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. I, Of the Nerves of the Brain.

AMong those eight Conjugations, which arise from the marrow of the brain drawn out in length, whilest it is yet contained within the limits of the skull, that offers it self in the first place,* 1.1 which makes the Optick Nerves, that are so famous among all the Masters of Ana∣tomy. For these are not only the biggest, if thou look upon their thick∣ness; but also without doubt the softest of all the nerves of the bo∣dy. But they arise out of the middle of the basis of the brain,* 1.2 on the forepart, according to the opinion of the Antients, but indeed, if the head be turned upside down in the dissection (wich is the proper way) out of the beginning of the former trunks of the spinal marrow, that their origi∣nal is as it were in the back part of the head,* 1.3 and presently each of them by little and little making towards its mate, they are united (not only joyned, as some would have it) over the saddle of the wedg-bone, and making one common square body, the marrow within them being mixed together. After that presently separating again, each of them is carried obliquely into the eye of its own side,* 1.4 entring the orb thereof through the first hole of the wedg-bone, and entring at the very centre of the eye. In this pair we may easily shew those two membranes, which are derived to the nerves from the two Me∣ninges of the brain, as also the very inner marrowy substance, which comes from the bo∣dy of the brain. Yet the nerve it self is not cleft into more branches, (as the other are) but lying hid makes the coats of the eye; and out of the thick membrane it forms that coat which is called Cornea, the horney one; out of the thin membrane that is called Ʋvea, the grapy one; but out of the substance of the marrow the Retina or coat like a net. For as soon as it is arrived at the centre of the eye, these membranes are displayed, and making a sphere contain the humors in them. [Use.] These nerves convey the faculty of seeing to the eyes; wherefore, they being obstructed, or comprest, a blindeness ensues.* 1.5 Galen hath a∣scribed holes to them, and Herophilus for the same reason called them 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the passages of the sight, teaching that there is a sensible hollowness plainly to be seen in them, whom for all that almost all Anatomists do contradict. But I have heretofore shewen in the University of Padua, and in a great assembly of them, that there are certain passages continuing from the beginning of these Nerves, as far as to the place where they meet together and presently after that vanish away toward the eye. And therefore I shewed that the Ancients may not only be excused, but also that they writ the truth, especially when none of them have said, that these passages were great, but only such as did not altogether escape the sight, if one would make tryal thereof in a great living creature, and by a cleer light, and presently after it is killed. For Galen himself requires these three conditions, 7. placit. 4 and lib. de oculis, that one may see them. But before we depart hence, I will bring in some problemes, that besides the history it self,* 1.6 I may also shew the use of that which I say, especially when in our time they only for the most part follow the study of Anatomy, who imploy their industry in the behalf of Phy∣sick. The first therefore shall be, what is the cause, that many upon sneesing often (espe∣cially [unspec 1] when they have povoked it for the nonce) have of a sodain faln blind. This hap∣pens, either because the branches of the sleepy arteries, which are so near to the optick nerves, that they touch, are filled, and bring so, press together those nerves; or else be∣cause

a copious, and that a phlegmatick humor has faln out of the brain into the optick nerves, and obstructed them. I have seen those that have been bling through the first cause, sometimes cured by a Seton; but I never remember, that any, in whom this a∣rose from phlegmatick humors, have recovered, except one having the French Pox, who being annointed with quick-silver, all the humors melting away, was restored to health. But it is not the part of a good and pious Physitian, to make use of those things, which, being full of danger, may do more harm, if they prove hurtful, then they can procure good, if they be profitable. And truly it is better not to cure blindeness, then to cause death, although oftentimes rashness helps them, whom reason helps not, as the most elegant of Physitians Celsus sayes elegantly. In the mean time in diseases of the eyes, they who practise Physick, may learn rather to administer those thing, which bring the phlegm out by the palat, then to draw the noxious humors to the nostrils. That I may conceal besides the danger which they avoid, that more profit arises from the medicines that void the phlegm out of the head through the mouth, which both long experience hath hitherto taught, and Anatomy perswades, when the optick nerves in their origi∣nal are not far distant from the palat; but farther from the spongy bone, and it is a pre∣ternatural way, by which the humors are carried, as hath been already demonstrated by [unspec 2] the learned Vesalius. Then it is disputed, by what means the eye can fall out of its orb, the optick nerve not being broke, whereof we may have very many histories. But it is not hard to give an answer, to wit, that the nerves may be very much extended in length. Whilest therefore this nerve receives much moisture in the inflammations of the eyes, it easily comes to pass that it is slackned; but the muscles themselves swelling very much, when they can no longer be contained in the orb, leap forth out of it. For this falling forth of the eyes most commonly proceeds from inflammations; such as are the stories the most learned Vega, who cured a woman in this case by procuring the flux of her terms, and a young [unspec 3] man by digesting ointments. But the question is very worthy to be made memtion of, and that gives me an occasion to explain it, which I have read in some Authors, that such as were before blind, upon receiving of a wound overthwart the forehead, and some upon a great loosness of the belly arising on a sodain, have received their sight, and that present∣ly. The cause of their blindness was no other then the compression of these nerves pro∣ceeding from the neighbour-vessels, to wit, the veins and arteries being swoln with blood, which such a wound presently emptyed. Wherefore I also sometimes, and not without success in that species of blindness with the Barbarians tall Gutta serena, open the middle vein of the fore-head, out of which I draw blood so long, till it ceases to run of its one ac∣cord.

