Royal Duverney.Academy of Sciences, decorated with the honorary title of professor of anatomy to the dauphin, and appointed in 1679 professor at the Jardin Royal, distinguished himself by the first accurate account of the organ of hearing, and by his dissections of several animals at the academy supplied valuable materials for the anatomical details of the natural history of animals published by that learned body. He appears to have been the first who demonstrated the fact that the cerebral sinuses open into the jugular veins, and to have been aware that the former receives the veins of the brain and are the venous receptacles of the organ. He understood the cerebral cavities and their mode of communication; distinguishes the posterior pillars of the vault from the pedes hippocampi; recognizes the two plates of the septum lucidum; and, what is still more remarkable, he first indicates distinctly the discussation of the anterior pyramids of the medulla oblongata—a fact afterwards verified by the researches of Mistichelli, F. P. du Petit and G. D. Santorini. He studied the ganglions attentively, and gives the first distinct account of the formation, connexions and distribution of the intercostal nerves. It is interesting to remark that his statement that the veins or sinuses of the spinal cord terminate in the vena azygos was verified by the subsequent researches of G. Dupuytren (1777–1835) and G. Breschet (1784–1845), which showed that the vertebral veins communicate by means of the intercostal and superior lumbar veins with the azygos and hemi-azygos. His account of the structure of bones and of the progress of ossincation is valuable. He recognized the vascular structure of the spleen, and described the excretory ducts of the prostate gland, the verumontanum, and the ante-prostates.
One of the circumstances which at this time tended considerably to the improvement of anatomical science was the attention with which Comparative Anatomy was beginning to be cultivated. In ancient times, and at the revival of letters, the dissection of the lower animals was substituted for that of the human body; and the descriptions of the organs of the latter were too often derived from the former. The obloquy and contempt in which this abuse involved the study of animal anatomy caused it to be neglected, or pursued with indifference, for more than two centuries, during which anatomists confined their descriptions, at least very much, to the parts of the human body. At this period, however, the prejudice against Comparative Anatomy began to subside; and animal dissection, though not substituted for that of the human body, was employed, as it ought always to have been, to illustrate obscurities, to determine doubts and to explain difficulties, and, in short, to enlarge and rectify the knowledge of the structure of animal bodies generally.
For this revolution in its favour, Comparative Anatomy was in a great measure indebted to the learned societies which were established about this time in the different countries of Europe. Among these, the Royal Society of London, embodied by charter by Charles II. in 1662, and the Academy of Sciences of Paris, founded in 1666 by J. B. Colbert, are undoubtedly entitled to the first rank. Though later in establishment, the latter institution was distinguished by making the first great efforts in favour of Comparative Anatomy; and Claude Perrault, Pecquet, Duverney and Jean Méry, by the dissections of rare animals obtained from the royal menagerie, speedily supplied valuable materials for the anatomical naturalist. In England, Nehemiah Grew, Edward Tyson and Samuel Collins cultivated the same department with diligence and success. Grew has left an interesting account of the anatomical peculiarities of the intestinal canal in various animals; Tyson, in the dissection of a porpoise, an opossum and an orang outang, adduces some valuable illustrations of the comparative differences between the structure of the human body and that of the lower animals; Collins Collins. has the merit of conceiving, and executing on an enlarged plan, a comprehensive system, embodying all the information then extant (1685). With the aid of Tyson and his own researches, which were both extensive and accurate, he composed a system of anatomical knowledge in which he not only gives ample and accurate descriptions of the structure of the human body, and the various morbid changes to which the organs are liable, but illustrates the whole by accurate and interesting sketches of the peculiarities of the lower animals. The matter of this work is so excellent that it can only be ascribed to ignorance that it has received so little attention. Though regarded as a compilation, and though indeed much of the human anatomy is derived from Vesalius, it has the advantage of the works published on the continent at that time, that it embodies most of the valuable facts derived from Malpighi, Willis and Vieussens. The Comparative Anatomy is almost all original, the result of personal research and dissection; and the pathological observations, though occasionally tinged with the spirit of the times, show the author to have been endowed with the powers of observation and judicious reflexion in no ordinary degree.
About this time also we recognize the first attempts to study the minute constitution of the tissues, by the combination of the microscope and the effects of chemical agents. Bone furnished the first instance in which this method was put in use; and though Gagliardi, who undertook the inquiry, had fallen into some mistakes which it required the observation of Malpighi to rectify, this did not deter Clopton Havers and Nesbitt, in England, and Courtial, H. L. Duhamel-Dumonceau and Delasone, and afterwards Herissant, in France, from resuming the same train of investigation. The mistakes into which these anatomists fell belong to the imperfect method of inquiry. The facts which they ascertained have been verified by recent experiment, and constitute no unessential part of our knowledge of the structure of bone.
Ten years after the publication of the work of Collins, Ridley, another English anatomist, distinguished himself by a monograph (1695) on the brain, which, though not free from errors, contains, nevertheless, some valuable observations. Ridley is the first who distinguishes by name the restiform processes, or the posterior pyramidal eminences. He recognized the figure of the four eminences in the human subject; he remarked the mammillary bodies; and he discovered the sinus which passes under his name.
Raymond Vieussens, by the publication of his great work on neurography in 1684, threw new light on the configuration and structure of the brain, the spinal cord and the nerves; and gave a description of the arrangement and distribution of the latter more precise than heretofore. Of the Vieussens.formation and connexions of the sympathetic nerve especially he gave views which have been generally adopted by subsequent anatomists. His new arrangement of the vessels, published in 1705, contains several curious opinions. His observations on the structure of the heart, published in 1706, and enlarged in 1715, exhibit the first correct views of the intimate structure of an organ which afterwards was most fully developed by the labours of G. M. Lancisi and J. B. Senac.
To the same period (1685–1697) belong the rival publications of G. Bidloo and William Cowper, the latter of whom, however, stained a reputation otherwise good by publishing as his own the engravings of the former. Cowper further distinguished himself by a minute account of the urethral glands, already known to Columbus and Méry; by a good description of the intestinal glands, discovered by Brunner and Peyer; and by demonstrating the communication of the arteries and veins of the mesentery.
The anatomical genius of Italy, which had slumbered since the death of Malpighi, was destined once more to revive in Lancisi, A. M. Valsalva, and his illustrious pupils G. D. Santorini and J. B. Morgagni. Valsalva especially distinguished himself by his description of the structure of the ear, which, in possessing still greater precision and minuteness than that of Duverney, is valuable in setting the example of rendering anatomy altogether Santorini. a science of description. Santorini, who was professor at Venice, was no unworthy friend of Valsalva and Morgagni. His anatomical observations, which relate to the muscles of the face, the brain and several of the nerves, the ducts of the lachrymal gland, the nose and its cavities, the larynx, the viscera of the chest and belly, and the organs of generation in the two sexes, furnish beautiful models of essays, distinguished for perspicuity, precision and novelty, above anything which had then appeared. These observations, indeed, which bear the impress of accurate observation and clear conception, may be safely compared with any anatomical writings which have appeared since. Those on the brain are particularly interesting. Morgagni. Morgagni, though chiefly known as a pathological anatomist, did not neglect the healthy structure. His Adversaria, which appeared between 1706 and 1719, and his Epistles, published in 1728, contain a series of observations to rectify the mistakes of previous anatomists, and to determine the characters of the healthy structure of many parts of the human body. Many parts he describes anew, and indicates facts not previously observed. All his remarks show how well he knew what true anatomical description ought to be. In this respect, indeed, the three anatomists now mentioned may be said to have anticipated their contemporaries nearly a century; for, while other authors were satisfied with giving loose and inaccurate or meagre notices of parts, with much fanciful supposition, Valsalva, Santorini and Morgagni laboured to determine with precision the anatomical characters of the parts which they describe.
The same character is due to J. B. Winslow (1669–1760), a native of Denmark, but, as pupil and successor of Duverney, as well as a convert to Catholicism, naturalized in France, and finally professor of anatomy at the Royal Gardens. His exposition of the structure of the human body is distinguished Winslow.for being not only the first treatise of descriptive anatomy, divested of physiological details and hypothetical explanations foreign to the subject, but for being a close description derived from actual objects, without reference to the writings of previous anatomists. About the same time W. Cheselden in London, the first Alexander Monro in Edinburgh, and B. S. Albinus in Leiden, contributed by their several treatises to render anatomy still more precise as a descriptive science. The Osteographia of the first-mentioned was of much use in directing attention to the study of the skeleton and the morbid changes to which it is liable. This work, however, magnificent as it was, was excelled by that of Albinus, who in 1747 published engravings, executed Albinus. by Jan Wandelaar (1691–1759), of the bones and muscles, which had never been surpassed in accuracy of outline or beauty of execution. The several labours of Albinus, indeed, constitute an important era in the history of the science. He was the first who classified and exhibited the muscles in a proper arrangement, and applied to them a nomenclature which is still retained by the consent of the best anatomists. He gives a luminous account of the arteries and veins of the intestines represents with singular fidelity and beauty the bones of the foetus, inquires into the structure of the skin and the cause of its colour in different races; represents the changes incident to the womb in different periods of pregnancy, and describes the relations of the thoracic duct and the vena azygos with the contiguous parts. Besides these large and magnificent works, illustrated by the most beautiful engravings, six books of Academical Annotations were the fruits of his long and assiduous cultivation of anatomy. These contain valuable remarks on the second structure and morbid deviations of numerous parts of the human body.
