Mikrokosmographia a description of the body of man. Together vvith the controuersies thereto belonging. Collected and translated out of all the best authors of anatomy, especially out of Gasper Bauhinus and Andreas Laurentius. By Helkiah Crooke Doctor of Physicke, physitian to His Maiestie, and his Highnesse professor in anatomy and chyrurgerie. Published by the Kings Maiesties especiall direction and warrant according to the first integrity, as it was originally written by the author.

QVEST. VI. Why when the right side of the head is wounded or obstructed the opposite part is resolued or becommeth Paralytical.

COncerning the Palsy the difficulty is greter, the knot harder to cleaue namely, why when one part of the head is wounded or one of the vē∣tricles of the braine obstructed or compressed, the opposite parts are resolued or become Paralyticall? That it is most true the examples * 1.1 are infinite, and all Physitions both ancient and moderne in their wri∣tings do agree vpon it. Hippocrates maketh mention of this kinde of Palsie in his booke de vulneribus capitis and in Coacis praenotionibus. Those (saith he) that becom impotent of wounds in their head do recouer if an Ague without hor∣ror ouertake them, otherwise they become apoplecticall in the right parts or in the left. That is paralyticall. For Hippocrates often saith Crus apoplecticum for the leg taken with the Palsie. In the history of the sonnes of Phanius and Euergus in his 7. booke Epidemiωn hee wri∣teth * 1.2 that they become impotent (if the wound be in the right part) on the left side, and on the right side if the wound were on the left part. Aretaeus in the 7. chapter of his first booke de Causis et sigmis diutur norum morborum is of the same minde. If (saith he) the head be woun∣ded at first on the right part the left side is resolued; if on the left the right side. Salicetus setteth this down for a Catholike or vniuersall Theoreme or Maxime. Whensoeuer any man is woun∣ded in the head so that a Palsie happen thereupon, if the wound be in the right part of the head the left side will be paralytical and contrariwise. The same hath Iohannes de Vigo obserued: and Hollerius in his Commentaries in Coacas praenotiones Hippocratis. And wee also saith Lau∣rentius * 1.3 our Author, haue obserued the same.

Wherefore that it is so, there is no controuersie; all the question is, why and how it com∣meth so to passe, and that indeed is much disputed. Some imagine that the nerues in their originall are so implicated that the right nerues run along the left side and the left along the right side, intersecting themselues in manner of a S. Andrewes Crosse, which * 1.4 intersection is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and therfore it is, say they, that when the right part is obstruc∣ted or otherwise affected the left side is conuelled or resolued and on the contrary, be∣cause the originall is affected. And this is the opinion of Cassius and Aretaeus. Cassius thought that the nerues do so take their originall from the Basis of the Braine, that those * 1.5 which arose from the right part were carried into the left, and those which arose from the left side into the right, crossing one another ouerthwart. Aretaeus is of the same opinion. The right nerues, saith he, do not proceede directly into the right parts vnto their termi∣nations; but as soone as they spring vp they cut ouer to the other side crossing one another like the letter X which the Graecians call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. But the leuity of this opinion needeth no * 1.6 consuration. For ocular inspection which wee call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 teacheth vs that all the nerues which arise out of the marrow of the braine are altogether distinguished and seperated in their originall, progresse and insertion; excepting onely the opticks which in the middle of their iourney do meet & that necessarily, that they might passe directly to the apple of * 1.7 the eye; that they might not grow flaccid or loose in their long iourny being very soft; that the simple & single obiect of the eye might not seeme double: and finally, that the formes and images of visible things might be vnited. Onely therefore the opticke nerues do meet,

yet so that they neuer intersect or crosse one the other. VVee haue also of late obserued, saith Laurentius, that the nerues of the second coniugation haue beene continuall in their originall.

As for the nerues of the spinall marrow, the right are separated from the left, neuer cutting one ouerthwart another. It is therefore absurd to referre the cause of the convul∣sion and Palsie which hapneth on the aduerse side to the intersection of the nerues & their Crosse permutation as Aretaeus would haue it, because it is a meere fable.

