The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. II. Treats of the superior, or ascendent Trunk of the Vena Cava, or Hollow-vein, and the branches which it scatters through the Head.

WEE are now to consider the other vein, which as we told you is called Cava, the Hollow one [a], which spreads it self much wider then the Gate-vein,* 1.1 as being distributed throughout the whole body. For its office is to nourish all those pars of our body, which conduce not to the concoction of the food, & those parts being spread far and wide, it is necessary, that the Hollow-vein also be very large, and ex∣tended to a great length: and because they ought to be nourisht with a thinner, and more elaborate blood, and not so thick and faeculent, as that wherewith the Stomach, Spleen, and Gall are nourisht; therefore the blood which the Hollow-vein makes, and carries, is also more pure, thin and sincere.

In delivering the History of this vein, although we are not of their opinion,* 1.2 who de∣rive its beginning either from the liver, or heart, yet because we must begin our Treatise of it somewhere, we thought fit to follow the received custome of Anatomists, and so for perspicuities sake we shall alwayes speak of it, as if it took its birth from the Liver. It may be added, that it spreads certain roots as it were in the Liver, just like the Gate-vein, in the History of which when for that reason we took our rise from those roots, we may not without cause begin thence also with the Hollow one. But this vein although it run directly through the whole Trunk of the body, and make one very notable stock [D] that is drawn out through the middle, and lowest belly, like one straight line continued, or rather in manner of a channel, or conduit pipe, is notwithstanding wont to be divi∣ded into two by reason of the Liver, and so one to be called the Ascendent Trunk, the other the Descendent. For indeed that is not true, to which many perswade themselves,

that the Hollow-vein in its going forth from the Liver, like the great Artery, when it comes out of the heart, is cleft into two trunks; but if hereafter they be called Trunks by me, you must beleive, that I do it only for orders sake in teaching. The Ascendent thetefore of upper Trunk [A.D.] is that which stands about the Liver, and is terminated about the Jugulum, or Hollow of the Neck; but that is called the Descendent, one [T.V.] which is beneath the Liver, and reaches down as far as the Legs. For both of them are af∣terwards divided into two branches, of which they of the Ascendent [m and q] ••re carried upwards to the head, as the Jugular or Neck-branches; or to the Arms, as the Brachiales [G and I] or Arm-veins; these of the Descendent Trunk to the Legs, and are called the Crural b anches. [T]. We will speak therefore of all these in order, so that we first deli∣ver the History of the Ascendent Trunk, then of its branches, that grows up partly to the Head, partly to the Arms, after that we will come to the Descendent Trunk, and its bran∣ches, that are digested into the Legs.