Albinus found a worthy successor in his pupil Albert von Haller (1708–1777), who, with a mind imbued with every department of literature and science, directed his chief attention, nevertheless, to the cultivation of anatomical and physiological knowledge. Having undertaken at an early age Haller.(twenty-one) to illustrate, with commentaries, the physiological prelections of his preceptor H. Boerhaave, he devoted himself assiduously to the perusal of every work which could tend to facilitate his purpose; and, as he found numerous erroneous or imperfect statements, and many deficiencies to supply, he undertook an extensive course of dissection of human and animal bodies to obtain the requisite information. During the seventeen years he was professor at Göttingen, he dissected 400 bodies, and inspected their organs with the utmost care. The result of these assiduous labours appeared at intervals in the form of dissertations by himself, or under the name of some one of his pupils, finally published in a collected shape between 1746 and 1751 (Disputationes Anatomicae Selectiores), and in eight numbers of most accurate and beautiful engravings, representing the most important parts of the human body, e.g. the diaphragm, the uterus, ovaries and vagina, the arteries of the different regions and organs, with learned and critical explanatory observations. He verified the observations that in the foetus the testicles lie in the abdomen, and showed that their descent into the scrotum may be complicated with the formation of congenital hernia. Some years after, when he had retired from his academical duties at Göttingen, he published between 1757 and 1765 the large and elaborate work which, with singular modesty, he styled Elements of Physiology. This work, though professedly devoted to physiology, rendered, nevertheless, the most essentially services to anatomy. Haller, drawing an accurate line of distinction between the two, gave the most clear, precise and complete descriptions of the situation, position, figure, component parts and minute structure of the different organs and their appendages. The results of previous and coeval inquiry, obtained by extensive reading, he sedulously verified by personal observation; and though he never rejected facts stated on credible authorities, he in all cases laboured to ascertain their real value by experiment. The anatomical descriptions are on this account not only the most valuable part of his work, but the most valuable that had then or for a long time after appeared. It is painful, nevertheless, to think that the very form in which this work is composed, with copious and scrupulous reference to authorities, made it be regarded as a compilation only; and that the author was compelled to show, by a list of his personal researches, that the most learned work ever given to the physiologist was also the most abundant in original information.
With the researches of Haller it is proper to notice those of his contemporaries, John Frederick Meckel, J. N. Lieberkühn, and his pupil John Godfrey Zinn. The first, who was professor of anatomy at Berlin, described the Casserian ganglion, the first pair of nerves and its distribution and that of the facial nerves generally, and discovered the spheno-palatine ganglion (1748–1751). He made some original and judicious observations on the tissue of the skin and the mucous net (1753–1757); and above all, he recognized the connexion of the lymphatic vessels with the veins—a doctrine which, after long neglect, was revived by Vincent Fohmann (1794–1837) and Lippi. He also collected several valuable observations on the morbid states of the heart and brain. Lieberkühn published in 1745 a dissertation on the villi and glands of the small intestines. Zinn, who was professor of medicine at Göttingen, published a classical treatise on the eye (1755), which demonstrated at once the defects of previous inquiries, and how much it was possible to elucidate, by accurate research and precise description, the structure of one of the most important organs of the human frame. It was republished after his death by H. A. Wrisberg (1780). About the same time J. Weitbrecht gave a copious and minute account of the ligaments, and J. Lieutaud (1703–1780), who had already laboured to rectify many errors in anatomy, described with care the structure and relations of the heart and its cavities, and rendered the anatomy of the bladder very precise, by describing the triangular space and the mammillary eminence at its neck.
The study of the minute anatomy of the tissues, which had originally been commenced by Leeuwenhoek, Malpighi and Ruysch, began at this period to attract more general attention. Karl August von Bergen had already demonstrated (1732) the general distribution of cellular membrane, and showed that it not only incloses every part of the animal frame, but forms the basis of every organ—a doctrine which was adopted and still more fully expanded (1757) by his friend Haller, in opposition to what was asserted by Albinus, who maintains that each part has a proper tissue. William Hunter at the same time gave a clear and W. Hunter. ingenious statement of the difference between cellular membrane and adipose tissue (1757), in which he maintained the general distribution of the former, and represented it as forming the serous membranes, and regulating their physiological and pathological properties—doctrines which were afterwards confirmed by his brother John Hunter. A few years after, the department of general anatomy first assumed a substantial form in the systematic view of the membranes and their mutual connexions traced by Andrew Bonn of Amsterdam. In his A. Bonn. inaugural dissertation De Continuationibus Membranarum, published at Leiden in 1763, this author, after some preliminary observations on membranes in general and their structure, and an exposition of that of the skin, traces its transition into the mucous membranes and their several divisions. He then explains the distribution of the cellular membrane, the aponeurotic expansions, and the periosteum and perichondrium, by either of which, he shows, every bone of the skeleton is invested and connected. He finally gives a very distinct view of the arrangement of the internal membranes of cavities, those named serous and fibro-serous, and the manner of their distribution over the contained organs. This essay, which is a happy example of generalization, is remarkable for the interesting general views of the structure of the animal body which it exhibits; and to Bonn belongs the merit of sketching the first outlines of that system which it was reserved for the genius of M. F. X. Bichat to complete and embellish. Lastly, T. de Bordeu, in an elaborate essay (1767) on the mucous tissue, or cellular organ, as he terms it, brought forward some interesting views of the constitution, nature and extent of the cellular membrane.
Though anatomy was hitherto cultivated with much success as illustrating the natural history and morbid states of the human body, yet little had been done for the elucidation of local diseases, and the surgical means by which they may be successfully treated. The idea of applying anatomical knowledge directly to this purpose appears to have originated with Bernardin Genga, a Roman surgeon, who published in 1672, at Rome, a work entitled Surgical Anatomy, or the Anatomical History of the Bones and Muscles of the Human Body, with the Description of the Blood-vessels. This work, which reached a second edition in 1687, is highly creditable to the author, who appears to have studied intimately the mutual relations of different parts. It is not improbable that the example of Genga led J. Palfyn, a surgeon at Ghent, to undertake a similar task about thirty years after (1718–1726). For this, however, he was by no means well qualified; and the work of Palfyn, though bearing the name of Surgical Anatomy, is a miserable compilation, meagre in details, inaccurate in description, and altogether unworthy of the honour of being republished, as it afterwards was by Antony Petit.
While these two authors, however, were usefully employed in showing what was wanted for the surgeon, others were occupied in the collection of new and more accurate facts. Albinus, indeed, ever assiduous, had, in his account of the operations of Rau, given some good sketches of the relative anatomy of the bladder and urethra; and Cheselden had already, in his mode of cutting into the urinary bladder, shown the necessity of an exact knowledge of the relations of contiguous parts. The first decided application, however, of this species of anatomical research it was reserved for a Dutch anatomist of the 18th century to make. Peter Camper, professor of anatomy at Amsterdam, published in 1760 and 1762 his anatomic-pathological Camper. demonstrations of the parts of the human arm and pelvis, of the diseases incident to them, and the mode of relieving them by operation, and explained with great clearness the situation of the blood-vessels, nerves and important muscles. His remarks on the lateral operation of lithotomy, which contain all that was then known on the subject, are exceedingly interesting and valuable to the surgeon. It appears, further, that he was the first who examined anatomically the mechanism of ruptures, his delineations of which were published in 1801 by S. T. Sömmerring. Camper also wrote some important memoirs on Comparative Anatomy, and he was the author of a well-known work on the Relations of Anatomy to the Fine Arts.
