Anatomy Based on Human Dissection: The Anatomy of Mundinus

Mondino de’ Luzzi

Translated and annotated by Charles Singer,¹ with additional notes by Michael McVaugh

I. INTRODUCTION

Of the Whole

As Galen, following the authority of Plato, hath said in the seventh book of his Methodus Medendi² "a work in any Science or Art is published for three reasons: first for the satisfying of friends, second for the useful exercise of the faculties, and third as a remedy for the forgetfulness which doth come with lapse of time." Moved by these I have projected a work for my pupils in Medicine. Now in Medicine a knowledge of the parts of the subject—that is of the human body—and the naming and relations of those parts, form a division of the Science—as Averroes hath it in the first book of his Colliget in the chapter on The Definition of Medicine.³ I therefore purpose to give, among other topics, some of that knowledge of the human body and of the parts thereof which doth come of anatomy. In doing this I shall not look to style but shall merely seek to convey such knowledge as the chirurgical usage of the subject doth demand.

Having placed the body of one that hath died from beheading or hanging in the supine position, we must first gain an idea of the whole, and then of the parts. For all our knowledge doth begin from what is known. For though the known is oft vague and though our knowledge of the whole is of a surety vaguer than that of the parts, we yet begin with a general consideration of the whole.

Now considering this whole we ought to know in what man doth differ from the brutes. He differeth then in three ways, to wit, in the form or position of his members, in his manners or arts, and in possession of certain parts.

First in form. Man, we note, is of upright stature and was so made for four reasons:

(1) For that the human body is wrought of matter which is ethereal and airy and is the lightest among all the animals; wherefore it doth ever upward strive.

(2) For that, compared with other animals of the same bigness, man hath a greater degree of heat and the trend of heat is also upward.

(3) For that man hath a most perfect form which he shareth with the Angels and Intelligences that rule the Universe. Thus are all his senses of right in the upper part of his body.

(4) For the end to which he was made. For he is thus upright that he may understand, and for this there serve the senses and, notably, that of sight as is seen in the preface of the Metaphysics.⁴

Wherefore in man sight and brain, and by consequence the head, must of need be so placed as to receive the divers impressions of the senses. Moreover the range of vision is wider when raised aloft. Wherefore governors of cities do place their watches on high, as in towers and the like, that they may see afar, as Galen doth say in the ninth part of his De juvamentis membrorum.⁵ So also Avicenna in the Canon, Book III at the beginning, saith that the need that the head of man should be uplifted did not come from the brain, nor from the ears, no, nor from the mouth nor nostrils, but from the eyes for the reason stated.⁶ Thus for all four reasons was man of upright stature. Wherefore he is named Antropos or Plantenus, that is with turned sole,⁷ and Microcosm that is the smaller world because, like the world the Macrocosm, he hath an upper and a lower,⁸ This then is the first difference which marketh him off from brutes.

The second cometh of Manners or of Art; for among animals he hath the gentlest manners, for is he not an animal that is political and civil? Nor hath he any Art implanted in him by Nature, as hath the spider, the bee and their like. Yet this is to the end that he may understand every art, for had he any one Art so implanted in him he would have been deprived of every other, as Galen hath it in the fourth part of his De juvamentis membrorum.

Thirdly Man doth differ also from other animals in his parts, for he is without many internal parts which they have,⁹ nor hath he parts that are given to them as a defence by Nature as are horns, beaks, claws. He is without these for that he hath the best of all, the hand to wit, whereby he may work for himself every manner of weapon for defence, as Galen also saith in the first part of his De juvamentis membrorum. Thus having none of these parts he yet hath all. For which same reason he hath not such parts as fur, feathers or scales. And another cause wherefore he is deprived of these is that he hath not overmuch superfluous earthy matter which is the substance of these parts. Thus also he hath no tail, for being upright in his gait he taketh rest by sitting and a tail preventeth thereunto.

Let this suffice for the anatomy of the whole.

Of the Parts

Although the parts be of two kinds, simple and composite, yet shall I not make a separate anatomical discussion of those that are simple, for their anatomy is not to be seen in a dissected body but rather in one decomposed in streams of water.¹⁰ Notwithstanding, in setting forth the anatomy of the organical members, I shall speak of the simple parts according to that which doth predominate in the organical member under discussion. Thus I shall treat of flesh in the anatomy of the thigh, of bones in that of the back and feet and of nerves in that of the brain and spinal cord.

As regards the official members of the body¹¹ know that in most of them as far as anatomy of a dead body is concerned, there are six points worthy to be observed, for so the Alexandrine commentator doth note in his Commentary on the Book of Sects,¹² to wit their (1) position, (2) substance, and following therefrom their "complexion," (3) size, (4) number, (5) figure and (6) relations.

As for the anatomy of the living, two points need be considered which are also to some extent evident in dead anatomy,¹³ The first is as to purposes and workings. The second is as to distempers that may fall thereto and the showing forth of the proper cure, if such there be.

Now there is division and number in the parts of the body, for there are those which are extreme and are called extrinsic or the extremities, and those that are deep and are called intrinsic. Of these latter, some there are ordained for the preservation of the kind and some for the preservation of the individual. Of the first sort are the reproductive members, of the second are those which be contained in the cavities or venters. Of these cavities or venters there are again three. The uppermost that holdeth the animate members is the head. The lowermost holdeth the natural members. The middle holdeth the respiratory members.¹⁴ I shall begin with the anatomy of the lowermost venter so that the organs there, being most corruptible, may be the first cast aside.

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III. THE GENERATIVE MEMBERS

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Of the Womb

To continue this discourse. If thou dost dissect a female body, after the vasa spermatica thou should-est see the anatomy of the womb. Examine it as thou hast other members, first as to place and connections, second as to shape, third as to size, fourth as to substance, fifth as to parts, sixth as to purpose and possible injuries.

