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. IV. Explains the lower, or descendent Trunk of the Hollow-vein.

WE have done with the upper Trunk, and branches of the Hollow-vein;* 1.1 it remains now that we treat also of the lower. Nevertheless (as we have above also ad∣monisht) they are not indeed two Trunks, as Galen would have them, but one only, which reaches in one continued line from its division about the fifth Back-bone of the Loyns [V] as far as to the Jugulum, or Hollow bf the Neck [D]: but, for methods sake in teaching, we thus divide it by reason of the Liver, which standing as it were in the middle of it, seems to part it into an upper and a lower Trunk. As there∣fore that is the upper one [AD] which runs up from the Liver to the Hollow of the Neck; so that is the lower [TV] which beginning at the same Liver, is terminated at the Os sacrum, or Holy-bone. And as the upper did run on undivided through the Chest, scat∣tering only some propagations at its sides; so the lower also slides down, intire through the whole Abdomen, or paunch, only some twigs sprouting from it. But when it has at∣tained to the fifth Rack-bone of the Loins, it is cleft into those two notable bran∣ches called Iliaci [XX] as the upper is into the Subclavian, which Iliacal branches after∣ward reaching into the Legs make the Crurall-veins; as the Subclavian carried into the Arms make the Brachiales, or Arm-veins. Let us speak therefore in this Chapter of the Trunk, and its propagations, as long as it yet is in the lower belly. Then let us come to the crural branches.

For the descendent Trunk then [TV] before it part into the branches, arise four veins.* 1.2 For as soon as it is come forth from the hinder part of the Liver, it declines to the right side of the Back, and sends forth a propagation from its own left side which they call Adiposa sinistra, the left fatty vein [υ on the left side] because it passes to the fat and outer membrane of the Kidneys, which arises from the Peritoneum or Rim of the Belly, as also to the Galandule, that grows above the Kidneys. There is another [υ on the right side] answering to this on the left side, but which does very seldome grow out of the Trunk, but rather from the upper side of the middle part of the Emulgent vein; and because it is distributed in the same manner as the left is, it is called Adiposa dextra, the right Fatty vein. Yet sometimes you may see the contrary also to happen, and this right vein to