The attention of anatomists was now directed to the elucidation of the most obscure and least explored parts of the human frame—the lymphatic vessels and the nerves. Although, since the first discovery of the former by Aselli, Rudbeck and Pecquet, much had been done, especially by Ruysch, Nuck, Meckel and Haller, many points, notwithstanding, relating to their origin and distribution in particular organs, and in the several classes of animals, were imperfectly ascertained or entirely unknown. William Hunter investigated their arrangement, and W. and J. Hunter. proposed the doctrine that they are absorbents; and John Hunter, who undertook to demonstrate the truth of this hypothesis by experiment, discovered, in 1758, lymphatics in the neck in birds. As the doctrine required the existence of this order of vessels, not only in quadrupeds and birds but in reptiles and fishes, the inquiry attracted attention among the pupils of Hunter; and William Hewson at length communicated, in December 1768, to the Hewson. Royal Society of London an account of the lacteals and lymphatics in birds, fishes and reptiles, as he had discovered and demonstrated them. The subject was about the same time investigated by the second Alexander Monro, who indeed claimed the merit of discovering these vessels in the classes of animals now mentioned. But whatever researches this anatomist may have instituted, Hewson, by communicating his observations to the Royal Society, must be allowed to possess the strongest as well as the clearest claim to discovery. The same author, in 1774, gave the first complete account of the anatomical peculiarities of the lymphatic system in man and other animals, and thereby supplied an important gap in this department. Hewson is the first who distinguishes the lymphatics into two orders—the superficial and the deep—both in the extremities and in the internal organs. He also studied the structure of the intestinal villi, in which he verified the observations of Lieberkühn; and he made many important observations on the corpuscles of the lymph and blood. He finally applied his anatomical discoveries to explain many of the physiological and pathological phenomena of the animal body. Ten years after, John Sheldon, another pupil of Hunter, gave a second history and description of the lymphatics, which, though divested of the charm of novelty, contains many interesting anatomical facts. He also examined the structure of the villi.
Lastly, Cruikshank, in 1786, published a valuable history of the anatomy of the lymphatic system, in which he maintains the accuracy of the Hunterian doctrine, that the lymphatics are the only absorbents; gave a more minute account than heretofore of these vessels, of Cruikshank.their coats and valves; and explained the structure of the lymphatic glands. He also injected the villi, and examined them microscopically, verifying most of the observations of Lieberkühn. The origin of the lymphatics he maintains rather by inference than direct demonstration. To these three works, though in other respects very excellent, it is a considerable objection that the anatomical descriptions are much mixed with hypothetical speculation and reasonings on properties, and that the facts are by no means always distinguished from mere matters of opinion. At the same time J. G. Haase published an account of the lymphatics of the skin and intestines, and the plexiform nets of the pelvis.
To complete this sketch df the history of the anatomy of the lymphatic system, it may be added that Paolo Mascagni, who had been engaged from the year 1777 to 1781 in the same train of lnvestigatron, first demonstrated to his pupils several curious facts relating to the anatomy Mascagni.of the lymphatic system. When at Florence in 1782 he made several preparations, at the request of Peter Leopold, grand duke of Tuscany; and when the Royal Academy of Sciences at Paris announced the anatomy of this system for their prize essay appointed for March 1784, Mascagni resolved on communicating to the public the results of his researches—the first part of his commentary, with four engravings. Anxiety, however, to complete his preparations detained him at Florence till the close of 1785; and from these causes his work did not appear till 1787. These delays, however, unfavourable as they were to his claims of priority to Sheldon and Cruikshank, were on the whole advantageous to the perfection of his work, which is not only the most magnificent, but also the most complete that ever was published on the lymphatics. In his account of the vessels and their valves he confirms some of Hewson’s observations and rectifies others. Their origin he proves by inference much in the same manner as Cruikshank; but he anticipates this author in the account of the glands, and he gives the most minute description of the superficial and deep lymphatics, both in the members and in the internal organs.
General accounts of the nerves had been given with various degrees of accuracy by Willis, Vieussens, Winslow, and the first Monro; and the subject had been much rectified and improved by the indefatigable Haller. The first example of minute descriptive neurography was given in 1748 by John Frederick Meckel, whose account of the fifth pair and of the nerves of the face will long remain a lasting proof of accuracy and research. The same subject was investigated in 1765 by Hirsch and in 1777 by Wrisberg. In 1766 Metzger examined the origin, distribution and termination of the first pair—a point which was afterwards very minutely treated by A. Scarpa in his anatomical disquisitions, published in 1780; and the internal nerves of the nostrils were examined in 1791 by Haase. The optic nerve, which had been studied originally by Varoli, and afterwards by Méry, Duverney, J. F. Henkel, Moeller, Hein and Kaldschmid, was examined with extreme accuracy, with the other nerves of the organ of vision, by Zinn in his elaborate treatise. The phrenic nerves and the oesophageal branches of the vagus were studied by Haase; the phrenic, the abdominal and the pharyngeal nerves, by Wrisberg; those of the heart most minutely by Andersch; and the origins, formation and distribution of the intercostal nerves, by Iwanov, C. G. Ludwig, and Girardi. The labours of these anatomists, however, were eclipsed by the splendid works of Walter (1783) on the nerves of the chest and belly; and those of Scarpa (1794) on the distribution of the eighth pair and splanchnic nerves in general. In minuteness of description and in beauty of engraving these works have not yet been equalled, and will never perhaps be surpassed. About the same time, Scarpa, so distinguished in every branch of anatomical research, investigated the minute structure of the ganglions and plexuses. The anatomy of the brain itself was also studied (1780) with great attention by the second Monro, M. V. G. Malacarne and Vicq d’Azyr.
Lastly, the anatomy of the gravid uterus, which had been originally studied by Albinus, Roederer and Smellie, was again illustrated (1774) most completely by William Hunter, whose engravings will remain a lasting memorial of scientific zeal and artistic talent.
The perfection which anatomical science attained in the last ten years of the 18th and during the 19th century is evinced not only in the improved character of the systems published by anatomists, but in the enormous advance which has taken place in the knowledge of the minute 19th century.structure of the animal tissues, of the development of the tissues and organs, and of the modifications in form and structure exhibited by various groups of animals.
The first who gave a good modern system was R. B. Sabatier; but his work was speedily eclipsed by the superior merits of the treatises of Sömmerring, Bichat and Portal. The excellent work by Samuel Thomas Sömmerring, originally published in the German language, between the years 1791 and Sömmerring. 1796; then in the Latin language, between the years 1794 and 1800; and in a second edition in the German language in 1800 and 1801, maintaining the high character which it first possessed for clear arrangement, accurate description and general precision, was, between the years 1841 and 1844 republished in eight volumes at Leipzig by Th. L. W. Bischoff, F. G. J. Henle, E. H. Huschke, Theile, G. G. Valentin, Vogel, and R. Wagner, with suitable additions, and a large amount of new and accurate information. In this edition Rudolph Wagner gives, in the first division of the first volume, the life, correspondence and literary writings of Sömmerring; and in the second volume the anatomy of the bones and ligaments. The third volume contains the anatomy of the muscles and the vascular system by Theile. G. G. Valentin devotes one volume, the fourth, to the minute anatomy of the nervous system and its parts, as disclosed by careful examination by the microscope; and it must be allowed that the author has been at great pains to present just views of the true anatomy of the brain, the spinal cord, the nervous branches and the ganglia. In the fifth volume, E. H. Huschke of Jena gives the anatomical history of the viscera and the organs of the senses, a department which had been left in some degree incomplete in the original, but for one division of which the author had left useful materials in his large figures already mentioned. In the sixth volume, an entire and complete system of general anatomy, deduced from personal observation and that of other careful observers, the materials being in general new, and in all instances confirmed and rectified is given by F. G. J. Henle. The seventh volume contains the history of the process of development in mammalia and man, by Th. L. W. Bischoff. The eighth volume treats of the pathological anatomy of the human body, by Julius Vogel, but contains only the first division, relating to the generalities of the subject. This, which is probably the most accurate as it is the most elaborate system of anatomical knowledge up to the date of its publication in 1844, was translated into the French language by Jourdan, and published in 1846 under the name of Encyclopédie anatomique. The eighth volume was translated into English in the year 1847. The Anatomie générale of M. F. X. Bichat is a monument of his philosophical genius which will last as long as the structure and functions of the human body are objects of interest. His Anatomie descriptive is distinguished by clear and natural arrangement, precise and accurate description, Bichat.and the general ingenuity with which the subject is treated. The physiological observations are in general correct, often novel, and always highly interesting. It is unfortunate, however, that the ingenious author was cut off prematurely during the preparation of the third volume. The later volumes are, however, pervaded with the general spirit by which the others are impressed, and are highly creditable to the learning, the judgment and the diligence of P. J. Roux and M. F. R. Buisson. The system of A. Portal is a valuable and correct digest of anatomical and French systematic anatomists. pathological knowledge, which, in exact literary information, is worthy of the author of the Histoire de l’anatomie et de la chirurgie, and, in accuracy of descriptive details, shows that Portal trusted not to the labours of his predecessors only. A. Boyer published in 1803 a complete treatise on descriptive anatomy. H. Cloquet formed, on the model of the Anatomie descriptive of Bichat, a system in which he avails himself of the literature and precision of Sömmerring and the details of Portal. An English translation of this work was prepared by Dr Robert Knox. Jean Cruveilhier published in 1834–1835 a good general treatise on descriptive anatomy, which was translated into English, and published as a part of The Library of Medicine. Cruveilhier’s treatise has passed through several editions. The most elaborate work of the French school is the great treatise of M. J. Bourgery, consisting of four divisions, on descriptive, general, surgical and philosophical anatomy (1832–1854). These are beautifully illustrated.
