The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XI. Of the Muscles of the Epigastrium, or lower belly.

NOw seeing that wee haue taught, what a muscle is, and what the dif∣ferences thereof are, and what simple and compound parts it hath, and what the use, action and manner of action in each part is; it remaines that wee come to the particular explication of each Muscle, begining with those of the lower belly, as those which we first meet withall in dissection.

These are 8 in number, 4 oblique, 2 on each side, two right or direct one, on * 1.1 the right, another on the left side; and in like manner 2 transverse. All these are alike in force, magnitude and action, so mutually composed, that the oblique descendant of one side, is conjoined with the other oblique descendant on the other side, and so of the rest.

We may adde to this number the 2 little. Supplying or Assisting muscles, which are of a Pyramidal forme and arise from the share-bone, above the insertion of the right muscles; Of the oblique muscles of each side the one ascends, the other de∣scends, whereupon it comes to passe, that they are called the Oblique descendant and * 1.2 Ascendant Muscles. Those oblique which wee first meet with, are the descendant, whose substance is partly sanguine, partly spermaticke; for they are fleshy, nervous, ligamentous, veinous, arterious and membranous. Yet the fle shy portion is predomi∣nant in them, out of which respect Hippocrates is wont to expresse the muscles by the name of fleshes; their greatnes is indifferent betweene the large and the small muscles; * 1.3 their figure 3 square. They are composed of the fore-mentioned parts, they are two

in number; their site is oblique taking their beginning, from the touching of the great saw Muscle and from the sixt and seventh true ribbes, or rather from the spaces between the sixe lower ribbes, and rather on the forepart of the muscles than of the ribbes themselues, from whence shunning the Veriebra's of the loines, the fleshy parts of them are terminated in the externall and upper eminency of the Haunch-bone, and the Membranous end in the lower eminency of the share-bone and the White-line. Yet Columbus dissenting from this common description of the oblique Muscles, thinks that they are onely terminated in the White line and not in the share-bone. For (saith he) wherefore should they be inserted into the share-bone which is not moved? But because it would bee an infinite labour and trouble to set downe at large the severall opinions of all Authors of Anatomy, I haue thought it sufficient for me to touch them lightly by the way. Their connexion is with the oblique ascendant * 1.4 lying vnder them, and with the direct, or right. Their temperament is twofold, the one hot and moist by reason of the belly and the fleshy portion of them; the other cold & dry in respect of their ligamentous and tendinous portion. Their action is to draw the parts into which they are inserted towards their originall, or els to unite them firme∣ly. Yet each of these privately and properly drawes the hip in an oblique manner to∣wards the Cartilago Scutiformis or brest-blade. Then follow the oblique ascendant, * 1.5 who haue the same substance, quantity, figure, composure, number and temper the descendant have. They are scituate between the descendant and transverse with whom * 1.6 they have connexion, especially by the vessels which are brought from the parts be∣neath. All the fleshy parts arise from the rackbones of the Haunch to the ends of the bastard ribs, which they seeme to admit above and below, being fleshy even to the fourth, and then becomming membranous they take their way to the white line, with a double aponeurôsis, which passes through the right Muscles above and be∣low, as wee may plainely see from the navill downewards. In their fleshy part they draw their originall from the spine of the Haunch bones a little lower than the descendent end in their fleshy parte. But for their membranous parts, they arise be∣fore from the share bone, but behinde from the spondiles of the Holy bone, and Vertebra's of the loines obliquely ascending vpwards to the white line, into which they are terminated by an aponeourôsis or membranous tendon (which seemes to penetrate the right Muscle vpwards and downewards, especially vnder the navil) but by their fleshy part at the ends of all the bastard ribbes, which they seeme to re∣ceive above and below. And because these muscles are terminated in the white line, they have also another use, yet such as is common to all the muscles of the Epigastrium, that is, to presse down the Guts. Their action is (if they performe it together) to draw * 1.7 downe the chest, and dilate the brest; but if their actions be separate, they draw the chest to the hip with an oblique motion. After these follow the right muscles, so called * 1.8 because they descend according to the length of the body, & because they have right or streight fibers.