* 1.3As therefore we have said, that many little Veins like roots grow out of the Hollow side of the Liver, which alwayes by degrees inserted into the greater veins, and all of them at length meeting together about the middle of it did make a Trunk; so in the same man∣ner out of the circuit of the Convex side of the Liver a numerous propagation of veins issues forth, which afterwards meet together in one Trunk. This Trunk makes its way through the nervous part of the midriff on its right side, and passing through it goes undivided to the Jugulum, or Hollow of the Neck, and because it climbs upwards, it is commonly called the Ascendent Trunk by them who conceive that the Hollow-vein rises out of the Liver. It is much lesser then the Descendent, because the upper parts are nourished by it alone; but almost all the inferior parts, that are contained in the lowest Belly, by the Gate-vein. But although it be not parted into any branches, until it come to the Jugu∣lum;* 1.4 yet before that it spreads some propagations at its sides, and of those, three notable ones. The first [ee] is that which is called Phrenica, or the vein of the Midriff, on ei∣ther side one, and is distributed throughout the whole Midriff, which is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, with a numerous issue, sending little branches to the neighbouring Pericardium, or purse of the Heart, and the mediastinum, or partition of the Chest; which when it has now got above, and entred the Chest, it inclines a little to the left hand, and enters the Pericardium, and being hidden very close over against the eight Rack-bone of the Chest, is very strong∣ly infixt into the right ventricle [C] of the heart; that Aristotle did not without cause guess, that it sprung from hence. But before it be so infixed, it sends out another pro∣pagation [bb] which is a notable one, and extends it self by the hinder part of the Heart, and the left side of it, towards the forepart, compassing the basis of the Heart like a Crown,* 1.5 from whence it is called Coronaria, or the Crown-vein of the Heart. This scat∣ters many branches through all the outer surface of the Heart, but especially through the left side▪ as that which needed a more copious aliment then the right side, because of the continual, and greater motion there. But because the flesh of the Heart is hard, and solid, it ought therefore to be nourisht with a thicker blood, from whence it is, that this branch grows out of the vein, before it enters the Heart, to wit, when the blood is somewhat thicker, and not yet attenuated in the cavities of the Heatt. Near to the original of this there is a little valve, or flood-gate, which hinders the blood from flowing back to the Hollow-vein, as it might easily do by reason of the continual motion of the Heart. When the Hollow vein has now gotten above the Heart, it becomes lesser, and perforates again the Pericardium, and for sakes the Rack-bones of the Back, and being got above the Gullet, the rough Artery, and the Aorta, or great Artery, (which lean so upon one another, that the Gullet takes hold of the bodies of the Rack-bones, the rough Artery lies upon that, and the aorta again upon this) it climbs upwards through the midst of the division of the Lungs, where the right part is separated from the left. But because by this means it could not get to the back, and the little branches, if it should have sent forth any such, had been very liable to danger of breaking, being so hanged up; therefore it sends forth a third propagation [cc] as soon as it is got out of the Pericardium or purse of the Heart.* 1.6 The Greeks call this vein 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the Latins sine pari, or carens conjuge, without a companion, or wanting a mate, because in a man there is but one, and it has no compa∣nion, or mate on the left side, as other veins have; though in creatures that chew the cud, it is double, and plainly to be perceived of both sides. But it issues forth about the fifth Rack-bone of the Chest out of the hinder part of the Hollow-vein, and the right side, and goes downwards, not directly, but inclining a little toward the right hand, is as it were reflected backwards to the Back-bone: but as soon as it reaches the eight, or ninth rib, it is cleft above the Spine of the Back into two branches, which running downwards pass through the division of the midriff, which is betwixt its two pro∣ductions, and so are spread abroad into the lowest Belly: Of these the left, which is some∣times the greater, hiding it self about the transverse Processes of the Rack-bones, and under the left production of the midriff and the original of the first bending Muscle of the thigh, is inserted into the left Emulgent, either near to its beginning, or (as it oft happens) into the middle of it. But the right, running on likewise under the mem∣branes

about the transverse processes of the right side, and the right production of the Septum or Midriff, and the beginning of the same first bender of the thigh, which keeps the right side, is implanted sometimes into the very Trunk of the Hollow-vein, sometimes into the first vein of the Loins. And we are indebted for this observation to the learned Fallopius, who would have the matter that is gathered together in the Chest, whether it be watery, or purulent and corrupt, or sanguinous, to be evacuated by the benefit of the left branch of this vein; of which notwithstanding we will say something briefly in the following Book. But this vein in its journey downwards shoots forth twigs of both sides, as well right, as left, of which the right are more notable, and larger, of which there are numbred almost alwayes ten; which run out to as many distances of the lower ribs, and make the inferior Intercostal veins. But I say they are almost alwayes ten, be∣cause it happens very seldome, that all the distances of the ribs receive branches from this vein, the two uppermost, to wit, the first and second distance getting their surcles or twigs from the fourth branch, that is presently to be mentioned. But these twigs run straight forwards near to to the lower side of the ribs, where there are cavities cut out for them, as we have taught in the second Book. And truly this place is diligently to be taken no∣tice of by Students in Chirurgery, because of the opening of the Chest in the disease called Empyema, that they may know that incision is to be made in the uppermost place of the rib, because in the lower the vessels would be harmed to the great indangering of life. But these veins do not run through the whole length of the true ribs, but are terminated together with the bony part. But the propagations of the Mammary vein nourish the six distances between the gristles of the seven true ribs, as we shall tell you by and by. Yet in the bastard ribs they run even beyond the Gristles towards the Abdomen or Paunch, into whose Muscles they insinuate themselves. But there are certain other little branches propagated from the same vein, by which nourishment is derived to the marrow of the Rack-bones, and the Muscles, to wit, those about which they are carried: some also are implanted into the Me∣diastinum near to the back. This vein sine pari without a companion, being thus constituted, the Hollow-vein ascends to the Jugulum, or Hollow of the Neck [D] being supported by the Mediastinum, and a certain soft and glandulous body, which the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and is placed in the highest part of the Chest, to defend the divarications of the veins there hang∣ing up from all danger of breaking.