Modern Human Anatomy (Anthropotomy)
The history of modern human anatomy in Great Britain begins with the time at which the dissection of the human body became part of the training of students of medicine, and this is one of the greatest debts, though by no means the best recognized, of the many which medical science owes to that remarkable man William Hunter. Before his time the anatomy professors of the most celebrated schools both at home and abroad used one or at most two subjects to illustrate their courses of lectures, and were in the habit of demonstrating the performance of surgical operations not on human bodies but on those of lower animals. Few students dissected the human body, because for such dissection they had no opportunities. The English law, since the time of Henry VIII., allowed only the bodies of persons executed for murder to be dissected, and the supply seems to have been sufficient for the humble needs of the time. The reformation of this antiquated and imperfect system took place in 1747, when Hunter established complete courses of anatomical lectures and opened a school for dissection. The practice of dissection grew so rapidly that by about 1793 there were 200 regular anatomy students in London, while in 1823 their number was computed at about 1000. Of course the supply of murderers was not enough for all these students, and the very fact that only murderers were allowed for this purpose made people bitterly hostile to the bodies of their relations and friends being dissected. In accounting for the great aversion which there has always been from dissection in England, it should be remembered that, although capital punishment was the penalty for very many offences at the beginning of the 19th century, only the bodies of murderers were handed over to the anatomists.
When once the absolute necessity of a surgeon’s having a good knowledge of anatomy was realized, bodies had to be procured at any hazard, and the chief method was to dig them up as soon as possible after their burial. This practice of exhumation or “body-snatching” on a large scale seems to have been peculiar to Great Britain and America, and not to have been needed on the continent of Europe. In France, Italy, Portugal and Austria no popular objection was raised to the bodies of friendless people, who died in hospitals, or of those whose burial was paid for by the state, being dissected, provided a proper religious service was held over them. In Germany it was obligatory that the bodies of all people unable to pay for their burials, all dying in prisons, all suicides and public women should be given up. In all these countries the supply was most ample, exhumation was unknown, and the cost of learning anatomy to the students was very moderate. In Great Britain the earlier exhumations seem to have caused very little popular concern; Hunter, it is said, could manage to get the body of any person he wanted, were it that of giant, dwarf, hunchback or lord, but later, when the number of students increased very rapidly, the trade of “resurrection man” became commoner, and attracted the lowest dregs of the vicious classes. It is computed that in 1828 about 200 people were engaged in it in London alone, though only a few gained their entire livelihood by it. In the first half of the 18th century, and for some time afterwards, the few dissections which were undertaken were carried out in the private houses of medical men. In 1702 a rule was passed at St Thomas’s Hospital preventing the surgeons or pupils from dissecting bodies there without the express permission of the treasurer, but by 1780 this rule seems to have lapsed, and a definite dissecting-room was established, an example which was soon followed by Guy’s and St Bartholomew’s.
In the early years of the 19th century the number of students increased so rapidly that a good many private anatomy schools grew up, and in 1828 we find that the total list of London dissecting rooms comprised those of Guy’s, London, St Bartholomew’s and St Thomas’s hospitals, the Webb Street school of Mr Grainger, the Aldersgate school of Mr Tyrrell, the Windmill Street school where Caesar Hawkins and Herbert Mayo lectured, and the schools of Messrs. Bennett, Carpue, Dermott and Sleigh. These schools needed and, it seems, obtained nearly 800 bodies a year in the years about 1823, when there were nearly 1000 students in London, and it is recorded that bodies were even sent to Edinburgh and Oxford.
When it is realized that the greater number of these were exhumed, it is easy to understand how hostile the public feeling became to the body-snatchers or “resurrection men,” and also in a modified form to the teachers of anatomy and medical students. This was increased by the fact that it soon became well known that many of the so-called resurrection men only used their calling as a cloak for robbery, because, if they were stopped with a horse and cart by the watch at night, the presence of a body on the top of stolen goods was sufficient to avert suspicion and search. It is in many places suggested, though not definitely stated, that the Home Office authorities understood how absolutely necessary it was that medical students should learn the details of the human body, on which they would be called to operate, and that the police had instructions not to interfere more than was necessary with the only method by which that education could be supplied, however unlawful it might be. So emboldened and careless did these body-snatchers become, and so great was the demand for bodies, that they no longer confined themselves to pauper graves, but took the remains of the wealthier classes, who were in a position to resent it more effectually; often they did not even take the trouble to fill in the graves after rifling their contents, and, in consequence, many sextons, who no doubt had been bribed, lost their posts, and men armed with firearms watched the London burial-places at night. The result of this was that the “resurrection men” had to go farther afield, and their occupation was attended with considerable danger, so that the price of a body gradually rose from £2 to about £14, which seems the maximum ever paid. In addition to this heavy sum the anatomical teachers had to pay the fines of the exhumers when they were caught, or to support their families when they were imprisoned. By 1828 the annual supply of bodies had dropped to about 450, and about 200 English students were forced each year to go to Paris for their anatomical instruction. There they could get a body for about seven francs and could also be taught by English anatomists who settled in that city for the purpose.
As early as about 1810 an anatomical society was formed, to impress on the government the necessity for an alteration in the law, and among the members we find the names of John Abernethy, Charles Bell, Everard Home, Benjamin Brodie, Astley Cooper and Henry Cline. It was owing to the exertions of this body that in 1828 a select committee was appointed by the government to report on the whole question, and to the minutes of evidence taken before this body the reader is referred for further details.
The report of this committee led to the Anatomy Act of 1832, but there can be little doubt that its passage through the House was expedited by the recent discovery and arrest of the infamous William Burke and William Hare, who, owing to the extreme difficulty of procuring subjects for dissection in Edinburgh and the high price paid for them, had made a practice of enticing men to their lodgings and then drugging and suffocating them in order to sell their bodies to Dr Knox. Hare turned king’s evidence but Burke was executed. (See MacGregor’s History of Burke and Hare, 1884, Lonsdale’s Life and Writings of Robert Knox, 1870. Many further details connected with the condition of anatomy, especially in Dublin, before the passing of the Anatomy Act, will be found in Memoirs of James Macartney by Professor A. Macalister, F.R.S.) The bill to legalize and regulate the supply of subjects for dissection did not pass without considerable opposition. In 1829 the College of Surgeons petitioned against it, and it was withdrawn in the House of Lords owing to the opposition of the archbishop of Canterbury, but in 1832 a new Anatomy Bill was introduced, which, though violently opposed by Messrs Hunt, Sadler and Vyvyan, was supported by Macaulay and O'Connell, and finally passed the House of Lords on the 19th of July 1832.
This is the act which governs the practice of anatomy in the British Isles up to the present day, and which has only been slightly modified as to the time during which bodies may be kept unburied in the schools. It provides that any one intending to practise anatomy must obtain a licence from the home secretary. As a matter of fact only one or two teachers in each institution take out this licence and are known as licensed teachers, but they accept the whole responsibility for the proper treatment of all bodies dissected in the building for which their licence is granted. Watching over these licensed teachers, and receiving constant reports from them, are four inspectors of anatomy, one each for England, Scotland, Ireland and London, who report to the home secretary and know the whereabouts of every body which is being dissected. The main clause of the act is the seventh, which says that a person having lawful possession of a body may permit it to undergo anatomical examination provided no relative objects; the other clauses are subsidiary and detail the methods of carrying this into effect. In clause 16, however, the old act of Henry VIII. is repealed and the bodies of murderers are no longer to be given up for dissection after execution.
There can be little doubt that this act has worked well and with a minimum of friction; it at once did away with body-snatching and crimes like those of Burke and Hare. No licensed teacher now could or would receive a body without a medical certificate and a warrant from the inspector of anatomy, and, when the bodies are buried, a proper religious service, according to the creed professed during life, is provided. The great majority of bodies are those of unclaimed poor in the workhouse infirmaries, but a few are obtained each year from the general hospitals. Occasionally a well-to-do person, following the example of Jeremy Bentham, leaves his body for the advancement of science, but even then, if his relatives object, it is not received.
The ample supply of subjects obtained by legitimate means which the anatomy act provided was followed by the opening of anatomical schools at all the great London hospitals and the universities, with the result that anatomical research was stimulated and text-books embodying the latest discoveries were brought out. It is wonderful, however, how much descriptive anatomy was taught in the days before text-books were common and how much of what is essential to the study of surgery and medicine the students knew. In looking through an old book of anatomical questions and answers dated 1812, one is struck by the fact that any one working through them with the body would probably pass an average modern anatomical examination to-day.