Wee will say nothing (to shunne prolixitie, which in all other places wee will avoid, of their substance and other conditions, which they have common with the fore mentioned Muscles. They are scituate in the eminentest or extuberating region of the belly, bounding the Epigastrium taken in generall, (or the superficiary belly,) they * 1.9 are devided by the manifest intercourse of the white line, even to the Navell, in which place they seeme to be united even to the place of their insertion. They draw their ori∣ginall not from the share bone, as some would have it, but according to the insertion * 1.10 of their nerves, from the sides of the Cartilago scutiformis & the ends of the sixt seventh and eight ribbs; but they end in the share bone where they make a common tendon sufficiently strong and short. Syluius, Vesalius and Columbus thinke they arise from the share bone, because they cannot be inserted into that bone, because it is immoveable. You may perceive in these Muscles certaine nervous & transverse intersections, often times three in number for the strength of these Muscles (of which Galen makes no men∣tion, although they may be seene in Apes.) And also in the inner side of these muscles you may see foure veines and as many arteryes, of which some creepe upwards, others run downwards. The upper called the Mamillary descend from the Axillarie by the side and lower partes of the Sternon, the slenderer portions thereof being distributed

by the way, to the Mediastinum, and about the fourth and fift rib to the Dugges, from whence they take their name.

That which remaines breaking out by the sides of the Brest-blade inserts it selfe into those muscles creeping along, euen almost to the navell; in which place * 1.11 they are manifestly united (that is the veines with the veines, and arteries with the arteryes) with the Epigastricke, which ascend from the vpper part of the Iliackes on each side under the said muscles untill they meet with these 4 mamil∣lary vessels. That you may finde this concourse of the veines and arteryes about the navill, you must follow both the upper and the lower somewhat deepe into the flesh: pressing the blood on both sides from above downewards, and from below up∣ward; untill you shall finde the exosculation of these vessels, which will appeare by this, that the blood will flow from this into that and from that into this; otherwise you can scarce perceiue it, by reason of the smallnes of such vessels which want blood. But that by the benefit of such concourse of the vessels, the matters may be communi∣cated and transported both from the wombe to the dugs, and againe from the dugs to the wombe, appeares in Nurses, who want their courses, when the milke comes into their dugs, and on the contrary lose their milke when their courses flow plentiful∣ly. Otherwise to what purpose should there be such concourse betweene the vessels of the pappes and wombe, for there are veines and arteries diffused to the sides of the wombe from the roote of the Epigastrickes; for indeed the Epigastrickes which in their ascent meete with the mamillary, goe not to the wombe, though they be next to them, and arise from the same truncke with the Hypogastricke veine of the wombe. The Action of these muscles is, to move or drawe neere together the parts of the Hypogastrium to the praecordia or Hypochondryes. Their use, in * 1.12 Columbus opinion is, to draw the Brest downewards so to dilate it. At the * 1.13 ends of these Nature hath produced two other small Muscles from the upper part of the share bone, of a triangular figure for the safety of the thicke and common tendon of the right Muscles, whereupon they are called Succenturiati, or assisters.

Some (moved with I know not what reason) would haue these two small Mus∣cles * 1.14 to help the erection of the yeard. Columbus thinkes they should not be sepa∣rated from the right, and that they only are the fleshy beginnings of the right. But on the contrary Fallopius manifestly proves them different and separate from the right and shewes their vse. The Transverse remine to be spoken of, so called by * 1.15 reason of their fibers which make right angles with the fibers of the right Mus∣cles.

They haue a quadrangular figure scituate vpon the greatest part of the Peri∣tonaeum, * 1.16 to which they sticke so close that they scarse can be separated. They take their originall from the production of the loines, the Eminency of the Haunch-bone, the transverse productions of the vertebra's of the loynes and the ends of the bastard ribs; contrary to the opinion of many, whom the insertion of the nerve con∣vinces, but they end in the white line, as all the rest doe.