The position of the womb thou wilt see as being situated in the concavity of the alchatim [sacrum], which hollow is surrounded behind by the spondyles of the allanis [sacral vertebrae] and of the tail, and in front by the part called pecten or femur [symphysis pubis]. Thus it is placed immediately between the rectum, which is, as it were, his keel posteriorly, and the bladder anteriorly. It is specially linked as to his neck to the neck of the bladder which is placed upon the neck of the womb even though the cavity of the womb may be higher than the cavity of the bladder. As between right and left, the womb is placed exactly in the middle.

Next thou mayest see the connections of the womb which are very many as being joined, so to say, with all the organs above it. Thus it is linked with heart and liver by veins and arteries, with the brain by many nerves, and consequently with the stomach by both, with the organs which are in the middle of the body as the diaphragm, kidneys and mirach, and specially with the breasts, as already described. It may be also that it hath connection with these organs by means of other veins which have their origin in the vena chilis and arise therefrom below the furcula [sternum] as will be stated below. It is also linked with the lower organs, as the bladder by means of its neck, and with the colon. It is joined to the anchae and to both sciatic joints by two thick and strong ligaments. These ligaments are broad and thick next the womb, and next the anchae are slender and proceed like horns from the head of an animal. They are therefore called the cornua matricis.¹⁵

Second as to shape. The womb is squarish with a sort of rotundity and it hath a long neck below. The reason for this shape was the narrowness of space and the use or need for which it was created which will afterward appear. It oweth this shape to being divided into seven cells as will be stated below.¹⁶

Third as to size. This is moderate and is about that of the bladder: but it varieth for other causes, since it waxeth or waneth by coitus and by pregnancy. A woman who hath borne hath a womb larger than she who is barren, and she that is wed hath larger organs than a virgin or than one that is continent. So also is it with men for use increaseth the size of an organ, according to Galen in the sixth part of the De interioribus.¹⁷ Also by reason of age, for a wife hath a larger womb than a maiden or old woman. Also by reason of the complexion and constitution of the body as a whole; this thou canst gather from the Canon of Avicenna, Fen II in the third chapter. For these reasons a woman I anatomized last year, that is in the year of Christ 1315, in the month of January, had a womb double as big as her that I anatomized in March of the same year.¹⁸ Yet a further cause for this may have been that which Avicenna doth put forward, to wit that the first had just had her monthly courses and the womb waxeth thicker and stouter at that time. The womb also doth differ in bigness according to the amount of generative power, for the womb of an animal that beareth several at a birth is larger than that of one that beareth but one. It is for that reason that the womb of a sow that I anatomized in the year 1316 was a hundred times greater than I ever saw in the body of a woman. There might be yet another reason in that the sow was actually pregnant and had in her womb thirteen porkers and in it I demonstrated the anatomy of the foetus and of pregnancy which I shall relate to you.

Fourth as to substance. The substance is nervous and membranous that it may expand to contain the foetus; also it is of cold and dry complexion. Also the substance is very thick because it must become thinner during expansion.

Fifthly thou shouldst see the tale of the parts thereof which are both external and internal. The external parts are first the sides on which are fastened the testicles and the vasa seminaria already discussed, and second the cornua and the neck, the extremity of which is the vulva which clasps the neck. Note that the vulva is the length of a palm’s breadth as is the penis. The vulva is broad and capable of expansion being of wrinkled membrane. These wrinkles are like to leeches; their purpose is that during intercourse it may be sensitive. Towards the upper part anteriorly and about two or three fingers’ breadth within the vulva is the orifice of the bladder. At the orifice of the vulva itself are two membranes which may be raised or lowered over the orifice. These hinder entrance of air and external matter into the neck of womb or bladder as the skin of the prepuce guardeth the penis. Therefore in the place already cited Haly Abbas calleth them praeputia matricis.¹⁹

The inner parts thou canst see by cutting the womb in the midst. Then thou wilt see the os and cavity. The os is very nervous made like the mouth of a new-born kitten or, to speak more properly, like the mouth of an old tench. In virgins his surface is covered with a thin veil which in the violated is broken and so doth bleed.²⁰

His cavity doth number seven cells, three to right and three to left and one in the midst at the top. These cells are nothing but certain cavities in the womb in which the semen may coagulate along with the menses and be there contained and united to the orifices of the veins.²¹

From this we can pass to the purposes of the womb. It is made chiefly for conception and consequently to cleanse or purge the whole body from superfluous, undigested blood. This is the case in human beings only. Other animals do not menstruate and in them such superfluities are consumed by the production of hide, fur, claws, beaks and feathers and the like of which man is deprived.

From this it is evident that the womb must be subject to a multitude of diseases, and many organs suffer in sympathy with it. What are the proper sufferings and accidents thereof and their cause and cures would indeed take long to tell and would be beyond our intention, but seek in the appropriate places already mentioned as in Avicenna Canon III, Fen 21, and in Serapion,²² Rhazes²³ and our Johannes.²⁴

The diseases which arise in sympathy with the womb are indeed as numerous as the organs to which it is connected or locally attached. What these are hath been already said and seen. One, however, thou canst diagnose from anatomy. It is described by Galen in De interioribus VI § 4. It is suffocation of the womb. There is suffocation not because the womb moveth in the material sense to the neck, throat or lung, for this cannot be; but because, being unable to expel the vapours downward, it is moved and contracted below so that it driveth them upward. Now if these vapours, by means of one of the connections heretofore described, should reach the stomach then they often cause hickup or vomiting and women say that they have their "womb in their stomach." If, however, the vapours reach the lung and hinder the action of the diaphragm they cause gasping and women say they have their "womb in their throat." But if they reach the heart, which happeth rarely, suffocation doth cause syncope and then they say their "womb hath reached the heart."²⁵ Yet always suffocation is from sympathy: owing to the connection the womb hath with the part. For the womb doth not reach these organs but only vapour goeth up.