come forth of the Trunk, and the left out of the Emulgent. For there are divers spor∣tings of nature to be seen in the veins; and you cannot easily meet with a dead body in which you may not finde something new, and differing from others. After this the Hol∣low-vein passing on, when it comes beyond the middle of the back, about the first Rack-bone of the Loyns, it brings forth a second pair of veins, [φ] very notable, which ha∣stens directly to the Kidneyes, upon whole substance it is wholly spent. And hence it is called Renale,* 1.3 the pair of Kidney-veins from its insertion; but from its use Emulgens, because the Kidnyes seem by this pair to milk out the whey or serous moisture in the blood, and to draw it to themselves. It is therefore very thick, but yet short, and not of equall length, nor rising directly opposite each to his fellow. It ••s short, because it did not need length, which for the most part is given by nature to vessels for some pre∣vious preparation. It is unequall, because it was fitting the left should be longer then the right, by reason that it was necessary to bring the spermatical vein out of it. But the beginning of both answers not directly one to another, lest one should be hindered by the action of the other. And the left is higher then the right, because the left Kid∣ney is also seated higher then the right. But the Emulgent branches, as soon as they arise out of the Trunk, do not presently go to the cavity of the Kidneys, but are first di∣vided into two greater branches, and so, accompanied with Arteries, enter the concavous side of the Kidneyes, and afterward being broken into lesser branches are scattered quite through the whole substance of the Kidneyes, and at last determin with their small hairy ends in certain fleshy processes, which they call Mammillares. These veins do serve not only for the bringing of nourishment to the Kidneyes, but also for the carrying down of the se∣rous moisture to those fleshy Processes called Mammillares, throught which it is strained into the pipes of the Ureters, and then gathered together into that cavity of theirs cal∣led the Pelvis,* 1.4 and so drops down by little and little into the bladder, as we shall shew, when we open the history of the Kidneys. And here the place is to be noted, in which the stones of the Kidneys are wont to be generated, which is not in the Emulgent vessels, I mean veins, or Artery; but rather in the very cavity of the Kidneys, or in the Pelvis and pipes of the Ureters. For in these if a viscous matter be at any time received, either it is hardened there by reason of a notable heat, or else through cold is congealed into grave••l or stone. For this matter is not only a crude and uncocted kinde of blood, which like a mucus matter sometimes is wont to abound in the mass of blood, but oftentimes also that excrementitious phlegm which falls down from the head, through the veins and Arteries, both into the hollow vein, and the great Artery, and sometimes into the Stomach and Guts. Of which this seem to be a manifest sign, that they who are subject to dis∣eases of the Stone, are very often troubled with reumes, and pains of the collique; of which whilst some perswade themselves that it is caused by wind, daily experience hath taught me, that it comes from phlegm; because I have observed, that they who are troubled with the stone in the Kidneyes, had their Colon or Collique-gut alwaies stuft with plenty of this phlegm, and that this being taken away, the Stone has been no longer bred. And therefore oft-times I give scouring Clysters, and such as gently purge phlegm, not only to such as have the Stone already, but also to such as are threatned with the breeding of it, with a great deal of benefit to the Patients. But all those things are perpetually to be avoided, which drive out the stones, as well because most of thar nature are hot, as also because they are able to drive down the crude matter plentiful∣ly to the Kidneyes. We though fit therefore to insist upon this, that we may accommo∣date the study of Anatomy to the very practice of Physick; especially seeing that the place wherein the stone is bred, is not commonly known, because the most famed Fer∣nelius, whom the greatest number of Physitians does for the most part follow, Lib. 6. Patholog. c. 12. thinks that small gravell is bred in the proper substance of the Kid∣neys,* 1.5 and washed from thence by the flowing of the Urine and carryed into the cavity, and so the Urine full of gravel slides down through the Ureters into the Bladder. But if any one enquire also the cause, why the left Kidney is more subject to the Stone, then the right; we must conclude, that this happens, because the Collique-gut lies more up on the left Kidney, in whose cells this phlegm, of which we spake, abounding, either it sweats through the pores, and is suckt into the Kidneys, or else by reason of its nearness, the Kidneys are exceedingly cooled; experience having often taught us, that this kinde of phlegmatick matter is indeed actually exceeding cold in the body, as they have sufficiently perceived,* 1.6 who have voided it in great plenty by Stool. After this there follows a third part [χ and ψ] called spermaticae,, or seminales, the spermatical, or seed veins, because they carry down matter for making of the seed. These differ in their original. For the left [ψ] arises from the inside, and middle part of the Emul∣gent, and communicating some surcles to that part of the Peritoneum, or rim of the bel∣ly, which covers the Muscles, that lye in the Loins, it goes fast by the said Peritone∣um, and descends obliquely; but when it has attained to the Os pubis, or the Share-bone, riding over it, it passes through the Peritoneum, and holes of the oblique and transverse Muscles of the Abdomen, with whose processes being sustained it is contorted into certain

varicous circlings, which are ••oyned with the spermatical Artery by Anastomoses or In∣oculations, and at length it ends in the Testicle of its own side. But the right spermati∣call vein [χ] arises not out of the Emulgent, but the Trunk it self, and the forepart of it, a little beneath the Emulgent-vein, and afterwards observes a like course with the former. And thus they are in males, though we may observe nature oftentimes vary∣ing in them: but in Women, although they arise in the same manner, and observe the same course with those in Men, as far as the Holy-bone; yet they fall not out of the Peritoneum, nor reach into the share-bones, but before they come to the Testicles, are cleft into two unequall branches; the lesser of which is scattered into the sides of the womb, toward the bottom of it; the greater being joyned to the spermatical Artery, and inocu∣lated with it, enters into the Testicle of its own side. Last of all the fourth pair is cal∣led [X] Lumbares, the Loin-veins [444] two,* 1.7 or three which the Hollow-vein sends forth from its back side, which looks towards the bodies of the Rack-bones of the Loins; and therefore they are not to be seen, unless the Trunk of the Hollow-vein be lif∣ted up. These veins go in through the holes of the Rack-bones, through which the Nerves go out, and so carry nourishment to the Spinal marrow. From them two other veins, tyed on both sides to the side of the Marrow, ascend toward the brain, with which afterward two veins descending from the internall Jugular, are joyned by an Anastomosis or Inoculation.