Some conceiue that not the nerues, but the veines and small arteries of the braine are * 1.8 implicated first in the basis of the braine, then in those two labarynthian textures, the one called Choroides, the other Rete mirabile, so that they are diuaricated out of the right side into the left, and our of the left side into the right. They thinke therefore that when the ventricle on the right side of the braine and the parts therof are obstructed or compressed, the left side is conuelled or resolued because the entercourse of the spirites is intercepted by the oppression or obstruction of their common fountaine, and at length by stopping of the way of the spirit which they perswade themselues is communicated to the whole body by the arteries not by the marrowey and inward substance of the nerues. I cannot but ac∣knowledge this conceite to bee very ingenuous and seemingly true if it were not that it is * 1.9 contradicted by the principles of Anatomy. For to winde vp the matter in a few words, this opinion taketh these two positions for good. First, that the vessels doe intersect or crosse one another, and againe that the Animall spirites are conuayed by vesselles not by the marrow of the nerues; which, how dissonant they are from the trueth may thus be de∣monstrated by the two common and most competent iudges of all Controuersies, reason and sence.

All the vessels which irrigate or water the whole body of the braine and his membranes * 1.10 are propagated from the internall Iugular veine and from the arteries called Carotides and Ceruicales: now we are taught by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or ocular inspection, that the diuarication of these is on this manner.

The right Iugular veine powreth the bloud into the right sinus of the dura mater as it were into a Cisterne, and the left into the left; out of the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Concourse of these two ariseth the third sinus, which running through the length of the sagittall suture is conuay∣ed * 1.11 to the top of the nose, and from this many small veines are diuersly dispersed into the pia mater: the fourth sinus concaued between the Braine and the After-brain determineth at the buttocks of the Braine.

These sinus as it were riuerets substituted by Nature instead of vessels, doe disperse the bloud on al hands, and from them as out of a presse, the bloud ariving vnto them from the Iugular veines, is expressed into the whole body of the Braine. The Iugular veines there∣fore doe meete and vnite themselues in the third and fourth sinus of the dura mater, but yet are neuer so implicated that the right doe passe vnto the left side, or the left vnto the right; there is no intersection of these vessels no 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Neither is there any intersection of the right Carotidall or sleepy arteries with the left, because they doe not power vitall spirits into those sinus or duplications of the membrane as the veines doe the bloud, neyther are the right implicated with the left, but each artery maketh his owne texture, the right artery the right texture and the left the left.

These textures or complications which are manifest in the vpper ventricles and cal∣led * 1.12 Plexus Choroides doe neuer so intersect themselues that the right should passe vnto the left, the left vnto the right parts, for the vpper ventricles are disseuered by their proper wall or distinction.

And if they say that the Carotides are implicated in the Basis of the braine at the sides of the buttockes and there intersect themselues. I will indeede confesse that the arteries of the same side are implicated, that is, are contorted manifould like the tendrilles of a Vine crumpled vp together for the better preparation of the spirits: but that they intersect them selues and from the right side passe vnto the left, that I constantly deny. For the holes of the buttocks do stand off one from the other, through which the arteries ascend to the Ba∣sis of the braine and from them 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or by a right line to the vpper ventricles: which he that will not otherwise beleeue may thus proue by his owne experiēce. Put a hollow Probe * 1.13 of Bugle into the right sleepy arterie and blow it, and you shall perceiue that the arteries of the right side will be distended more then the arteries of the left. Let vs therefore cleare our conceites of this mist and cloud of errour concerning the intersection of the vesselles

which Autopsie it selfe conuinceth to be a forged conceite.

Beside experience we haue good reason also against it: for if we admit this interse∣ction * 1.14 of the vessels, then it wil necessarily followe, that whensoeuer the right partes are stuffed or compressed the left parts shalbe resolued; because the course of the spirit is in∣tercepted. But wee finde it often to fall out, that when the right Ventricle is obstructed the parts of the same side are resolued. But let vs for disputation sake admit (though wee * 1.15 do not grant it) that those smal arteries and complications of them do intersect one an∣other, must it thervpon needes follow that when the vesselles are compressed the Palsye should seize vppon the contrary side? The arteries are onely conceptacles of the Vitall spirits. Those Vital spirits do onely conferre their helpe to the cherishing, rowzing vp, and restoring of the in-bred heate of the particular parts, but affoord no helpe at all to motion or sense. Now in the palsy the part liueth though the Motion and Sense be both of them quite intercepted. Wherefore by the Arteries the Animal spirit is not conuey∣ed which is the author of all sense and motion.