And here the Hollow-vein is first divided into two notable branches [EE] from which all those veins arise, that run as well to the Head, as to the Arms,* 1.7 or to certain Muscles of the Abdomen. Of these one goes to the right side, and the other to the left, which as long as they yet are in the Chest, are called Subclavii, Subclavian branches, because they go un∣der th•• Claviculae, or Collar-bones; but as soon as they have gotten out of the Chest, and attain to the Arm-hole, they are named Axillares, the Axillary-veins [F]. From both of them very many propagations issue forth, some of which arise from their upper part, and some from their lower. In our recital of them we will observe this order, that they which are nearest to the Trunk, shall be first mentioned by us; and they last, which are farthest from it.

The first propagation then issues out near the very root of the divarication or divi∣sion of the Trunk, and is called Intercostalis superior, the upper intercostal-vein;* 1.8 [e] there is of either side one, which being very little, and descending along by the roots of the ribs, as far as to the third rib, sends two twigs [ff] overthwart, like the vena sine pari, to the two distances of the upper ribs. But if the vena sine pari send its propagations to all the distances (as it sometimes happens) then it is wanting not without cause. Sometimes the same vein arises from the Trunk of the Hollow-vein, before its division into the Sub∣clavian-branches.

Another vein [g] sometimes arises from the fore-part of the Bifurcation; sometimes from the root of the Subclavian-branch, and is double, of either side one: sometimes al∣so only one grows out of the middle of the Trunk, before it be divided; which at length, when it has attained unto the Breast-bone, is parted into a right, and a left branch. For Nature is wont to sport, as sometimes in its other works, so especially in the rise of veins, so that they are not spread in all bodies after the same manner.* 1.9 But this is called Mam∣maria, the Mammary-vein, which, whensoever it arises, going toward the fore-part, strives to get up to the higher part of the Brest-bone, and descends by the side of it, and when it comes to the Breast-blade, about its sides goes out of the Chest, and runs on di∣rectly under the right Muscles of the Abdomen, even to the Navil, near to which it is joyned by Anastomosis, or Inoculation [10] with an Epigastrick-vein [9] that ascends and meets it; by the benefit whereof arises that notable sympathy betwixt the womb and Breasts of women, of which we shall speak more hereafter in the eight Chapter, when we shal•• insist on that History of the Epigastrick vein. But before it leave the Chest, in its descent, it distributes one branch a piece to the six distances betwixt the Gristles of the seven upper true ribs, of either side, which are terminated with the Gristles near to the end of the bony part of the ribs, in which place we told you that the branches of the vein sine pari, (with the extremities of which these are joyned) were ended. From these

veins, which are distributed in this manner to the distances of the Gristles, some others very worthy of our notice do arise, which are disseminated both in the Muscles that lye upon the Breast, and into the Paps. Near to these a third [h] arises, and sometimes al∣so grows out of the Trunk,* 1.10 which is called Mediastina, because it spreads it self into the Mediastinum, or membrane that closes up the cavity of the Chest, being extended all a∣long by it,* 1.11 with the left Nerve of the Midriff. The fourth [i] commonly called Cervi∣calis, or the Neck-vein, is a large vein of both sides, which running obliquely, upward, and backward, to the Transverse processes of the Rack-bones of the Neck, and climbing up through their holes, (from whence perhaps it might be better named Ʋertebralis) affords sprigs to the Muscles that lye next upon the Rack-bones. When this vein has got above the Transverse Process of the seven Rack-bones, it derives a notable branch to the Sinus or Ganale; in the Neck, through the hole that is made for the outlet of the Nerves; and then another, when it comes above the Process of the sixth spondyl, or Rack-bone, and a∣gain another, when it has left the fifth Spondyl until at last it comes to the Process of the first Rack-bone, which notwithstanding it does not touch, much less does it pass into the Skull, (as Vesalius would have it) near which it goes partly to the same sinus or canale, partly it is distributed into the hinder part of the Neck. For there are two long sinus filled with blood, which are made out of the hard membrane of the Brain, one of each side, being placed at the sides of the ma••row of the Neck. From these little branches are di∣stributed, which nourish the marrow of the Back-bone, and the neighbouring parts; they being about the Juncture of the head with the first Rack-bone, and end near to the seventh Rack-bone of the Neck. These two sinus, of which one is of the right, another on the Left-side, have some communion betwixt themselves by a little pipe, and that a short one, which is derived overthwart from the one to the other, for the most part about that region of the Neck, which is betwixt the second and third Rack-bones. At last there is a fift vein [l] which arises from the hinder part, called Muscula imferior, or the lower Muscle-vein, which is distributed in many branches to the Muscles in the lower part of the Neck, (and so extending the Head and Neck, from whence the vein might be rightlyer called Cervicalis, or the Neck-vein) and also to those in the higher part of the Chest near to the Rack-bones.