Now how and by what ways it could reach them thou hast seen. What is the cure thereof seek in the authorities, for anatomy dealeth principally with the observation of the facts.

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IV. THE SPIRITUAL MEMBERS

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Of the Heart

Having removed the membranes thou wilt see the lung, and in the midst the heart, covered by the lobes of the lung, that the heat and the breath generated therein may be cooled by the air drawn into the lung, and thus be tempered.

First the place and position of the heart is evident, for it is in the midst between front and back, between right and left. The point doth incline to the left but the root to the right, that it may blow in heat and breath to the right side which ought to be warmer than the left. It is also in the midst between upper and lower and removed from the extremities. It was so placed as the source and ultimate root of all the organs.²⁶

Second the connections appear as a consequence, as also the size thereof. It is not too large nor too small, yet is greater in man than in any other animal of the same bigness since he hath more heat.

Third the shape will be evident to thee, for it is of the form of a pine or pyramid. Everything that is excessively hot must needs be of that form for the proper shape of the prime heat is the pyramid. There is also another reason: the division of the ventricles and of those things that arise therein.²⁷

Fourth thou must see the tale of the parts thereof, from which will be evident to thee the substance, complexion and purpose. Some of the parts are outside the substance thereof, but some are within. Outside the substance are the capsule and the organs that have their origin therein which will hereinafter be seen. The pericardium is nervous or membranous and much dilated. It is made to guard the heart from injuries and to prevent it coming into contact with the other organs during expansion. The reason it is not joined to the heart was to prevent the heart being hindered in movement by weight. There was also another reason, to wit that it might contain a watery substance by which the heart should be moistened and bedewed, lest owing to its great and continuous movement it be dried up: so watery substance is ever found in the capsule. If the capsule were without such aqueous matter it would shrink and become corrupt, and if it be too abundant the heart doth fall into violent beating, trembling and heart disease as Galen doth state in his De interioribus.²⁸

Of the essential parts of the heart some are outer and some inner. The outer are fat and the additamenta or auricles of the heart and what ariseth therefrom.

The fat is found in the outer surface of the heart, near the extremity rather than in the active part: for fat is formed by cold or diminished heat, and since the heart is very warm it is generated there in order that the heart may not be dried up owing to his great and constant movement. The additamenta cordis are certain membranous parts suited for expanding and contracting. These are formed for the purpose that when excess of blood is formed in the heart or excess of spirit is generated in the left ventricle, it may yet be contained by dilatation.²⁹

But thou wilt demand, as did Galen in the place above-quoted, wherefore did not Nature make the heart large enough to contain the full amount of blood and spirit instead of supplying these additamenta cordis? I answer that had the heart been very large the force thereof had been weakened by reason of the dispersion of the spirit. Wherefore animals of large heart are timid as the hare and the stag. Moreover since a large quantity of spirit and blood is not at all times to be found in us, had the heart been over-large the cavity had been often-most part empty; but as for these auricles, they can easily contract when not full and therefore there is no empty space therein. Also weight is avoided. The organs that spring from the heart will be seen afterward.

The inner parts of the heart are ventricles, right, left and middle.³⁰ Cut then the heart first in the right side beginning from the point, yet guarding thyself against reaching the opposite wall, but dividing at the side of the middle ventricle. Thou wilt at once come upon the right ventricle and see two orifices therein. One of these orifices openeth toward the liver and the vena chilis entereth thereby. This is the largest orifice, for through it the heart draweth blood from the liver and expelleth blood unto all the other organs. Moreover as the heart taketh in through this orifice more than it doth expel, Nature ordained that, at the time of contraction of the heart, it should be shut when it hath to expel and should open again when the heart expandeth. Wherefore it hath three ostiola [cardiac valves] which open from without inward. By the same orifice also the expulsion of the perfectly prepared blood doth take place. Yet is not the whole expelled, for a certain portion is sent out to the lung and another portion crosseth to the spirit. Nature therefore ordained that these ostiola should not be too greatly depressed lest they should entirely close the orifice.

Observe here two points. First that sense plainly showeth thee that vena chilis hath her origin from the heart, since she is united to the substance of the heart and doth not go through it³¹ but is greatest next her base and root, like to the stock of a tree. Second that from this vein, before that she entereth the hollow of the heart, there goeth off a vein which compasseth the root of the heart round about, and from which come forth branches dispersed through the substance of the heart. It is from the blood of this vein that the heart is fed.

Next is another orifice toward the lung, that of the vena arterialis [pulmonary artery], which carrieth the blood from the heart to the lung, for lung serveth heart in a manner to be stated. In repayment whereof heart doth send blood to lung by this vena arterialis, named vena for that it carrieth blood, named arterialis for that it hath two tunics. These two tunics it hath, first, because it goeth to an organ in continual motion, and second, because it carrieth very subtile and choleric blood. Wherefore, that the blood be not evaporated nor the vein ruptured, it hath these two tunics. In the orifice of this vein are three ostiola, which open from within outward and shut from without inward with perfect accuracy. Thus by this orifice the heart doth only expel at the time of its contraction and yet doth not bring in aught at the time of expansion.

When thou hast seen this, cut open the left ventricle, leaving whole the middle wall where is the third ventricle. At once will be evident the cavity of the left ventricle, the wall of which is thicker and more dense than that of the right. Nature wrought it so for three reasons. First this ventricle hath to contain the spirit, but the right only blood. Now blood is heavier than spirit. Therefore by reason of its contents the right had been heavier than the left and so the heart had not been evenly balanced. But that it might be of equal weight, the left wall was made thicker to compensate thereby the weight of the blood in the right ventricle. Another reason is that the spirit which it hath to contain is easily dissipated and against this the wall was made thick. A third reason is that this ventricle must form spirit from blood. Now spirit is formed from blood by a strong subtilizing and evaporating heat; and heat is the stronger when in a thicker substance.³²

In the cavity and near the base are two orifices. One is the orifice of the arteria adorti [aorta] called adorti because it sprang (orta) immediately from the heart,³³ or because from it spring, as from the chief source, all the arteries of the body. By it the heart, as it contracteth, sendeth the spirit generated therein to all the organs. Therefore Nature ordained that at his root and orifice were to be placed three very dense ostiola which shut straitly from without inward and open from within outward.