These propagations being thus sent out,* 1.8 when the Hollow-vein has almost attained to the Sacrum, or Holy-bone, about the fifth Rack-bone of the Loins, it inclines under the great Artery, and is cut into two notable branches called Iliaci [XX] which having gone a little way are again cleft into two others [Y and Z] of unequal bigness, of which one is called the inner, the other the outer. The inner is less, the outer lager and greater. But before they be so divided, they scatter two other propagations, the first of which [5] is commonly called Muscula superior, the upper Muscle-vein, which is disseminated overthwart,* 1.9 through the Muscles of the Loins, and Abdomen, or paunch, from whence I would call it Muscula lumbalis, the Muscle-vein of the Loins: the other [6] is named Sacra, or the Holy-vein,* 1.10 because it reaches some little twigs to the upper holes of the Holy-bone, for the nourshing of the said bone and the Spinal-marrow.

But from both the Iliacal branches many veins issue,* 1.11 before they go out of the Peri∣toneum or Rim of the Belly toward the Legs; and from the inner branch two. The first [7] arises from the out-side called Muscula media, the middle Muscle-vein; because it is scattered into all the Muscles of the Buttocks, and into their skin: For it carries aliment to all those Muscles, which are of the out-side, or Back of the bone Ilium or Hanch-bone, as also to the very joint of the Hip, that for this cause it ought to be especially taken notice of by them who would somewat curiously consider the cause of the ach in the Hip, or the Sciatica.* 1.12 I should think that this vein may not be amiss called Glutaea from its insertion, because it is implanted into the Muscles called Glutaei, or Muscles of the Buttocks. The other [8] grows out of the inside, and is a notable vein,* 1.13 called Hypo∣gastrica, or the vein of the water-course, from its distribution into almost all the parts of the Hypogastrium, or water-course.* 1.14 From this issues a branch named Haemorrhoidalis exter∣na, the outer Emroid-vein, because if at any time it swels with a more faeculent blood, or hot, or salt, it makes the outward Emroids of the Fundament. This affords twigs to the holes of the Os sacrum, or Holy-bone, but bestows greater branches upon the Muscles of the Rectum Intestinum, or the Strait gut, as far as to the outer skin of the Fundament. There is also another branch arising from the same Hypogastrick-vein, which we call Cysticus,* 1.15 the Bladder-branch, and is worthy of observation both in men and women; in men, be∣cause it is spent upon the Bladder; but in women, because in them being sustained with a fat membrane, it goes with some twigs to the Bladder; but with more to the bottom of the Womb; and with more manifest ones to the Neck of it, by which veins alone some think that the monthly courses flow in Virgins, and some also think the same in Wo∣men. But the monthly courses do not only flow out by these branches, but by those also which we told you were sent from the spermatical branch, and which go to the bottom of the womb, not to the Neck. For the menstruous blood is is usually purged out, whether in Virgins or women, every month; not only through the Neck, but especialy through those passages of the Womb, called Cotyledones. Which we have shown here at Padua, publickly in the Theater, the first year of our being Professor, in the carkass of a certain Woman having her monthly courses. For we saw that the Hypogastrick branches, and the sperma∣tick vessels with the Testicles were filled with blood, and that the Womb it self did pour out a thicker blood, the little mouths of the veins in the inner part of the Womb lying o∣pen, and manifestly gaping. Yet I saw twice in others, that the menstruous blood came out of the veins of the Neck only, not also out of the womb, and in another on the contrary that it flowed out of the Womb only. But the ordinary way is for women to be purged at them both and not at one only, except when besides the intent of nature obstructions do seem to hinder their flowing.