I know well that when the Iugular Veines and the Carotidall arteries are obstru∣cted, the Caros Apoplexy and Lethargie do follow; whēce the Carotidal Artery is cal∣led Lethargical and Apoplectical, and Hippocrates vseth to call that kinde of Apoplexie, * 1.16 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the interception of the Veynes: but this Apoplexie hapneth but by acci∣dent and is cureable, wherein accesse is denied to the vitall spirite which ministereth matter to the Animall. But the Question in this place is of a true Palsy which happeneth vpon the exolution, madefaction, and (that I may vse the Arabians word) Mollification of the Nerues, or when the wayes of the Animall spirits are shut vppe or intercepted. These wayes are the Nerues, which albeit they haue no conspicuous cauity, yet is their inward substance altogether spongie, through which the Animal faculty and those im∣petuous spirits which Hippocrates calleth 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 do easily finde their way.

Many learned men there are, who will not admit of this trueth, and especiallie a∣mong * 1.17 the late writers Rondeletius striueth to prooue that the Animal spirit is conueyed through the Arteries not through the marrowy substance of the Nerues: the onely vse of the Marrow he acknowledgeth to bee, that like flockes it may sustaine and streng∣then the smal and slender vessels. Argenterius also thinketh that the spirits neuer forsake the Arteries.

It was an old opinion of Praxagoras as Galen remembreth in the 7. chapter of his first Booke De Placitis Hippocratis & Platonis, that the Nerues were continuated with the * 1.18 Arteries, and that the Nerues were nothing else but Arteries become now slender and smal. But the weaknes and insufficiency of this opinion is hence conuinced, because the intercostal Arteries are smal & threddy, & the arteries of the brain which make the two * 1.19 textures therof as fine as haires, and yet no man euer durst call them Sinews. But of this we shall haue better occasion to dispute in our booke of the vessels. In this place it shal be sufficient to haue saide that the Animal spirits cannot passe by the Arteries because they were destined and ordained by Nature for the transportation of the Vital spirites: now two spirits distinct in forme and kinde as we vse to say, cannot be conueyed by the same Vessels. When the Opticke Nerue is obstructed the action of the sight perisheth, * 1.20 are there then any small Arteries intercepted? Or is their interception the cause of blindnesse? Nothing lesse, for the part should be vtterly extinguished if it wer no more illustrated with the beames of the Vital spirits. Wherefore when the marrowy substance is affected, when the spondils or rack-bones are luxatedt he body is often resolued, be∣cause * 1.21 the Marrow of the Nerue is pressed, by reason of which compression the passage of the animal spirit is intercluded.

In those that are afflicted with the Stone, the legge on the same side becommeth stupified, the Nerues and Muscles which are ordained to bend it being compressed by the Kidnie lying thereupon. As for those smal Arteries which run thorough the Mem∣branes that couer the nerues they minister the spirit of life vnto the Nerues, not the fa∣culty of Sense and Motion. Againe, the Arteries of the braine do not essentially dif∣fer from other arteries, but other where the Arteries neyther engender nor conteine A∣nimall spirits, therefore not in the braine.

Add heereto, that the forme of euery thing is stamped vpon the aliment and the spirit, onely by the substance of the part: now in those complications there is onelie a power to prepare and as it were to delineate the spirites, their forme they haue onely

from the Marrowy substance of the braine. Finally, as the Braine by reason of this mar∣rowy substance is called the braine, and this marrow is the principal part of this noble Organ the seate of the Memory; Reason and Discourse: so I thinke that the chiefe part of the nerue is the marrow thereof, which carrieth the commaundement of the Sensa∣tiue and Motiue Faculty, not onely by irradiation but by a corporeal spirit. And ther∣fore it is that Galen in his eight Bôoke de vsupartium calleth the braine Nervum amplis∣simum & molissimum, A soft and large Nerae; and againe he calleth a nerue Cerebrum du∣rius & resiccatum, A hard and dryed Braine. But if (as Rondeletius conceited) the inwarde part of the nerue hadde beene onely ordained for the establishing and sustaining of the sinal Arteries ioyned to their Membranes, then certainely is the Marrowye part of the nerue the basest and most ignoble.