Their action is to presse the guts, especially for the expulsion of excrements. * 1.17

But all the 8 recited Muscles, besides their proper use, haue another com∣mon, * 1.18 that is, they stand for a defence of Bulwarke for all the parts lying under them, and serve for the expulsion both of the excrements, infant, and vapoures, and also for the strenghtening of the voice, as experience shewes in those who sound Trumpets and Cornets.

Therefore these Muscles doe equally on every side presse the Belly; But the Midriffe, the intercostall Muscles assisting it, doth drive from above downe-wards, from which conspiring contention followes the excretion of the excre∣ments by the fundament; but unlesse the Midriffe should assiste, these Muscles would presse the excrements no more downewards, than vpward to the mouth.

Although to this excretion of the excrements, it is not sufficient that the Epigastricke, Midriffe and intercostall Muscles presse the belly, but the Mus∣cles * 1.19 of the throtle must be also shut. For the mouth being open the excrements never goe well forth; because the vapours that passe out of the

mouth, which being restrained and driven to the Midriffe, by stretching it powerfully thrusts downe the excrement. Wherefore Apothecaryes when they give glisters, bid * 1.20 the Patient to open his mouth, that the glister may easilyer goe up, which otherwise would scarsely go up, the mouth being shut, because so we should have no place empty in us, into which the glyster might be admitted.

[illustration]

The first Figure of the Lower belly.

AABCD. The upper, lower and laterall parts of the Peritonaeum.

EE. The white Line from the Gristle of the Breast-bone, called the Brest-blade, to the Commis∣sure or meeting of the Share-bones,

F. The Gristle of the Breast-bone Cartilago ensi-formis or the Breast-Blade.

G. The Navill which, all the Muscles being taken away, must be kept for the demonstration of the Vmbilicall Vessels.

H H. The productions of the Pe∣ritonaeum which contain the Se∣minarie Vessels on either side.

**. The hole which giveth way to the Seminarie Vessels of Men.

II. A Veine and an Arterie from the Epigastricke, which being carried upward under the right Muscles, doe here hang down, and are distributed into the lo∣wer part of the Abdomen.

KK. A Veine and an Arterie from the internall Mammarie proceeding from under the Bone of the Breast, are carried downeward through the right Muscles and are disseminated into the upper part of the Ab∣domen.

1, 2. The place wherein the right Muscles arise, which being here cut off, do hang down, that their Vessels may the better be scene.

3, 4. The Anastomosis or inoccula∣tion of the foresaid Vessels, ma∣king the consent of the Abdomen and the Nose, & of the Wombe with the Breasts, as some think.

LL. Branches of Veines running into the sides of the Peritonaeum. N. The place of the Haunch Bone bared, to which the Oblique and the Transverse Muscles doe grow.

Of the whiteline, and Peritonaeum or Rim of the belly.

The white line is nothing els, than the bound and extremities of the Muscles of the Epigastrium distinguishing the belly in the middest into two parts, the right * 1.21 and left. It is called white, both of its owne colour, and also for that no fleshy part lyes vnder it, or is placed above it. It is broader above the navill, but narrower below, because the right muscles doe there grow into one, Now we must treat of the Coat or membrane, Peritonaeum or Rim of the belly; it is so called, because it is * 1.22 stretched over all the lower belly, and particularly over all the parts conteined in the ventricle, to which also it freely lends a common coat. It hath a spermaticke substance as all other membranes have; the quantity of it in thicknes is very small, (for it is al∣most * 1.23 as thin as a spiders web) yet differing in divers places in men, and women; for men have it more thick and strong aboue the Navil, that so it may conteine the ex∣tension of the stomacke, often stretched beyond measure with meat and drinke. On the contrary women have it so thick and strong below their navell that it seemes double, that so they may more easily endure the distention of their wombe caused by the child conteined in it. But above the navell men and women have the Peritonaeum of an equall strength, for the selfe same reason. The longitude and latitude of it is knowne by the circumscription of the belly.

The figure is round and some what long; it puts forth some productions, * 1.24 like finger stalles, both for the leading and strengthening the spermaticke vessells and the Cremaster muscles of the Testicles, and besides it the eiaculatory vessels, as also to impart a coat to the testicles and all the naturall parts.