The various phases which anatomy in the British Isles has passed through have also been experienced in America, though it is difficult to compare the two countries owing to the fact that each state in the Union makes its own laws as to dissection, and that these vary considerably. The first anatomy act worthy of the name was that of Massachusetts, and was passed in 1831, one year before the British act. There is reason to believe, however, that, in some states, all the evils of body-snatching existed up to the end of the 19th century. In some more enlightened states, such as Pennsylvania and Massachusetts, the modern acts are, in advance of the British in that they are mandatory instead of permissive, and their compulsory nature is found rather to reduce than to increase public opposition to dissection. A study of the history of anatomy in the United States during the 19th century furnishes an instructive lesson on the futility of attempting to suppress dissection by legislation and on the serious and sometimes terrible crimes to which any such attempt naturally leads. It also teaches that, when unclaimed bodies must be given up and must be treated reverently and buried decently, there is less friction than when public boards have the right of arbitrarily refusing to allow their unclaimed dead to be used for the service of the living.
In all the important countries of Europe, with the exception, of Russia and Turkey, anatomy acts exist. They almost all differ from the British act in being mandatory instead of permissive; in other words, certain unclaimed bodies must be given up to the schools of anatomy. As a rule these come from the general hospitals, but sometimes, as in Germany, Austria and Sweden, suicides are received and form a considerable part of the whole number. Even where executed criminals are available they nowadays form a negligible contribution, but the unclaimed bodies of people dying in prison are provided for in the French, Belgian, Norwegian, Swedish, German and Italian regulations, and in Paris they form an important element of the supply. In Russia several attempts to gain an anatomy act have been made, but have always been opposed by those in authority, and there is good reason to believe that bodies are procured by bribing hospital and mortuary attendants. It is said that the army contributes a large percentage of the total number. In Turkey no facilities for dissecting the dead body exist, as the practice is against the Mahommedan religion; the German pathologists in Turkey, however, insist on making post mortem examinations. In the British colonies anatomical regulations vary a good deal; sometimes, as in New South Wales, the act is founded on that of Great Britain and is permissive, but in Victoria the minister may authorize the medical officer of any public institution supported wholly or in part by funds from the general revenue to permit unclaimed bodies to be dissected, provided the persons, during life had not expressed a wish against it. This act in its working is equivalent to a mandatory one, since the power of refusing bodies is not left in the hands of, in this respect, uneducated poor law guardians.
In the early years of the 19th century Sir Charles Bell’s work on human anatomy is by far the most important in the British Isles. He wrote the article on the nerves in his brother John Bell’s work on the anatomy of the human body, as well as his own classical works on the anatomy of expression, the hand and the arteries; but his chief work was the discovery of the difference between motor and sensory nerves. Sir Astley Cooper brought out his beautifully illustrated monograph on hernia in 1807. Besides these, the Edinburgh school had contributed the systematic treatises of Andrew Fyfe, John Bell, the third Monro and John Gordon. In 1828 appeared the first edition of Quain’s Anatomy, written by Jones Quain. This monumental work, which is still among the very first of English text-books, has run through ten editions, and is of even greater value to the teacher and researcher than to the medical student, because of its excellent bibliographies and the way in which it has been kept abreast of modern morphological knowledge by its various editors. Hardly any of the original work now remains. In 1858 another famous text-book on systematic anatomy appeared, written by Henry Gray, and this has always been particularly popular with students both in Great Britain and in America; it pays more attention to the surgical applications of anatomy than to the scientific and morphological side, and has reached its sixteenth edition.
The Cyclopedia of Anatomy and Physiology, edited by Dr Robert Todd from 1835 to 1859, which contained articles on both human and comparative anatomy, is now somewhat out of date, but did much for the advancement of the science when it appeared.
In 1893 a text-book written by several authors and edited by Henry Morris appeared. It has run through three editions and is especially popular in America. The latest English systematic work of first-rate importance is the splendid compilation edited by D. J. Cunningham (1902) and written, with one or two exceptions, by pupils of the veteran anatomist Sir William Turner. It is dedicated to him and will long serve as a memento of the work which he has done in training anatomists for the whole of the British empire. Besides these systematic treatises, many dissecting manuals have been published. The earliest were the Dublin Dissector and the London Dissector; others still in use are those of G. V. Ellis, C. Heath, D. J. Cunningham, and J. Cleland and J. Mackay. In 1889 Professor A. Macalister published a book on anatomy, which combined the advantages of a text-book with those of a dissecting guide.
In America the English text-books are largely used in addition to that edited by F. H. Gerrish. There is a special American edition of Gray.
Many systematic works on modern anatomy have come from Germany. J. F. Meckel, J. C. Rosenmüller, C. F. Krause, G. F. Hildebrandt, J. Hyrtl, H. Luschka and A. Meyer have all published works which have made their mark, but by far the most important, and, as some consider, still the best of all anatomical text-books, is that of F. G. J. Henle, professor of anatomy in Göttingen, which was completed in 1873. The beautiful illustrations of frozen specimens of the body brought out by W. Braune added a great deal to the student’s opportunities of learning the relations of the various structures, and are largely used all over the world. Rudinger’s Anatomy also contains many plates showing various sections, but the most complete text-book in the German language is that by Prof. Karl von Bardeleben of Jena; this is in eight volumes and contains notices of the latest literature on descriptive and morphological anatomy by the most prominent German anatomists. In addition to these W. Spalteholz and C. Toldt have brought out valuable atlases. In France J. Testut’s and Poirier’s anatomies, both of great excellence and beautifully illustrated, are the ones in common use.
There are two epoch-making dates in the history of modern English anatomy besides that of the passing of the Anatomy Act in 1832. The first of these is 1867, when the first volume of the Journal of Anatomy and Physiology appeared. This afforded a medium for English anatomists to publish their original work, besides containing valuable reviews and notices of books and work published abroad; it has appeared quarterly without a break since that time, and was long under the immediate direction of Sir William Turner.
The second date is 1887, when the Anatomical Society of Great Britain and Ireland was founded through the exertions of Mr C. B. Lockwood. It meets three times a year in London and once, in the summer, at some provincial school. It numbers some one hundred and fifty members, and enables anatomists from the whole British empire to meet one another and discuss subjects of common interest. Its first president was Prof. Murray Humphry of Cambridge, and its official organ is the Journal of Anatomy and Physiology.
No account of modern anatomical work would be complete without drawing attention to the great mass of special periodical literature containing the records of original work which are being published. It is said that some three or four thousand articles on anatomy appear in six hundred journals each year. To mention a few of these, in addition to the British Journal of Anatomy and Physiology there is an American Journal of Anatomy, the French Bulletin et mémoires de la société anatomique, and La journal de l’anatomie et de la physiologie, and the German Internationale Monatschrift für Anatomie und Physiologie, Anatomischer Anzeiger, Waldeyer’s Archiv für Anatomie und Physiologie, Schwalbe’s Zeitschrift für Morphologie und Anthropologie, Gegenbaur’s Morphologisches Jahrbuch, edited by Ruge, and Merkel’s Anatomische Hefte.Unfortunately the outlook of anatomy in Great Britain is not altogether satisfactory. The number of subjects for dissection has since 1895 been steadily diminishing, especially in London. This is due partly to the modern system of insuring lives for small sums and so decreasing the number of unclaimed bodies, and partly to the fact that, owing to the permissive nature of the British Anatomy Act, several boards of guardians will not allow even unclaimed bodies to be used for dissection and for the teaching of operative surgery. It is not popularly understood that a dearth of bodies means not only a check to abstract science, but a serious handicap to medical education, which must react more upon the poor than upon the rich, since the latter can afford to pay for the services of medical men educated abroad, where no difficulties are placed in the way of their learning fully the structure of the body they have to treat in disease. (F. G. P.)
Anatomy—Superficial and Artistic
The objects of the study of superficial anatomy are to show, first, the form and proportions of the human body and, second, the surface landmarks which correspond to deeper structures hidden from view. This study blends imperceptibly with others, such as physical anthropology, physiognomy, phrenology and palmistry, but whereas these deal chiefly with variations, superficial anatomy is concerned with the type.
With regard to the proportions of the body the artist and anatomist approach the subject from a slightly different point of view. The former, by a process of artistic selection, seeks the ideal and adopts the proportions which give the most pleasing effect, while the latter desires to know only the mean of a large series of measurements.
The scheme which Dr Paul Richer suggests (Anatomie artistique, Paris, 1890), and Professor Arthur Thomson approves (Anatomy for Art Students, 1896), is to divide the whole body into head-lengths, of which seven and a half make up the stature. Four of these are above the fork and three and a half below (see figs. 1 and 2). Of the four above, one forms the head and face, the second reaches from the chin to the level of the nipples, the third from the nipples to the navel, and the fourth from there to the fork. By dividing these into half-heads other points can be determined; for instance the middle of the first head-length corresponds to the eyes, the middle of the second to the shoulder, of the fourth to the top of the hip-joint, and of the fifth to the knee-joint.