* 1.7The second pair arises, as the ancient Anatomists say, from the sides of the basis of the fore∣part of the brain, near to the original of the first pair. But the new dissection shews, that it issues out at the inside of the beginning of the spinal marrow, and that they are so u∣nited in their original, that they make one common angle, which is the cause why both the eyes are moved together to the same sides. It is much smaller, if you compare it with the first pair, and harder, and goes out of the skull through the second hole of the wedg-bone, which is somewhat long, and so it enters the orb of the eye. By and by it is divided into many sprigs,* 1.8 which goe to the muscle of the eye; and the first climbing [unspec 1] up above the first pair or the optick nerves, is disposed of into the two muscles, as well that [unspec 2] which lifts up the eye lid, as that which lifts up the eye. Another very conspicuous one is [unspec 3] disseminated in many surcles into the muscle which moves the eye inward. The third, no contemptible one neither, being divided first into two fibres, and by and into more, is sent into the muscle that draws down the eye: the fourth, into the lower or lesser of the oblique muscles, that rowls the eye about toward the outer angle; at length it issues out some thin fibres, which being joyned with the first pair are distributed to the outer membranes of the eye, so that this second pair is propagated only to four muscles of the eye, and to that which lifts up the eye-lid. [Use.] The use of this pair is to impart the faculty of motion to the muscles the eyes.

* 1.9The third pair arises with a very small nerve out of the lower, and hinder part of the marrow of the brain, and runs directly forward under the basis of the brain, being tyed to the second conjugation; together with which it enters into the Orb of the eye through the said second hole of the wedg-bone. By and by it is divided into four bran∣ches, [unspec 1] of which the first offers a little branch to the upper, and greater of the oblique mus∣cles of the eye, or that called the muscle of the pulley, and then falling out through the hole of the fore-head-bone above the orb of the eye, in the skin, and muscle of the fore-head, which ought rather to be called the muscle of the eye-brows. This branch is diligently to be taken notice of;* 1.10 because I have long since observed, that, it being hurt with a slight wound, the eye-lid fell down, whilest the muscle of the eye-brow by reason thereof fell into a Pal∣sie. I have seen also the same palsie caused by cold, and naorcotick medicines, somewhat un∣reasonably applyed for the procuring of sleep. But hence also a reason may be rendered, why Hippocrates 1. Prognostick, reckons it among the signs of death in acute diseases to sleep with the eyes half open. For this is an ill sign for that reason, because it signifies,

that the nerves are very much dryed, and so the brain it self, whence it comes to pass that they who are so diseased, for the most part suffering convulsions afterward dye. In some also a fore-runner of the Falling-sickness is wont to arise from the same cause in the eye-lids, the eyes, and the whole face, when this third pair is pluckt by the humors beget∣ting the falling-sickness, and so a convulsion of the eyes and face is caused. The second [unspec 2,] branch is carried downward, and falls out through the hole of the fourth bone of the upper jaw, which is under the orb of the eye, and presently scattering into more propagations, on the fore part of the face, is spent upon the muscles that move the upper lip, and wing of the nose outward, as also upon the lip it self, and the gums of the teeth, called Incisorii, or shredders. The third is sent through the hole of the second bone of the upper jaw, behinde the caruncle that is placed in the inner angle of the eye, to the wide cavity of the nostrils, being spread throughout its coat, whereby is comes to pass that it is endued with a very sharp sense, and being but lightly touch't causes sneesing. The fourth goes out through that crevise which is betwixt the first bone of the upper jaw and the wedg-bone, in the outer angle of the eye, or through the fourth hole of the wedg-bone, and departs to the inner side of the temporal muscle. [Ʋse.] The use of this pair is to convey the faculty of moving to the said muscles.