* 1.12From the upper part of the Subclavian branches, whilest the Hollow-vein is yet in the Chest, three propagations issue forth; two of which do very well-deserve to be no∣ted, which take their way upward, under the muscles that bend the Head. The former of the two looks more inward, and is called Jugularis interna, the inner Jugular vein: the other inclines to the outer parts, and is commonly called Jugularis externa, the outer Ju∣gular vein. For both of them arise near to the Jugulum, or Hollow of the Neck, and ascend by that to the Head. The inner is greater, and the outer less in a man; but in Brutes tis contrary. But when almost all Appellations are derived, and that best, not from the place, through which the veins pass, but from their insertion, perhaps they might be rightlyer named Cephalicae or Capitales, Head-veins. The inner Jugular vein [m] takes its original near to the joint, by which the Clavicles or Patel-bones are tyed to the Chest, and as soon as it arises, is joyned with the arteria carotis, or sleepy Artery, and a Nerve of the sixt pair, as companions in its journey, at the side of the rough Artery, and climbing to the Chops, about the middle of the way is parted into two branches, of which one is called the outer, the other the inner branch. The outer is so called, be∣cause it comes not into the inner parts of the Head, but being divided into two at the corner of the lower Jaw, distributes one branch to the Chops, and the other near to the Ears, and Face. The inner branch, all the way, is joyned to the Arteria Carotis, or sleepy Artery, even to the basis of the Skull, whither when it is arrived on the backside, it is likewise cleft into two branches, but of unequal bigness. For the first [n] is greater and more hinderly, being carried backward obliquely, which having propagated some twigs to the Muscles under the Gullet, and in the forepart of the Rack-bones of the Neck, through the second hole of the Occipitium or Nowl-bone enters the Skull with the lesser branch of the Arteria Carotis, through which said hole the sixt pair of the Nerves de∣scends: and thus this branch enters the first [1] and second [2] sinus of the thick mem∣brane. The second branch [p] be in smaller, and more to the forepart, quite forsaking the Arteria Carotis, or sleepy Artery, goes to the fore-part of the Head, and after that by the way it has bestowed a Surcle not very notable upon the Organ of hearing, it enters the Skull through the seventh hole of the Wedg-bone, or Os cuneiforme. This is dispersed through the basis, and sides of the thick membrane, with a numerous issue of branches, the prints whereof are observed in the inner surface of the bones of the forepart of the Head, as we have said above in the second Book. We will call these two branches, be∣cause they go to the brain, Encephalici, as if you should say Cerebrales, of the Brain, and that shall be the greater Encephalicus,* 1.13 this the lesser. The external Jugular vein [q] a∣scending under the skin, and the Musculus Quadratus, or square-Muscle, that draws down the Cheeks,* 1.14 by the sides of the Neck, when it comes to the Ear, is cleft into two branches [r] one of which I call Profundus, the deep one, because it enters the Muscles, and retires