There is another orifice, that of the arteria venalis [pulmonary vein]. It is named arteria as conveying vapour and venalis as having but one tunic, for Nature was not over solicitous in guarding it. What goeth through it is a smoke-like vapour or air which the heart draweth from the lung. Now the heart doth both attract and expel through this vein; wherefore Nature placed here in the orifice thereof no more than two ostiola which do not shut perfectly. These ostiola are raised high up that they may be of service to the wall of the heart when it expelleth and transmitteth the spirit [through the arteria adorti] so that the spirit may not be expelled by the arteria venalis. These ostiola are wondrous works of Nature.

No less wondrous is the middle ventricle. For this ventricle is not one cavity but many small cavities, extended rather toward the right than the left, to the end that the blood which crosseth from the right ventricle to the left may be continually subtilized so as to be turned into spirit. This subtilizing prepareth it for being generated into spirit. Now Nature, when transmitting something through the organs or by any path, never doth so idly but ever prepareth it for the form which it shall receive, as she doth when she transmitteth chyle through the meseraics to the liver. Thus doth Galen oft indicate in his book De juvamentis membrorum for example in part V On the meseraic veins.

So much for the parts of the substance of the heart. There are other parts which spring from it and they are four, to wit the vena chilis, the vena arterialis, the arteria adorti, and the arteria venalis. Two of these go to the lung, the anatomy of which thou mayest now see.

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V. THE ANIMAL MEMBERS

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Of the Eyes

Afterward cut both the bones of the eyes and thou wilt see the place of the eye and the connections with the optic nerve and with the motor nerves.³⁴

The position of the organ is now clear. It was not placed very deep, since it hath to receive the species into the midst,³⁵ nor was it much raised above the face, that it may not be hurt by exterior things, for the eyes are very soft and easily affected. For their protection in man Nature ordained eyebrows to guard them from things coming from above, eyelids to guard them from things coming from in front, tuberosities of the jaws to guard them from things coming upward or from the side while the nose doth guard them at the other side.

Now in the eye are seven tunics and three humours. Thou wilt see the tunics by the straight and careful division of the eye into two, a fore and a hind part. In the fore part are four tunics of which three are joined to the three tunics of the hind part, while for one of them, to wit the cornea, there is no continuation in the depth or interior.

(1) The first tunic is the cornea, so named as resembling horn in substance and colour. It is transparent and solid. Transparent that, being of no colour, it hinder not the reception of colour, and solid as marking it off from the adjoining external world.

(2) The second tunic is the conjunctiva, so named because it doth join, cover and veil the whole of the eye save the cornea.

(3) To this is joined behind the tunica sclerotica. It surroundeth the whole eye within.

(4) Under the tunica conjunctiva in the fore part is the uvea, so named as resembling the dark skin of a black grape. In the midst, toward the cornea, is a hole named pupilla, through which the species of visible things may reach the crystallinus and not be hindered by the opaque uvea. And the reason why the eye was not entirely covered by this tunica uvea is threefold. First that by his colour, green, purple or azure, it doth strengthen the visual spirit since it is the medium between extreme colours. Second that, had it not been there, the visual spirit had been too much dissipated by exterior light. Therefore, that this spirit be held united in one place, to wit in the crystallinus, this tunic had an opening, the pupilla. For if it happen that this hole is expanded, by Nature or otherwise, and even more if it be contracted, the sight is hindered. Third that every species of thing seen reach the eye in a pyramidal figure, the base being the thing seen and the apex of its cone the eye, or its angle in the crystallinus. It is therefore necessary that his hole be narrow.

This tunic is called uvea because it doth contain the humor uveus or albugineus formed to moisten the eye, so as to be an internal medium receptive of the species of things seen. Now such a medium must be under the sway either of air or water and, since air was impossible, water was put there.

Moreover since the spiritus visualis doth run thither from the domination of the air,this humour was put in the urea to separate the humor crystallinus from the exterior air, and to separate the humor crystallinus from the cornea. It also serveth the purpose of keeping the foramen pupillae expanded, for it doth come out of the hole in the uvea to swell the cornea. So it is that in those at the point of death, in whom this humour is dried up, the cornea doth sink and become flat. Then it is said by the common people that "a web cometh before the eyes," which is a certain sign of death. On account of such drying up the pupilla also doth become contracted and for many causes there is also dilatation of the pupilla. In fact I have been able to perceive indications of obscure diseases of the eye by means of the uvea.

There remaineth only to speak of cataract. Now there is cataract when vapour is generated which falleth from the brain or riseth from the stomach and passeth through the pupil to the humour between the crystallinus and the pupilla. It doth hinder the reception of species, and, because this vapour hath motion, at first the species do seem to move. Likewise, since it hath colour, it doth affect the crystallinus therewith. And since it is an external object from which species are wont to be formed, the power of vision doth judge that it is external things that move. So it doth appear as though flies or bugs or ants were walking across his field of vision.

Later this vapour is changed into water which, condensing and passing into confirmed cataract, covereth the whole of the pupil and doth entirely prevent sight. If it so fall that it doth not wholly obstruct, it may be confined to the side or middle of the pupilla. If at the side he doth see and judge the thing to be smaller in size. If in the middle, he doth judge the thing to have a hole in it, since the part which he cannot see doth seem like to a hole.