The fourth pair arises out of the marrow of the brain on the back-side,* 1.11 goes out of the skull through the sixth hole of the wedg-bone, and running strait down, propagates three branches from it self. The first is presently after its going out of the skull, which being writhed sometimes about in manner of the tendrels of a vein, or gourd, and united to two [unspec 1] sptigs of the Auditory nerve (of which we are to speak next) afterward distributes surcles to the temporal muscle, that lifts up the lower jaw, and that which moves it forward from the head, as also to the muscles of the cheeks. After this the pair running farther down, issues forth a second branch, which propagates surcles in order to the gums of the upper cheek-teeth called the grinders, and also to the teeth themselves. The third branch issuing forth from the back-side of the nerve, and entring the hole of the lower jaw-bone that is bored in the inner surface of it, at the original of the processes, bestows little branches in order to the roots of the teeth, and at length going forth through the fore-most hole in the outer surface is terminated in the lower lip, and skin of it. The remainder of this nerve is spent upon the coat of the tongue near to the root, and gives it the power of distinguishing sapors or tasting.

But note in this place, that these two pairs which we have now recounted, I say,* 1.12 the third and fourth are commonly reckoned for one by Anatomists, and that the third; but with this distinction, that they say this very pair arises with a double root; the one smaller, and the other thicker. They call that the smaller root, which we set down for the third pair; that the thicker, which we make the fourth. But we distinguish them, because indeed they are not joined together, neither in their original, nor in their progress. But that which they ac∣count for the fourth pair, seems not to be distinguished from the third; as Valuerda himself grants, lib 7. Anatomiae. cap. 4.

The fifth pair issues out of the marrow of the brain drawn out in length,* 1.13 on that side whereon a part of the cerebellum or after-brain is joyned to it, arising out of two nerves, of which one is softer, the other harder. These go out of the membrane together, and enter the organs of hearing. through the hole of the temple-bone, that is bored in the stony process thereof, being a large one and winding.* 1.14 After this that harder part goes forthwith to the foreside, being carried through a peculiar channel, and returns back∣ward again obliquely through the same bone, and departs into the first cavity of the in∣ner ear. From thence being more reflected, it sends forth two propagations, one higher, the other lower; but both pass through their peculiar holes. The upper is carried through the transverse hole of the same bone, through which also a little vein passes into the or∣gan of hearing; and a little after it is come forth of it, is joined with that branch of the fourth pair (as we have delivered; but as others commonly count the pairs of the third) which we told you was writhed about, like the tendrell of a Vine. The lower goes out through the third hole of the same bone, which is very narrow and winding; and being carried overthwart above the muscle of the lower jaw, that moves it sidewards, descends into the chops, having disseminated a pretty many propagations into the nostrils. But forthwith it is joyned with the propagation of the fourth pair, that resembles the tendrell of a Vein, or that sprig which goes to the tongue, from which it passes to the roots of the teeth, and muscles of the cheeks, as also to the skin that goes about the root of the outer, or little ear. Anatamists do beleive, that by means of the branch it comes to pass, that they who are born deaf, are for the most part dumb also.* 1.15 But that softer part of this pair is carried together with the hard part; and when it is come to that first ca∣vity of the inner ear, it is spread throughout it in manner of a membrane, and so it deserves to be called the Auditory nerve, as ministring all the spirits, that serve for hea∣ring.* 1.16

The sixth pair arises somewhat more toward the lower and hinder part, then the fifth,* 1.17

and not with one, but with many little nerves severed from each other, which for all that are presently joyned together, although they do not close so as to make one only, but two distinct ones alwaies, yet are they contained in one membrane, arising from the Durae meninx of the brain, which hath deceived many, so that they have accounted them for one. Being thus joyned, they descend both together out of the skull, through the second and third hole of the nowl bone; through which same the lesser branch of the sleepy Artery, and the greater of the Jugular vein enter into the skull. There being then two nerves,* 1.18 the one in its egress inclines more to the forepart of the said hole, and is the lesser of the two; the other to the hinder part, and is the greater. That presently after its going forth of the skull, tends straight downward to the muscles or the tongue and chops, and to the parts placed in the mouth, upon which it is wholly consumed.