into the more inward parts, the other Cutaneus the Skin-branch. The deep or inner one [s] in its first divarications meets with Glandules about the Chops, and sends forth propagations worthy of our notice to the Larinx or Throttle, and the Glandules that grow to it, as also to the Muscles of the Chops, and of the bones called hyoides, among which that which creeps all along under the tongue, is a notable one, and is scattered into many little branches, which are seen, if the Tongue be lift up,* 1.15 even before dis∣section. From this deep branch three other arise, which enter into the inner parts of the Head and the Skull. The first, after it has spread little branches into the Chops, and Mouth, enters the Skull, through the first hole of the Temple-bone. The next [e] passes out of the fore part of the eye through the second hole of the Wedg-bone, at which the second pair of Nerves gets out, and runs with some Surcles th••ough the thick∣er Membrane upwards. The third is scattered out of the bredth of the Nostrils through the hole of the Os cribrosum, or five-bone into the same Membrane. These two nourish this forepart, to which the third sinus reaches not, but ends near to the partition of the Mamillary Processes. But the outer or Skin-branch [u] creeping by the skin of the Head,* 1.16 and stayed up with the Glandules under the Ear, which they call Parotides, is divided into two branches; of which the Anteriour [x] is is carried upward obliquely through the Cheeks to the inner corner of the Eye, distribu••ing little branches by the way to the Nose; and going on to the Eye-brow, is joyned with the remainder of the branch of the other side, and makes the Strait vein, which they call vena frontis, the Fore-head vein, [y] and which in madness is opened to very great advantage. To this the Satyrist alludes, when speaking of a certain foolish fellow, he sayes,—Mediam pertun∣dite venam.

The other or Posteriour branch is carried behind, and sends branches to the Temples [z] and skin of the Back—part [α] of the Head. A third vein, which arises out of the upper part of the Subclavian branches, is commonly called Muscula superior,* 1.17 the upper Muscle-vein, in relation to another of the same name arising out of the lower part. It issues out near to the external Jugular vein, and is dispersed into the Muscles, and skin of the back-side of the Neck, in regard whereof we shal not do amiss to call it Cervicalis su∣perior or the higher Neck-vein [β]. But now let us return to the distribution of the Subcla∣vian-vein, from which we have digrest. This vein, as soon as it gets out of the cavity of the Chest, is called Axillaris [F], and when it comes to the Arm-pit,* 1.18 is divided into two notable branches, called Cephalica or Head-vein [G] and Basilica [I], which are afterward disseminated throughout the whole Arm. But before the Axillary-vein be thus divided, it sends forth two twigs: the first [γ] is called Scapularis interna the inner Blade-vein and is distributed, through the Muscles on the inside of the Shoulder-blade: the other [δ] is named Scapularis externa, or the outer blade-vein, it is a pretty big one, and is implan∣ted into the muscles of the outer, and gibbous part of the same Shoulder-blade.* 1.19 But the vein Basilica also, before it enters the Arm, shoots out two propagations; one called Thoraci∣ca superior, or the upper Chest-vein [ε] because it arises out of a higher part then the follow∣ing; it is a very notable one, and runs through the inside of the pectoral Muscle that brings the Arm forward to the Brest; it distributes branches also to the other Muscles of the Brest, as also to the skin of the Dugs in women. The other is called Thoracica inferior,* 1.20 the lower Chest-vein [ζ], a great and notable one likewise, which descending along the side of the Chest is distributed especially through the third broad Muscle or Latissimus that moves the Arm backward, scattering many little branches from it self, which afterwards are joyned by Anastomosis or inoculation, with the branches of the vein sine pari, that fall out of the Chest. And this vein sometimes grows out of the former, or the upper Chest-vein. These branches being thus distributed, the Axillary-vein reaches into the Arm.

Notes

• * 1.1

  The use of the Hollow-vein.
• * 1.2

  The method to be observed in the History of this Vein.
• * 1.3

  The Ascendent Trunk.
• * 1.4

  Propagations of the Ascen∣dent Trunk. Phrenica.
• * 1.5

  Coron••ria.
• * 1.6

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

  The division of the Hollow vein into the two Subclavi∣an branches.
• * 1.8

  Propagations from the lower part of the Subclavian branches. Intercostalis su∣perior.
• * 1.9

  Mammary.
• * 1.10

  Mediastina.
• * 1.11

  Cervicalis.
• * 1.12

  Propagations that arise from the upper part of the Subcla∣vian branches. Jugularis in∣terna. Externa.
• * 1.13

  Jugulari•• Externa.
• * 1.14

  Profundus.
• * 1.15

  Three br••n∣ches entring the skull.
• * 1.16

  Cutamea••▪
• * 1.17

  Muscula supe∣rior.
• * 1.18

  The division of the Axillary vein into two branches. Its propagati∣ons before its di••ision.
• * 1.19

  Scapularis in∣terna. Externa. Thoracica supe∣rior.
• * 1.20

  Thoracica infe∣rior.