From this observe the method of cure of confirmed cataract which is by chirurgical operation.³⁶ It is not, however, done by taking the cataract entirely away for, before it could be drawn off, the whole of the humour albugineus would come out. This, however, is the manner. They force a needle into the cornea far from the pupil, the cornea being pierced deeply in an oblique direction as far as the pupil. Then they press the needle to the place of the cataract or condensed humour and they drive the cataract down as far as possible. Then by pressure and other means they prevent it from rising again. They do not call such an operation a "cure" of cataract but they speak of it as abatere that is "to press down" the cataract.

So much for the fourth tunic called the uvea.

(5) Next in the posterior or interior part of the eye is the fifth tunic, called the secundina either because it is the "second" from the sclerotic or because it resembles the "afterbirth" (secundina).

(6) After this is the tunica aranea surrounding the crystallinus in the anterior part since in posterior part the retina (7) is joined thereto. Between the two is contained the humor vitreus and in the very midst of it the humor crystallinus. This is round or spherical in shape somewhat flattened as to his fore part. This humour doth lie more towards the fore part than doth the humor vitreus in which it is placed. Now this humor was made to be a place for the crystallina and to nourish it.³⁷

So is the anatomy of the eye ended.

Of the Ear

Having finished these, turn to the ear.³⁸ It is placed at the side of the head for sound doth come from right and left, from before and behind, from above and below. So the instrument thereof should be placed right and left but not in the fore part, because there the instruments of the other senses were placed.

Now the ear in man was made of round form and cartilaginous. It was round to be very capacious. It was cartilaginous to be safe from external injury and sonorous. The entrance thereof is a long passage ending at the os petrosum in the cavity of which is implanted the spiritus audibilis which is the instrument of hearing. The entrance to this cavity is covered by a fine membrane woven of the fibres of the nerves of hearing as hath been said above.

The bones which are below the os basilare cannot be well seen unless they are removed and boiled, but owing to the sin involved in this I am accustomed to pass them by.³⁹ Thou canst, however, see the beginning and end of the jawbones. These begin from the suture or adorea which is between the skull and the os basilare which is at the extremity of the eyebrow and forehead. The jawbone doth pass hindward by the os petrosum and endeth at the ear and at the teeth the anatomy of which I have told above.

^1. [Reproduced by permission from The Fasciculo di Medicina. Venice, 1493, with an Introduction, etc., by Charles Singer (Florence: R. Lier & Co., 1925), I, 59–60, 75–77, 82–84, 94–96. (I wish to express my gratitude to the executors of the late Professor Charles Singer.) Apart from renumbering in sequence, I have retained, for the most part unchanged, Singer’s explanatory notes, pp. 100–101, 104–106, and 109–110.

Mundinus (Mondino de’ Luzzi), professor of anatomy at Bologna from 1290 until his death in 1326, is universally given credit for the reintroduction of systematic human dissection into anatomy. His is the first anatomical text we have that so clearly and consistently reflects personal investigation. This new concern may have been an outgrowth of the surgical renaissance at Bologna towards the end of the thirteenth century (see Selection 111, n. 1), or perhaps of the postmortem examinations beginning to be performed there (for a later example, see the next selection). But how influential his Anatomy was is debatable. Though a considerable number of manuscripts of the book exist, it apparently never became a standard university text. Moreover, while dissection did become a more or less regular feature of medical education during the fourteenth century, professors of anatomy did not continue, like Mundinus, to teach from the cadaver, but gave formal lectures instead, with an assistant illustrating on the dissected subject. Mundinus’ work—with all its flaws, and its willingness to accept tradition—is still the outstanding medieval achievement in anatomy.—M.M.]

^2. The Methodus medendi,

of Galen (130–200 A.D.) is a vast work which occupies the whole of Vol. X of C. G. Kühn’s Claudii Galeni Opera Omnia, 22 volumes, Leipzig, 1821–1833, the edition to which references to Galen are usually made. Extremely popular throughout the Middle Ages, the Methodus medendi formed the basis of a large part of mediaeval therapeutics. It was often spoken of as the Megatechne or Macrotechne to distinguish from the Microtechne, or Ars medica a smaller work contained in Vol. I of Kahn’s edition.

The Methodus medendi was translated several times into Latin. It had been turned into Arabic by Hunain ibn Ishak (809–873 [he died in 877—Ed.]). A translation was made from the Arabic by Constantine the African (died 1087). This translation survives in numerous MSS and has been printed. (Opera Isaaci, Lyon 1515, p. 189.) Another translation made in the late XIIIth century was direct from the Greek. It also is quite common in MSS but it has not, I think, been printed. Probably it was this Graeco-Latin translation and not the Arabic-Latin version that was used by Mundinus.

The passage quoted by Mundinus is a greatly abbreviated paraphrase of the opening of the Methodus medendi.

^3. Averroes is the mediaeval Latin form of the name of the heretical Spanish writer Ibn Roschd of Cordova (died 1198). Averroes takes a very important place in the history of scholasticism by reason of his commentaries on the works of Aristotle. In medical matters he influenced the Latin West chiefly through his work kèt âb al kollig ât i.e. "universal book of medicine" which was known to the Latin West as the Colliget. This work was widely read in the later Middle Ages in a translation into Latin made by a Jew named Bonacosa at Padua in 1225 [actually 1285—Ed.]. MSS of the version of Bona-cosa are well known. Bonacosa’s version was printed at Venice in 1482 and appeared in several later editions.

^4. The Metaphysics of Aristotle to which Mundinus refers he had probably read in the Arabic-Latin version of Michael Scot (1175?–1234?). The Metaphysics opens with the sentence "All men by nature desire to know. An indication of this is the delight we take in our senses; for even apart from their usefulness they are loved for themselves; and above all others the sense of sight." Mundinus in these paragraphs proceeds to exhibit the characteristic mediaeval application of the Aristotelian doctrine of the four elements and their arrangement, along with Ether, in a series, Earth, Water, Air, Fire, Ether, of which Earth, the densest, is lowermost and Ether, the most tenuous, is uppermost. This doctrine is set forth especially in the Aristotelian works De generatione et corruptione, the Meteorologica and the De caelo et mundo all of which were commonly available in Latin translations in the time of Mundinus.