The elbow-joint, when the arms are by the side, is a little above the lower limit of the third head-length, whilst the wrist is opposite the very centre of the stature, three head-lengths and three-quarters from the crown or the soles. The tips of the fingers reach a little below the middle of the fifth head-length. (In fig. 1 the fingers are bent.) By making the stature eight head-lengths instead of seven and a half the artistic effect is increased, as it is also by slightly lengthening the legs in proportion to the body. Approximate average breadth measurements are two heads for the greatest width of the shoulders, one and a half for the greatest width of the hips, one for the narrowest part of the waist, and three-quarters for the breadth of the head on a level with the eyes.
The relation of superficial landmarks to deep structures cannot be treated here in full detail, but the chief points may be indicated. Certain parts of the head may easily be felt through the skin. If the finger is run along the upper margin of the orbit, the notch for the supraorbital nerve may usually be felt at the junction of the inner and middle thirds. At the outer end of the margin is its junction with the malar bone, and this easily felt point is known as the external angular process. The junction of the frontal and nasal bones at the root of the nose is the nasion, while at the back of the skull the external occipital protuberance or inion is felt and marks the position of the torcular Herophili, where the venous sinuses meet. The zygoma may be felt running back from the malar bone to just in front of the ear, and two fingers’ breadth above the middle of it marks the pterion, a very important point in the localization of intracranial structures. It corresponds to the anterior branch of the middle meningeal artery, to the Sylvian point where the three limbs of the fissure of Sylvius diverge, to the middle cerebral artery, the central lobe of the brain or island of Reil, and the anterior part of the corpus striatum. The fissure of Sylvius can be marked out by drawing a line from the external angular process back through the Sylvian point to the lower part of the parietal eminence.
|Fig. 1.||Fig. 2.|
|α,||Serratus magnus.||β,||Dimple over posterior superior|
|β,||Deltoid.||spine of ilium.|
|γ,||Biceps.||γ,||Lower angle of scapula.|
|δ,||Poupart’s ligament.||δ,||External head of triceps.|
|ε,||Patella.||ε,||Depression over great trochanter.|
|T.P.||Transpyloric plane.||ζ,||Popliteal space.|
The scale between the figures represents head-lengths.
The position of the sulcus of Rolando is important because of the numerous cortical centres which lie close to it. For practical purposes it may be mapped out by taking the superior Rolandic point, 1 in. behind the bisection of a line drawn from the nasion to the inion over the vault of the skull, and joining that to the inferior Rolandic point, which is just above the line of the fissure of Sylvius and 1 in. behind the Sylvian point. The external parieto-occipital fissure, which forms the boundary between the parietal and occipital lobes of the brain, is situated practically at the lambda, which is a hand’s breadth (23 in.) above the inion. The lateral sinus can be mapped out by joining the inion to the asterion, a point two-thirds of the distance from the lambda to the tip of the mastoid process; thence the sinus curves downward and forward toward the tip of the mastoid process. A point 1 in. horizontally backward from the top of the external auditory meatus will always strike it.
Cranio-cerebral topography has been dealt with by Broca, Bischoff, Turner, Feré, Pozzi, Giacomini, Ecker, Hefftler and Hare. Among the more recent papers are those of R. W. Reid (Lancet, 27th September 1884), W. Anderson and G. Makins (Lancet, 13th July 1889), Prof. Chiene (detailed in Cunningham’s Text-Book of Anatomy), V. Horsley (Am. Journal Med. Sci., 1887), G. Thane and R. Godlee (Quain’s Anatomy—appendix to 10th edition). D. J. Cunningham discusses the whole question in his “Contribution to the Surface Anatomy of the Cerebral Hemispheres” (Cunningham Memoirs. No. vii. R. Irish Academy, Dublin, 1892), and he has prepared a series of casts to illustrate it.
The Face.—On the front of the face a line drawn down from the supraorbital notch between the bicuspid teeth to the side of the chin will cut the exit of the second division of the fifth nerve from the infraorbital foramen, a quarter of an inch below the infraorbital margin, and also the exit of the third division of the fifth at the mental foramen, midway between the upper and lower margins of the body of the jaw. In practice it will be found that the angle of the mouth at rest usually corresponds to the interval between the bicuspid teeth. The skin of the eyelids is very thin, and is separated from the subjacent fibrous tarsal plates by the orbicularis palpebrarum muscle. On everting the lids the delicate conjunctival membrane is seen, and between this and the tarsal plates lie the meibomian glands, which can be faintly seen as yellowish streaks. From the free edges of the eyelids come the eyelashes, between which many large sweat-glands open, and when one of these is inflamed it causes a “stye.” Internally the two eyelids form a little recess called the internal canthus, occupied by a small red eminence, the caruncula lachrymalis, just external to which a small vertical fold of conjunctiva may often be seen, called the plica semilunaris, representing the third eyelid of birds and many mammals. By gently drawing down the lower eyelid the lower punctum may be seen close to the caruncula; it is the pinhole opening into the lower of the two canaliculi which carry away the tears to the lachrymal sac and duct. On the side of the face the facial artery may be felt pulsating about an inch in front of the angle of the jaw; it runs a tortuous course to near the angle of the mouth, the angle of the nose and the inner angle of the eye; in the greater part of its course its vein lies some distance behind it. The parotid gland lies between the ramus of the jaw and the mastoid process; anteriorly it overlaps the masseter to form the socia parotidis, and just below this its duct, the duct of Stensen, runs forward to pierce the buccinator and open into the mouth opposite the second upper molar tooth. The line of this duct may be marked out by joining the lower margin of the tragus to a point midway between the lower limit of the nose and the mouth. The facial or seventh nerve emerges from the skull at the stylomastoid foramen just in front of the root of the mastoid process; in the parotid gland it forms a network called the pes anserinus, after which it divides into six branches which radiate over the face to supply the muscles of expression.
The Neck.—In the middle line below the chin can be felt the body of the hyoid bone, just below which is the prominence of the thyroid cartilage called “Adam’s apple,” better marked in men than in women. Still lower the cricoid cartilage is easily felt, while between this and the suprasternal notch the trachea and isthmus of the thyroid gland may be made out. At the side the outline of the sterno-mastoid muscle is the most striking mark; it divides the anterior triangle of the neck from the posterior. The upper part of the former contains the submaxillary gland, which lies just below the posterior half of the body of the jaw. The line of the common and the external carotid arteries may be marked by joining the sterno-clavicular articulation to the angle of the jaw. The eleventh or spinal accessory nerve corresponds to a line drawn from a point midway between the angle of the jaw and the mastoid process to the middle of the posterior border of the sterno-mastoid muscle and thence across the posterior triangle to the deep surface of the trapeziums. The external jugular vein can usually be seen through the skin; it runs in a line drawn from the angle of the jaw to the middle of the clavicle, and close to it are some small lymphatic glands. The anterior jugular vein is smaller, and runs down about half an inch from the middle line of the neck. The clavicle or collar-bone forms the lower limit of the neck, and laterally the outward slope of the neck to the shoulder is caused by the trapezius muscle.
The Chest.—It is important to realize that the shape of the chest does not correspond to that of the bony thorax which encloses the heart and lungs; all the breadth of the shoulders is due to the shoulder girdle, and contains the axilla and the head of the humerus. In the middle line the suprasternal notch is seen above, while about three fingers’ breadth below it a transverse ridge can be felt, which is known as Ludovic’s angle and marks the junction between the manubrium and gladiolus of the sternum. Level with this line the second ribs join the sternum, and when these are found the lower ribs may be easily counted in a moderately thin subject. At the lower part of the sternum, where the seventh or last true ribs join it, the ensiform cartilage begins, and over this there is often a depression popularly known as the pit of the stomach. The nipple in the male is situated in front of the fourth rib or a little below; vertically it lies a little external to a line drawn down from the middle of the clavicle; in the female it is not so constant. A little below it the lower limit of the great pectoral muscle is seen running upward and outward to the axilla; in the female this is obscured by the breast, which extends from the second to the sixth rib vertically and from the edge of the sternum to the mid-axillary line laterally. The female nipple is surrounded for half an inch by a more or less pigmented disc, the areola. The apex of a normal heart is in the fifth left intercostal space, three and a half inches from the mid-line.