Let therefore the opinion of Galen and of the Ancients remaine with vs as current and Cannonicall, to wit, that the Animall spirits passe through the marrow of the nerues not through the Arteries.

These things being thus establisned, it remaineth that we discouer the cause of the pal∣sie which happeneth on the contrary side to the wounded or affected part. When the * 1.22 right part of the Head is wounded a portion of the Ichor may fall 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Rectitude into the right fore ventricle; now out of it into the third (which is common) there is a manifest passage, (this Ventricle Galen calleth the middle either because it is in the very center of the Braine, or else because it is scituated betwixt the two vppermost and the fourth Ven∣tricle which is the lowest) and the humour conteyned in that Ventricle is as it were in the center of the Braine. Wherefore if it follow the Motion of the Elementary forme it must fall into a lower place: now the sound part is alwayes the lower, because the patient euer leaneth or lyeth vpon the sound side not vpon the sore side for auoyding of paine. VVhat therefore should hinder but that the humour may fall out of the thirde ventricle into the fourth, and from thence into the spinall marrowe on the opposite part vnto that which is wounded, and so that part become Paralyticall or resolued? The Braine is not as some haue dreampt diuided from the top to the very bottome; the vpper Ventricles determine into a common cauity into which they thrust downe their supersluities. This common ca∣uity is directed into the fourth Ventricle which is common both to the After-braine and the spinall Marrow. It is not therefore against our Anatomicall Principles or groundes, that Matter, Flegme and Blood may be transmitted from the right Ventricle to the thirde, and from hence through; he fourth Ventricle into diuers parts of the spinal marrow, now into the right side and now into the left, as either of them is lower or weaker.

Another reason also may be brought of the palsy in the sound part not in the affected, * 1.23 because Nature vseth to auoyd the excrementitious humour by the wound, as sometimes by a flux of blood, sometimes by quitture, sometimes by Medicines which draw away and exhaust the humour either sensibly or insensibly, so that the affected part is well purged by some or more of these meanes; but the opposite part which is not expurged is easily af∣fected either by simpathy or when the matter is transmitted or falleth vpon it.

Some thinke that almost all the spirits do flow to the part wherein the tumor or infla∣mation * 1.24 is, whence it is that the opposite part being defrauded of them is resolued.

Notes

• * 1.1

  That the op∣posite parts are resolued, prooued by authorities.
• * 1.2

  A history out of Hippocrates.
• * 1.3

  Diuers opini∣ons how this Palsie com∣meth.
• * 1.4

  The first.
• * 1.5

  Of Cassius and Aretaeus that the nerues crosse one another.
• * 1.6

  Consuted. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.
• * 1.7

  None but the opticks doe intersect.
• * 1.8

  The 2. opini∣on that the spirits passe by the arte∣ries which in∣tersect.
• * 1.9

  Consuted.
• * 1.10

  The diuarica∣tion of the ves¦sels of the braine.
• * 1.11

  The sinus or duplication of the dura me∣ninx.
• * 1.12

  The arteries of the brayne do not inter∣sect.
• * 1.13

  Experience.
• * 1.14

  Reason.
• * 1.15

  The Art••••ies do not cōuty the Animall spirits.
• * 1.16

  A light kinde of Apoplexie whence.
• * 1.17

  Rondeletius o∣pinion that the Animall spirits passed through the Arteries.
• * 1.18

  Praxagoras o∣pinion out of Galen.
• * 1.19

  Consuted.
• * 1.20

  That the Ani∣mall spirites passe not by the Arteries.
• * 1.21

  Diuers Argu∣ments.
• * 1.22

  The cause of the palsie in the opposite part.
• * 1.23

  Another rea∣son.
• * 1.24

  Another.