^5. The De juvamentis membrorum of Galen is an abbreviated Latin translation of an Arabic version of the first nine books of the De usu partium corporis humani (K III, I–IV, 366 ["K" is used throughout by Singer to refer to Kühn’s edition of Galen’s works—M. M.]) which is in seventeen books. The De usu partium itself was not available in its entire form in Latin until after the death of Mundinus. He therefore had at his disposal only the Arabic-Latin version of the De juvamentis which was prepared by an unknown writer in the XIIIth century and is commonly encountered in MSS of the XIIIth, XIVth and XVth centuries. This abbreviated De juvamentis is one of the main sources of Mundinus. The passage referred to here is to be found in VIII § 5 of the De usu partium (K III, 703).

^6. The so-called Canon (in Arabic Alkanûn fil tebb) of the Bokhariote Ibn Sina (980–1037) known to the West as Avicenna was by far the most influential medical work among the Latins of the later Middle Ages. It was translated by Gerard of Cremona (died 1185 [actually 1187 —Ed.]). This translation was probably among his last works and possibly was not completed by him. It is found in innumerable MSS. The Latin translation of the Canon was first printed in 1473 and continued to appear in a whole series of editions down to 1658. Avicenna is one of the main literary sources of Mundinus and most of the Arabic anatomical terms used by Mundinus are taken from this Latin translation of the Canon. For those who care to compare the anatomical sections of the Canon with Mundinus, the French translation of the anatomical section in P. de Koning’s Trois traités d’anatomie Arabes, Leyden 1903 will be found convenient.

^7. The word plantenus is obviously taken from planta, the sole. The ridiculous derivation of anthropos, represented as antropos, and its impossible association with

a turning, is a mediaeval commonplace of considerable antiquity.

^8. I have discussed the nature of this theory and its origin and implications in my article on "Hildegard" in Studies in the History and Method of Seience, Vol. I, Oxford, 1917, and in a contribution on "The Dark Ages and the Dawn" in F. S. Marvin’s Science and Civilization, Oxford, 1923. [See Selection 3, note 3.—Ed.]

^9. This contrast of the anatomy of animals and of man came quite naturally to a mediaeval writer, more so perhaps than it would to many modern medical men. In the time of Mundinus such dissection as was carried on was largely on the bodies of animals. Mundinus himself refers in several places to animal dissections.

^10. By simple parts the mediaeval anatomists meant something like what we mean by tissues and what Aristotle meant by homoiomeria. Among the anatomical processes applied both to human and animal bodies by the mediaeval anatomists was maceration, This was carried on to a degree that left the ligaments and tendons but removed the softer parts. There are several descriptions and many references to this process among mediaeval anatomical writings [compare the beginning of Selection 95—Ed.].

^11. The official members are those which subserve the needs of the higher organic or principal members. Thus Andrew Boorde writes in 1547 in his Breviary of Health "Princypal members be foure, the herte, the brayne, the lyver, and the stones. . . . All other members be officiall members, and dothe offyce to the pryncypall members."

^12. The Book of Sects to which Mundinus refers is doubtless the

De sectis ad eos qui introducuntur (K. I, 64). There was an "Alexandrian Commentary" on this which exists in Arabic (represented by the British Museum MS 1356). There are a number of MSS of the XIIIth and XIVth centuries that claim to be translations into Latin of the De sectis. Some of these would doubtless be found to be translations of this Arabic version of the Alexandrian commentary.

^13. The titles Anatomia mortuorum and Anatomia vivorum were attached to two pseudo-Galenic Latin tracts on anatomy that were widely diffused in the days of Mundinus. Concerning the source and authorship of these works a considerable literature has arisen. The last contributor to the subject is F. Redeker (Die Anatomia magistri Nicolai phisici und ihr Verhältnis zur Anatomia Chophonis und Ricardi, Leipzig, 1917). Those interested in this complicated and difficult question can trace the literature back from the full bibliography in his work.

^14. The classification into animate or animal members associated with the brain, respiratory or vital members associated with the heart, and natural members associated with the liver is based on the Galenic physiology with its threefold system of spirits, animal, vital and natural.

^15. [There was a persistent medieval tradition of a horn-shaped structure arising on both sides near the cervix—probably the result of a mistaken interpretation of the cut edge of the vagina. See M. Holl, "Über die sogenannten Hörner des Uterus," Archiv für Geschichte der Medizin, XIII (1921), 107–115.—M. M.]

^16. The extraordinary idea of the division of the uterus into seven cells doubtless came to Mundinus from the very widely read work of Michael Scott De secretis naturae § 7. . . . The notion of the uterus as divided in a number of parts goes back to works of the Hippocratic Collection.

^17.De locis affectis VI § 6 (K VIII, 441).

^18. Jan. 1315 old reckoning is Jan. 1316 of our calendar. Thus the date of composition of the work of Mundinus may be 1316 or 1317.

^19. Haly Abbas Liber regalis Theorice III § 34 in Stephen of Antioch’s translation (Ed. Lyons 1523 fo. 41). The praeputia matricis are the labia minora.

^20. In mediaeval anatomies the cervix is repeatedly confused with the vagina and the os with the vulva. This was still the case with Vesalius in 1543.

^21. See note 16.

^22. The work referred to under the name Serapion is probably the Breviarium of the Syrian Jahiah ibn Serabi (circa 900 A.D.) known as Serapion senior or Serapion Damascenus. This work was translated by Gerard of Cremona (perhaps from Hebrew) before 1185 and printed at Venice in 1497 and often subsequently. Almost equally popular was the work of Serapion junior who lived about a hundred years later. He produced a work De medicinis simplicibus. This book was translated into Latin during the youth of Mundinus (about 1290) by Simon of Genoa working in conjunction with the Jewish interpreter Abraham of Tortosa. The book was printed at Milan in 1473 and several times afterwards.