The Abdomen.—In the mid-line a slight furrow extends from the ensiform cartilage above to the symphysis pubis below; this marks the linea alba in the abdominal wall, and about its middle point is the umbilicus or navel. On each side of it the broad recti muscles can be seen in muscular people. The outline of these muscles is interrupted by three or more transverse depressions indicating the lineae transversae in the recti; there is usually one about the ensiform cartilage, one at the umbilicus, and one between; sometimes a fourth is present below the umbilicus. The upper lateral limit of the abdomen is the subcostal margin formed by the cartilages of the false ribs (8, 9, 10) joining one another; the lower lateral limit is the anterior part of the crest of the ilium and Poupart’s ligament running from the anterior superior spine of the ilium to the spine of the pubis (see fig. 1, δ); these lower limits are marked by definite grooves. just above the pubic spine is the external abdominal ring, an opening in the muscular wall of the abdomen for the spermatic cord to emerge in the male. The most modern method of marking out the abdominal contents is to draw three horizontal and two vertical lines; the highest of the former is the transpyloric line of C. Addison (fig. 1, T.P.), which is situated half-way between the suprasternal notch and the top of the symphysis pubis; it often cuts the pyloric opening of the stomach an inch to the right of the mid-line. The hilum of each kidney is a little below it, while its left end approximately touches the lower limit of the spleen. It corresponds to the first lumbar vertebra behind. The second line is the subcostal (fig. 1, S.C.), drawn from the lowest point of the subcostal arch (tenth rib); it corresponds to the upper part of the third lumbar vertebra, and is an inch or so above the umbilicus; it indicates roughly the transverse colon, the lower ends of the kidneys, and the upper limit of the transverse (3rd) part of the duodenum. The third line is called the intertubercular (fig. 1, I.T.), and runs across between the two rough tubercles, which can be felt on the outer lip of the crest of the ilium about two and a half inches from the anterior superior spine. This line corresponds to the body of the fifth lumbar vertebra, and passes through or just above the ileo-caecal valve where the small intestine joins the large. The two vertical or mid-Poupart lines are drawn from the point midway between the anterior superior spine and the pubic symphysis on each side vertically upward to the costal margin. The right one is the most valuable, as the ileo-caecal valve is situated where it cuts the intertubercular line, while the orifice of the vermiform appendix is an inch lower down. At its upper part it meets the transpyloric line at the lower margin of the ribs, usually the ninth, and here the gallbladder is situated. The left mid-Poupart line corresponds in its upper three-quarters to the inner edge of the descending colon. The right subcostal margin corresponds to the lower limit of the liver, while the right nipple is about half an inch above the upper limit of this viscus.
The Back.—There is a well-marked furrow stretching all the way down the middle line of the back from the external occipital protuberance to the cleft of the buttocks. In this the spinous processes of the vertebrae can be felt, especially if the model bend forward. The cervical spines are difficult to feel, except the seventh and sometimes the second, and although the former is called the vertebra prominens, its spine is less easily felt than is that of the first thoracic. In practice it is not very easy to identify any one spine with certainty: one method is to start from the prominent first thoracic and to count down; another is to join the lower angles of the two scapulae (fig. 2, γ) when the arms are hanging down, and to take the spine through which the line passes as the seventh.
The spinal furrow is caused by the prominence of the erector spinae muscles on each side; these become less well marked as they run upward. The outlines of the scapulae can be well seen; they cover the ribs from the second to the seventh inclusive. The scapular spine is quite subcutaneous, and can be followed upward and outward from the level of the third thoracic spine to the acromion, and so to the outer end of the clavicle. On the lower margin of the acromion is a little tubercle known as the metacromial process or acromial angle, which is very useful for taking measurements from. The tip of the twelfth rib may usually be felt about two inches above the middle of the iliac crest, but this rib is very variable in length. The highest point of the iliac crest corresponds to the fourth lumbar spine, while the posterior superior iliac spine is on a level with the second sacral vertebra. This posterior superior spine is not easily felt, owing to the ligaments attached to it, but there is usually a little dimple in the skin over it (fig. 2, β). By drawing horizontal lines through the 1st, 3rd and 5th lumbar spines, the transpyloric, subcostal and intertubercular lines or planes may be reproduced behind and the same viscera localized.
The Arm.—Running downward and outward from the inner half of the clavicle, where that bone is convex forward, is the clavicular part of the pectoralis major, while from the outer third of the bone, where it is concave forward, is the clavicular part of the deltoid; between these two muscles is an elongated triangular gap with its base at the clavicle, and here the skin is somewhat depressed, while the cephalic vein sinks between the two muscles to join the axillary vein. The tip of the coracoid process is situated just under cover of the inner edge of the deltoid, one inch below the junction between the outer and middle thirds of the clavicle. The deltoid muscle (fig. 1, β) forms the prominence of the shoulder, and its convex outline is due to the presence of the head of the humerus deep to it; when this is dislocated the shoulder becomes flattened. The pectoralis major forms the anterior fold of the axilla or armpit, the posterior being formed by the latissimus dorsi and teres major muscles. The skin of the floor of this space is covered with hair in the adult, and contains many large sweat glands. The axillary vessels and brachial plexus of nerves lie in the outer wall, while on the inner wall are the serrations of the serratus magnus muscle, the outlines of some of which are seen on the side of the thorax, through the skin, when the arm is raised (fig. 1, α). Below the edge of the pectoralis major, the swelling of the biceps (fig. 1, γ) begins to be visible, and this can easily be traced into its tendon of insertion, which reaches below the level of the elbow joint. On each side of the biceps is the external and internal bicipital furrow, in the latter of which the brachial artery may be felt and compressed. The median nerve is here in close relation to the artery. At the bend of the elbow the two condyles of the humerus may be felt; the inner one projects beneath the skin, but the outer one is obscured by the rounded outline of the brachio-radialis muscle. The superficial veins at the bend of the elbow are very conspicuous; they vary a good deal, but the typical arrangement is an M, of which the radial and ulnar veins form the uprights, while the outer oblique bar is the median cephalic and the inner oblique the median basilic vein. At the divergence of these two the median vein comes up from the front of the forearm, while the two vertical limbs are continued up the arm as the cephalic and basilic, the former on the outer side, the latter on the inner. On the back of the arm the three heads of the triceps are distinguishable, the external forming a marked oblique swelling when the forearm is forcibly extended and internally rotated (fig. 2, δ). In the upper part of the front of the forearm the antecubital fossa or triangle is seen; its outer boundary is the brachio-radialis, its inner the pronator radii teres, and where these two join below is the apex. In this space are three vertical structures—externally the tendon of the biceps, just internal to this the brachial artery, and still more internally the median nerve. Coming from the inner side of the biceps tendon the semi-lunar fascia may be felt; it passes deep to the median basilic vein and superficial to the brachial artery, and in former days was a valuable protection to the artery when unskilful operators were bleeding from the median basilic vein. About the middle of the forearm the fleshy parts of the superficial flexor muscles cease, and only the tendons remain, so that the limb narrows rapidly. In front of the wrist there is a superficial plexus of veins, while deep to this two tendons can usually be made to start up if the wrist be forcibly flexed; the outer of these is the flexor carpi radialis, which is the physician’s guide to the radial artery where the pulse is felt. If the finger is slipped to the outer side of this tendon, the artery, which here is very superficial, can be felt beating. The inner of the two tendons is the palmaris longus, though it is not always present. On cutting down between these two the median nerve is reached.
The wrist joint may be marked out by feeling the styloid process of the radius on the outer side, and the styloid process of the ulna on the inner side behind, and joining these two by a line convex upward. The superficial appearance of the palm of the hand is described in the article on Palmistry; with regard to anatomical landmarks the superficial palmar arterial arch is situated in the line of the abducted thumb, while the deep arch is an inch nearer the wrist. The digital nerves correspond to lines drawn from the clefts of the fingers toward the wrist. On the back of the forearm the olecranon process of the ulna is quite subcutaneous, and during extension of the elbow is in a line with the two condyles, while between it and the inner condyle lies the ulnar nerve, here known popularly as the “funny bone.” From the olecranon process the finger may be run down the posterior border of the ulna, which is subcutaneous as far as the styloid process at the lower end. On the dorsum of the hand is a plexus of veins, deep to which the extensor tendons are seen on extending the fingers. When the thumb is extended, two tendons stand out very prominently, and enclose a triangular space between them which is sometimes known as the “anatomical snuff box”; the outer of these is the tendon of the extensor brevis, the inner of the extensor longus pollicis. Situated deeply in the space is the radial artery, covered by the radial vein. On the dorsum of the hand there is a plexus of veins, and deep to these the tendons of the extensor longus digitorum stand out when the wrist and fingers are extended.