It is composed of slender, membranous and nervous fibers, certaine smalle * 1.25 branches of veines and arteries concurring with them, which it receiues for life and nourishment from the adherent parts. * 1.26

This membrane is one in number, and besides every where one and equall, although Galen would haue it perforated in that place where the spermaticke ves∣sels * 1.27 descend to the Testicles; But in truth we must not thinke that a hole, but ra∣ther a production as we said before.

The latter Anatomists haue observed, the Coate Peritonaeum is doubled below the Navell, and that by the spaces of these reduplications the vmbilicall arteryes as∣cend to the Navell.

It is scituate nere the naturall parts and compasses them about, and joined by * 1.28 the coat, which it giues them, as also on the sides, it is ioyned to the vertebra's of the loines, from whose ligaments, (or rather periostium) it takes the originall: on the lower part it cleaves to the share bone, and on the upper to the midriffe whose lower parte it wholy invests; on the fore or outer parte it stickes so close to the transverse muscles, that it cannot bee pluckt from them but by force, by reason of the complication and adhaesion of the fibers thereof with the fibers of the proper membrane of these muscles, which membrane in Galens opinion proceeds * 1.29 from this Peritonaeum, that so it is no marvaile that we may more easily breake, than separate these two coats. It is of temperature cold and dry, as all other membranes are.

It hath many uses, the first whereof is, to invest and cover all the parts of the * 1.30 lower belly, specially the kall, least it should be squeesed by great compressures and violent attempts into the empty spaces of the muscles, as it sometimes hap∣pens in the wounds of the Epigastrium, unles the lips of the ulcer bee very well united: for then appeares a tumor about the wound by the Guts and kall thrust∣ing without the Peritonaeum into those spaces of the muscles; from whence pro∣ceeds cruell paine.

Another vse is to further the casting forth of the excrements by pressing the ventricle and gutson the foreside, as the Midriffe doth above, as one should doe it by both their hands joyned together.

The third use is, it prohibites the repletion of the parts with flatulency after the expulsion of the excrements, by straitening and pressing them downe.

The fourth and last is, that it conteines all the parts in their seat and bindes them to the backe-bone, principally that they should not flye out of their places by violent motions, as leaping and falling from on high.

Lastly wee must know, that the Rim is of that nature that it will easily di∣late it selfe, as wee see in Dropsies, in women with child, and in tumors against nature.

Notes

• * 1.1

  eight muscles of the Epiga∣strium.
• * 1.2

  The Oblique descendant. Their sub∣stance. Their great∣nesse and figure.
• * 1.3

  Their compo∣sur and fite.
• * 1.4

  Their con∣nexion. Their tem∣perament. Their action.
• * 1.5

  The oblique ascendant.
• * 1.6

  Their site and connexion.
• * 1.7

  Their Action
• * 1.8

  The right muscles of the Epigastrium.
• * 1.9

  Their site.
• * 1.10

  Originall.
• * 1.11

  The meeting together of the Epigastrick and mamillary veines and arteryes.
• * 1.12

  Their action.
• * 1.13

  Their use.
• * 1.14

  The Pyraml∣dal or assisting muscles.
• * 1.15

  The transverse muscles of the Epigastrium.
• * 1.16

  Their figure and site.
• * 1.17

  Their Action.
• * 1.18

  The common use and action of the eight muscles of the Epigastrium.
• * 1.19

  Why when the mouth is open the excre∣ments go more slowly forth.
• * 1.20

  Why when the mouth is open the excrements go more slow∣ly forth.
• * 1.21

  What the white line is
• * 1.22

  What the Pe∣ritonaeum is.
• * 1.23

  The substance and quantity.
• * 1.24

  The figure.
• * 1.25

  The compo∣sition.
• * 1.26

  The number.
• * 1.27

  Lib. de 〈◊〉〈◊〉.
• * 1.28

  The fite and connexion.
• * 1.29

  Lib. 6, Meth,
• * 1.30

  Vse.