^23. Rhazes is the Persian Abu Bekr Muhammad ibn Zakhariah al Razi (died 932) the greatest of all Arabic writing clinicians. The name Rhazes (al Razi) means man of Ray, a town near Tehran. The book referred to by our author is probably the vast work known as Continens translated by the Sicilian Jew Faradj ben Salem (Farragut) of Salerno during the lifetime of Mundinus (about 1280) and first printed at Brescia in 1486.

^24. The writer referred to as our John is that puzzle of medical historians known as Mesue junior. The identity of this writer is still obscure but it appears not improbable that part of the work which passed under his name was turned into Arabic from Latin—perhaps in the XIIth century by a Sicilian Jew—thence into Hebrew and thence back again into Latin! The work as it stands is doubtless a compendium gathered from many sources. There are a great number of MSS of it and it is the most frequently printed of all early medical books, the editio princeps being that of Venice, 1471. . . . The book was very familiar to the Bologna professors of the XIVth century and was part of the curriculum; hence his description as our John.

^25. The idea of the womb as mobile was very widespread in the Middle Ages and may still be encountered among the ignorant. To it we owe our word hysteria (

= womb). Other names for that disease are suffocation of the womb, the hysteric passion, the vapours and in German Mutterweh. The idea was kept before the public and the profession by the very wide circulation of the work of Moschion De morbis mulierum. This had been adapted into Latin from Soranus in the Vth or VIth century and a MS of the VIth century has survived. (Leyden Voss 4° 9*). It was translated into most vernac-ulars—English among them. Curious to relate it was also translated back again into Greek. Its ideas penetrated into many mediaeval works on diseases of women, e.g. the "Cleopatra," pseudo-Trotula and others. The work of Galen An animal sit quod est in utero (K XIX, 158) appears to have been unknown in the Middle Ages.

^26. The idea of the central position of the heart, a mediaeval commonplace, comes from Aristotle, e.g. De partibus animalium III § 4, 665 b 15. The conception was long dominant in physiology and still influenced William Harvey in the preface to the De motu cordis, Frankfurt 1628.

^27. In general the description of the heart by Mundinus is borrowed from Avicenna who in turn took it from Aristotle. The absurd idea that "what is hot must be pyramidal" is a mediaeval commonplace of Peripatetic origin. It does not occur in the chapter on the heart in the Canon of Avicenna.

^28. The pathology of heart disturbance is described by Galen in the De locis affectis (K VIII, 302 ff.) which is the reference of our author.

^29. Mediaeval anatomists, following Galen, always regard the auricles as of secondary importance, mere additamenta.

^30. The idea of the middle ventricle, about which Mundinus makes such pother, has its origin in a misunderstanding. It results from an attempt to combine the views of Aristotle and Galen. Aristotle, who never dissected a human body, derived his anatomical conceptions largely from cold-blooded animals in some of which the heart is provided with three cavities. He considered that the heart had three chambers, the largest being on the right, the smallest on the left, and one of intermediate size between the two. As far as they can be identified, the largest was the right ventricle plus the right auricle, the smallest or left chamber was the left auricle, while the intermediate cavity appears to have been the left ventricle.

Galen’s description differed altogether from that of Aristotle. He tells us, expressly and somewhat contemptuously, that "it is no marvel if Aristotle erred in many anatomical matters, a man who thought, forsooth, that the heart in the larger animals had three chambers." (De anatomicis administrandis VII § 157, K II, 62.) Galen always describes the heart as having but two chambers, the right and left ventricles, a wholly subordinate part being assigned to the auricles. These latter were regarded as safety-overflows, expanding to hold superfluous blood when the chambers of the heart to which they correspond became too full.

No third ventricle is described by Rhazes or Haly Abbas and its existence is expressly denied by the latter. Avicenna, in his Canon, however, makes an effort to combine the views of Aristotle and Galen. Speaking of the anatomy of the heart (Lib. III, Fen.XI, § 1) he describes the ventricular portion as follows: "In the heart are three cavities, two large, and a third as it were central in position. So that the heart has firstly a receptacle [the right ventricle] for the nutriment with which it nourishes itself—this nutriment is thick and firm like the substance of the heart; secondly a place where the pneuma is formed [the left ventricle], being engendered of the subtil blood; and, thirdly, a canal between the two." A somewhat similar account is given in Constantine’s translation of Isaac. The idea soon crept into European medicine, for in a Pisan MS dating from the first half of the thirteenth century (Roncioni MS 99) a crude figure of a three-chambered heart is to be found.

The first translator of the Canon of Avicenna, Gerard of Cremona, whose work appeared towards the end of the twelfth century, improved on his original. "In the heart" he said "are three ventricles; two are large and the third as it were between, which Galen called the fovea or non-ventricular meatus, so that there may be a receptaculum for the thick and strong nourishment, like to the substance of the heart, with which it is nourished, and also a storehouse for the pneuma (spiritus) generated in it from the subtil blood. And between the two are channels or meatuses." Henri de Mondeville (died about 1320), a contemporary of Mundinus, by going direct to the current Arabico-Latin text of Galen (De juvamentis, Book VI) avoided some of the errors of Avicenna, with whom, however, he still describes three ventricles. Mundinus does little but copy Avicenna. There is an attempt to show the central chamber of the heart in a wretched little figure in the edition of Mundinus by J. A. Adelphus, Strassburg 1513. A drawing by Leonardo shows the channels of communication which were supposed to exist between the two ventricles.