The Leg.—Just below Poupart’s ligament (fig. 1, δ), a triangular depression with its apex downward may be seen in muscular subjects; it corresponds to Scarpa’s triangle, and its inner border is the tendon of the adductor longus, which is easily felt if the model forcibly adducts the thigh. In this triangle the superficial inguinal glands may be made out. The head of the femur lies just below the centre of Poupart’s ligament. The sartorius muscle forms the outer boundary of the triangle, and may be traced from the anterior superior spine obliquely downward and inward, across the front of the thigh, to the inner side of the knee. The two vasti muscles are well marked, the internal being the lower and forming with the sartorius the rounded bulging above the inner side of the knee. The internal saphenous vein runs superficially up the inner side of the thigh from behind the internal condyle to the femur to the saphenous opening in the deep fascia, the top of which is an inch horizontally outward from the spine of the pubis. On the other side of the thigh a groove runs down which corresponds to the ilio-tibial band, a thickening of the fascia lata or deep fascia; the lower end of this leads to the head of the fibula. On the front of the thigh, below the sartorius, the rectus muscle makes a prominence which leads down to the patella, the outlines of which bone are very evident (fig. 1, ε). The only part of the femur besides the great trochanter which is superficial is the lower end, and this forms the two condyles for articulation with the tibia. If the posterior part of the inner condyle be joined to the mid-point between the anterior superior spine and the symphysis pubis, when the thigh is externally rotated, the line will correspond in its upper two-thirds to that of the common and superficial femoral arteries, the former occupying the upper inch and a half. The common femoral vein lies just internal to its artery, while the anterior crural nerve is a quarter of an inch external to the latter. The rounded mass of the buttock is formed by the gluteus maximus muscle covered by fat; the lower horizontal boundary is called the fold of the nates, and does not correspond exactly to the lower edge of the muscle. At the side of the buttock is a depression (fig. 2, ε) where the great trochanter of the femur can be felt; a line, named after Nelaton, drawn from the anterior superior spine to the tuberosity of the ischium, passes through the top of this. On the back of the thigh the hamstrings form a distinct swelling; below the middle these separate to enclose the diamond-shaped popliteal space (fig. 2, ζ), the outer hamstrings or biceps being specially evident, while, on the inner side, the tendons of the semi-tendinosus and semi-membranosus can be distinguished. The external popliteal nerve may be felt just behind the biceps tendon above the head of the fibula.
On the front of the leg, below the knee, the ligamentum patellae is evident, leading down from the patella (fig. 1, ε) to the tubercle of the tibia. From this point downward the anterior border of the tibia or shin is subcutaneous, as is also the internal surface of the tibia. Internal to the skin is the fleshy mass made by the tibialis anticus and extensor longus digitorum muscles. At the inner side of the ankle the internal malleolus is subcutaneous, while on the outer side the tip of the external malleolus is rather lower and farther back. Both this malleolus and the lower quarter of the shaft of the fibula are subcutaneous, and this area, if traced upward, is continuous with a furrow on the outer side of the leg which separates the anterior tibial from the peroneal groups of muscles, and eventually leads to the subcutaneous head of the fibula. At the back of the leg the two heads of the gastrocnemius form the calf, the inner one (fig. 2, η) being larger than the outer. Between the two, in the mid-line of the calf, the external saphenous vein and nerve lie, while lower down they pass behind the external malleolus to the outer side of the foot. The internal saphenous vein and nerve lie just behind the internal border of the tibia, and below pass in front of the internal malleolus. At the level of the ankle-joint the tibialis posticus and flexor longus digitorum tendons lie just behind the internal malleolus, while the peroneus longus and brevis are behind the external. Running down to the heel is the tendo Achillis with the plantar is on its inner side. On the dorsum of the foot the musculo-cutaneous nerve may be seen through the skin in thin people when the toes are depressed; it runs from the anterior peroneal furrow, already described, to all the toes, except the cleft between the two inner ones. There is also a venous arch to be seen, the two extremities of which pass respectively into the external and internal saphenous veins. The long axis of the great toe, even in races unaccustomed to boots, runs forward and outward, away from the mid-line between the two feet, so that perfectly straight inner sides to boots are not really anatomical. The second toe in classical statues is often longer than the first, but this is seldom seen in Englishmen. On the outer side of the sole the skin is often in contact with the ground all along, but on the inner side the arch is more marked, and, except in flat-footed people, there is an area in which the sole does not touch the ground at all.
- The article in the 9th edition of this Encyclopedia, dealing with the history of anatomy, and written by the late Dr Craigie of Edinburgh, has gained such a just reputation as the classical work on the subject in the English language that it is substantially reproduced. Here and there points of special or biographical interest are drawn attention to in the shape of footnotes, but any reader interested in the subject would do well to consult, with this article, the work of R. R. von Toply, Studien zur Geschichte der Anatomie im Mittelalter (Leipzig, 1898). In addition to this Professor A. Macalister has published a series of articles, under the head of “Archaeologia Anatomica,” in the Journal of Anatomy and Physiology. These are written from a structural rather than a bibliographical point of view, and will be found under the following headings: “Atlas and Epistropheus,” J. Anat. vol. xxxiii. p. 204; “Veins of Forearm,” vol. xxxiii. p. 343; “Poupart’s Ligament,” vol. xxxiii. p. 493; “Tendo-Achillis,” vol. xxxiii. p. 676; “Parotid,” vol. xxxv. p. 117; “Trochanter,” vol. xxxv. p. 269.
- The oldest anatomical treatise extant is an Egyptian papyrus probably written sixteen centuries before our era. It shows that the heart, vessels, liver, spleen, kidneys, ureters and bladder were recognized, and that the blood-vessels were known to come from the heart. Other vessels are described, some carrying air, some mucus, while two to the right ear are said to carry the breath of life, and two to the left ear the breath of death. See A. Macalister, “Archaeologia Anatomica,” J. Anat. and Phys. vol. xxxii. p. 775. But see also the article Omen.
- An interesting article on the character and work of the Maidstone surgeon, John Halle, by E. Barclay Smith, will be found in the J. Anat. and Phys. vol. xxxiv. p. 275.
- It has been pointed out by Dr J. F. Payne that Vicary's work is merely an abridged copy of an unpublished English anatomical treatise of the 14th century. The name of the author is unknown, but internal evidence shows that he was a London surgeon. The manuscript was written in English in 1392. See British Medical Journal, January 25, 1896.
- The passage of Servetus is so interesting that our readers may feel some curiosity in perusing it in the language of the author; and it is not unimportant to remark that Servetus appears to have been led to think of the course of the blood by the desire of explaining the manner in which the animal spirits were supposed to be generated:—“Vitalis spiritus in sinistro cordis ventriculo suam originem habet, juvantibus maxime pulmonibus ad ipsius perfectionem. Est spiritus tenuis, caloris vi elaboratus, flavo colore, ignea potentia, ut sit quasi ex puriore sanguine lucens, vapor substantiam continens aquae, aeris, et ignis. Generatur ex facta in pulmone commixtione inspirati aeris cum elaborato subtili sanguine, quem dexter ventriculus sinistro communicat. Fit autem communicatio haec, non per parietem cordis medium, ut vulgo creditur, sed magno artificio a dextro cordis ventriculo, longo per pulmones ductu agitatur sanguis subtilis; a pulmonibus praeparatur, flavus efficitur, et a vena arteriosa in arteriam venosam transfunditur. Deinde in ipsa arteria venosa, inspirato aeri miscetur et exspiratione a fuligine expurgatur; atque ita tandem a sinistro cordis ventriculo totum mixtum per diastolen attrahitur, apta supellex, ut fiat spiritus vitalis. Quod ita per pulmones fiat commumcatio et praeparatio, docet conjunctio varia, et communicatio venae arteriosae cum arteria venosa in pulmonibus. Confirmat hoc magnitudo insignis venae arteriosae, quae nec talis nec tanta esset facta, nec tantam a corde ipso vim purissimi sanguinis in pulmones emitteret, ob solum eorum nutrimentum; nec cor pulmonibus hac ratione serviret, cum praesertim antea in embryone solerent pulmones ipsi aliunde nutriri, ob membranulas illas seu valvulas cordis, usque ad horum nativitatem; ut docet Galenus, &c. Itaque ille spiritus a sinistro cordis ventriculo arterias totius corporis deinde transfunditur, ita ut qui tenuior est, superiora petit, ubi magis elaboratur, praecipue in plexu retiformi, sub basi cerebri sito, ubi ex vitali fieri incipit animalis, ad propriam rationalis animae rationem accedens.”—De Trinitate, lib. v.
- Highmore was a physician practising at Sherborne all his life (1613–1685).
- Glisson was for forty years professor of physic at Cambridge.
- Wharton was a graduate both of Oxford and Cambridge, and physician to St Thomas's Hospital.
- Willis was Sedleian professor of natural philosophy in Oxford in 1660. Later he practised in London.
- Tyson was a graduate both of Oxford and Cambridge. He was reader of anatomy at Surgeons' Hall, London.
- Collins was an M. D. of Padua, Oxford and Cambridge. He was physician in ordinary to Charles II.
- Havers was a London physician, and died in 1702.
- Robert Nesbitt (d. 1761) studied at Leiden and practised as a physician in London.
- Humphrey Ridley (1653–1708) was a London physician who studied at Leiden.
- Bidloo was a Dutch anatomist and Cowper a London surgeon.
- Hewson was a partner with William Hunter in the Windmill Street School of Anatomy.
- W. Cruikshank followed W. Hunter as lecturer at the Windmill Street school.
- Scarpa was professor of anatomy at Modena and Pavia.