But we have observed, and seen divers times, whilest we were about the cure of Ulcers in the privie members, and the neck of the Womb, that at what time the monthly courses do flow, the month of the Womb gapes. I saw also then, that those parts were dilated with a certain stinking moisture, and that the neck of the Womb appeared much larger then it was wont to be at other times. And therefore no man need to wonder at that, which hath been observed by some Writers of our age, that in the time of their courses these parts have been so widened in some, that being new married, although they were true Virgins, they have for this reason been accused, and thought to have been defloured. Wherefore if it happen, that any, who are new married, doubt of their Wives virginity, because they finde the privy passage very wide, it will behove them to consider, whether their flowers were not at that time upon them. Now at length the remainder of the inner Iliacal Trunk makes to the Share bone, and taking to it a propagation of the outer Ilia∣call, together with which it makes one vein, and so passing throught the Perito neum, and hole of the Share-bone, it spreads it self into the leg, and is extended almost beyond the middle of the Thigh on the inside.

* 1.16From the outer branch in like manner some veins issue: and first of all, that which is called Epigastrica, or vein of the lower Belly [9] which arises from the higher part of the branch, and is so named, because it goes to the Muscles of the Epigastrum, to wit, the rich muscles of the Abdomen. For passing with its chief branch out of the Peritoneum or Rim of the Belly, it climbs strait up of both sides under the right Muscles, till it come near to the Navill, where it is joyned by Anastomosis with the descending Mammary-veins. But this Anastomosis or Inoculation is seldome found in men, but in women it is very conspicuous, from whence also Galen Lib. de Dissect. Ven. & Arter. Cap. 8. witnesseth, that great sympathy betwixt the womb and the Brests or Dugs is caused by these two vessels. But the most learned Hippocrates has explained this sympathy in many Apho∣risms of the fifth Section. For in the fiftieth Aphorism he sayes, If you would stop the courses in a woman, apply a very great Cupping-glass to her Brests. And in the thirty seventh; If the Brests of a great bellied woman, do of a suddain become small, the child proves Abortive. And in the thirty eight; If one of the brests of a great bellyed wo∣man become small, one of the Twins, that she goes with, proves Abortive; and that a Male, if the right Breast be small; a Female, if the left; so the womb being diseased, the Nipples become pale; and upon a Dropsie in the Womb they swell up. But there is a sympathy also not only by reason of the veins, but also of the Nerves, that come from the sixth conjugation. Whence we see, that if the Brests of a Woman, or Virgin be han∣dled, they are provoked to lust; so that for this reason also those Women, that have great Breasts may be accounted more lustful, as Afra is in Martiall. But it is convenient to note concerning the originall of this Vein, that very often it arises out of the Cru∣rall branch, which we shall by and by describe, but oftner out of the Iliacal. Another vein is the Pudenda [11] which arises from the inside of the outer Iliacall branch,* 1.17 after it is come out of the Peritoneum or Rim of the Belly, and it is called Pudenda, because it is spent upon the privities of both Sexes. For in men it is destributed into the Scrotum or Cod, and into the skin of the Yard; but in women it is propagated to the Lips and skin of the privy passage, to the Nympha or wings, and other parts of it; but in both men and women to the Glandules, that lye about the leskes, whence arises that confluxe of matter into these Glandules,* 1.18 in a pestilent or venereous Bubo. Lastly, the Muscula inferior, or lower Muscle-vein [12] is that which goes to the joint of the Hip, and is disseminated into the skin and muscles thereabout, by reason whereof in my judgment by a stricter Appellation it might be better called Coxendica, or Coxalis, the Hip-vein.

Notes

• * 1.1

  The inferiour Trunk of the Hollow vein.
• * 1.2

  Four propa∣gations arising from the Trunk before its division. Adiposa.
• * 1.3

  Emulgentes.
• * 1.4

  The place in which the stones of the Kidneys are bred.
• * 1.5

  Why the left Kidney is more subject to the stone, then the right.
• * 1.6

  Spermatica.
• * 1.7

  Lumbare••.
• * 1.8

  The division of the Trunk into the two Ili••cal bran∣ches.
• * 1.9

  Muscula supe∣rior.
• * 1.10

  Sacra.
• * 1.11

  Propagations of the inner I∣liacal branch.
• * 1.12

  Glutaea.
• * 1.13

  Hypogastrica.
• * 1.14

  Haemorrhoidals externa.
• * 1.15

  Cysticus.
• * 1.16

  Propagations of the outer I••iacal branch. Epigastrica.
• * 1.17

  Pudenda.
• * 1.18

  Muscula Infe∣rior.