^31. The idea that certain of the vessels go right through the heart is encountered in Plato’s Timaeus which was much read in the Middle Ages in the ancient paraphrase of Chalcidius. . . . The view is here opposed by Mundinus. . . .

^32. No early figures of the heart are satisfactory or indeed lucid. . . . The fact is that neither Mundinus nor his commentators nor the Arabian writers on which they all drew understood fully the physiological system of Galen.

^33. The derivation is a false one. Adorta appears to be a mere corruption of Aorta which is a word found as early as the Hippocratic writings and is probably related to

to raise.

^34. A great deal of attention was paid by the Arabians to the structure and diseases of the eye, and the essentials of the description by Mundinus are to be found in Rhazes, Haly Abbas and others. The tradition presented by these writers passed early to the West, and is reproduced, for example, in the works of Constantine Africanus and in the anatomy to which the name of Richardus Anglicus is attached. Avicenna’s description of the eye is somewhat different, and gave rise to another tradition reproduced in the works of John of Peckham and of Roger Bacon, and influencing the views of Leonardo and Vesalius. The views on the anatomy of the eye expressed by Rhazes and Haly Abbas were, on the whole, more widely accepted than those of Avicenna.

The treatment of the eye was always felt to be hardly within the range of the ordinary practitioner of surgery, and its structure, as we learn from Guy de Chauliac (1300–1370) was not usually included in the general course of anatomy. The custom was rather to refer the student to special works such as that of Alcoatim. The Ophthalmologia which Salome ibn Alcoati wrote in 1159 was translated by an unknown worker in the XIIIth century. (The Latin text was printed by J. L. Pagel in his Neue literarische Beiträge zur mittelalterliehen Medizin, Berlin, 1896. See also J. Hirschberg in Graefe-Saemisch Handbuch der gesamten Augenheilkunde XIII p. 70, Leipzig, 1908).

The description of the eye by Mundinus is that still generally accepted at the end of the XVth and beginning of the XVIth century and closely resembles that of Alcoatim. It is distinctly better than that of his contemporary Henri de Mondeville (1260–1320) or than the pseudo Richardus Anglicus, and superior also to most ?? the descriptions of the eye dating from the fourteenth and fifteenth centuries brought to light by Sudhoff. [Compare Pecham’s description of the structure of the eye, in Selection 62.7.—Ed.]

In reading any early description of the eye, it is to be remembered that until the nineteenth century the "emanation theory" prevailed. Light was regarded as o the nature of a stream emitted from the object seen, and the act of vision was considered as a collision of this emanation with an emission of something from the eye itself, called in mediaeval writings the "visual spirit." The emanations took, in the view of some, the form of thin shells, of the things seen. These passing into the eye became the species. [See "The Act of Sight" Selections 62.11–13—Ed.]

^35. Into its midst. In mediaeval physiology the actual site of visual sensation was a central body, the humor crystallinus. This structure was, in fact, the crystalline lens, but even Leonardo and Vesalius placed it in the centre of the globe of the eye. The first to displace it therefrom was Felix Plater (1536–1614) in his work De partibus corporis humani structura et usu (Basel, 1583). Plater recognised the real nature of the retina.

^36. We have here an interesting account of couching cataract. The operation had been described by Celsus (1st century B.C.) whose work, however, was unknown to Mundinus being rediscovered only in the XVth century. Galen mentions the operation but does not describe it. Paul of Aegina (625–690) gives a good description of it but the part of his work in which it occurs had not been translated into Latin in the time of Mundinus. There is an excellent and elaborate description of the operation by Avicenna but the procedure is different from that of Mundinus. A similar operation to that of Mundinus is, however, described by Albucasis (died 1106) whose work on surgery was translated by Gerard of Cremona about 1180 and became known in Northern Italy from about 1230 onward. It is highly probable that it would have been studied by Mundinus who might also have read of it in the work of Alcoatim (see note 34). Arabian writers in general paid much attention to the cataract operation, and the impress of their influence on Western ophthalmology is encountered as early as the work of Benvenutus Grapheus who was a student of Salerno at the end of the XIIth century and whose work exists in many MSS. Benvenuto describes the same operation as Mundinus . . . .

^37. The technical terms here used for the eye may be conveniently referred to in J. Hirschberg’s Wörterbuch der Augenheilkunde, Leipzig, 1887.

^38. This account of the anatomy of the ear is probably taken from the Pseudo-Galenic De anatomia vivorum.

^39. [The official attitude of the medieval Church towards human dissection is still a matter of some debate, but there can be no doubt that many anatomists, like Mundinus, were afraid that a sin was involved. The immediate reason is probably the bull issued by Pope Boniface VIII in 1300, concerning the disposition of those "who, when dying in foreign lands, have expresser a desire to be buried in their own country. The custom consists of disemboweling and dismembering the corpse, or chopping it into pieces and then boiling it so as to remove the flesh before sending the bones home to be buried—all from a distorted respect for the dead. Now, this is not only abominable in the sight of God, but extremely revolting under every human aspect. Wishing, therefore, as the duty of our office demands, to provide a remedy for this abuse, by which the custom, which is such an abomination, so inhuman and so impious, may be eradicated and no longer be practiced b?? anyone, We, by our apostolic authority, decree and ordain that no matter of what position or family or dignity they may be, no matter in what cities or lands or places in which the worship of the Catholic faith flourishes, the practice of this or any similar abuse with regard to the bodies of the dead should cease forever, no longer be observed, and that the hands of the faithful should not be stained by such barbarities." (The full text is given in James J. Walsh, The Popes and Science [New York: Fordham University Press, 1911], pp. 32–33.) The immediate addressees of the bull were probably the Crusaders—St. Louis of France, for example, had been treated this way upon his death in Tunis in 1270—but anatomists must have felt that the phrase "any similar abuse" applied to their own activities. Intentionally or not, the bull seems to have considerably restricted the practice of human dissection for at least fifty years.—M. M.]