* 1.19This on the contrary sends its first propagation to the muscles seated on the backside of the neck, especially to the first muscle of the shoulder-blade, called Cucullaris or the cowl∣muscle, and then adhering to the seventh pair, and the aforesaid Artery and vein, by the benefit of certain membranes, it runs down to the side of the throttle, to whose muscles, especially those seated in the inner cavity, it distributes surcles overthwart. Here many propagations of nerves meeting together, and parting asunder again, a cer∣tain texture is made, wherein knots are found not unlike to the glandules that are tyed to the divarications of the vessels; which was first observed by the most learned Anato∣mist Fallopius, who would have it resemble the body of one alive. But the greater nerve it self going into the middle betwixt those same vessels which I spake of, is carried leisurly from the throttle to the rough artery, and running down at the side thereof, tends to the chest.

* 1.20But before it enters thereinto, it is divided over the hollow of the neck into two branches, of which one is the outer and less: the other the inner and greater. We shall now speak briefly of the distribution and propagations of them, but so that being the right trunk is disseminated into another manner then the left, we set down the history of each by it self; and first of the right, then of the left.

* 1.21The outer branch then of the right nerve sends out propagations presently after the divisi∣on to the muscle that bends the head, called Mastoideus, as also to that of the bone hyoides, called sternohyoides, and that of the Larinx or throttle, called sternothyroides; after this it [unspec 1] enters the cavity of the chest, and when it comes to the axillary Artery, issues forth from its inside sometimes three, sometimes two surcles, one under another, which are turned about the said axillary Artery, as it were an axel-tree, or (to say truly) a kind of pulley, and closing together make one nerve, which being [unspec 2] fastned to the right side of the rough Artery, by the benefit of a membrane, runs back from the lower part thereof to the highest, and hasts to the right side of the throttle, lea∣ning upon a glandule which is placed at the root of the right side. Having past this, it is forthwith divided into many surcles, which are spent upon the muscles of their own side, which are placed in the throttle, and h••ve their heads downward, giving motion to them.* 1.22 And this nerve is called Recurrens, the ••eturning one from its progress, and is very famous among all, being so made by ••ki••••ful nature with great wisdom that it might be inserted into the muscles of the ••••ottle, whose heads look downward, when all the nerves that give motion, ought to be inse••ted into the heads, and to look towards the end, not on the contrary. And bec••••se the throttle is an organ of the voice, but the voice cannot be uttered without motion of the muscles, that either open the cartilages of the throttle, or shut them; therefore these nerves, which impart to the muscles the power of moving and contracting themselves, being either bound hard or cut off, it happens for that cause, that the voice is taken away. This may be very handsomely shewn in dogs, or in a hog, because one continually makes a noise with barking, the other with grun∣ting. For one of these nerves being cut off, half the voice is taken away; but both being cut, it is wholly lost. The recurrent propagation being thus constituted, the outer branch [unspec 3] running down obliquely under the hollow of the neck, after that by the way it hath [unspec 4] distributed surcles of an indifferent bigness into the Pleura, or membrane of the ribs, and [unspec 5] into the coat of the lungs, and given others to the pericardium or pu••se of the heart, and to the heart it self, it descends farther within the duplication of the mediastinum, and near to the rack-bones is divided into two branches, which make the right nerve of the left orifice of the stomach, are carried obliquely, and the•• piercing through the midriff, together with the gullet, to which for all that they afford ••••ver a branch, are consumed upon the le••t orifice of the stomach, with many branche•• 〈◊〉〈◊〉 a little net, and so encompass it together with the left nerve,* 1.23 that it seems wholly to 〈◊〉〈◊〉 of nerves. Hence there is so great a sym∣pathy of the stomach, not only with the b••a•• 〈◊〉〈◊〉 with the heart also; that such diseases as pain the upper orifice, seem to be of the ••t, and indeed so they are, the same heart suffering pain, because of this nerve being ••••ined. And this is the true cause, to wit, the communion of this nerve, not the ne•• 〈◊〉〈◊〉 of both the entrails, as others say. The inner branch goes to the inner side of the ••o•••• of the first ••ib of the chest, and cleaving to

the rack-bones under the Pleura, runs down through the roots of the rest of the ribs, ta∣king to it a little branch from every one of the Intercostal nerves that issue out of the back-bone; then passing through the midriff with the Descendent trunk of the great artery it is carried as far as to the Os sacrum or great bone, at the region whereof it issues out three propagations, which are distributed into the natural inner parts. The first goes to the lower membrane of the Kall, and descending through it is parted into three little branches, of which one is distributed to the right side of the same membrane, and to that part of the Colique Gut, that is joyned into it: another the least of them, and a very small one, to the guts duodenum and the Jejunum about its beginning; the third to the bottom of the stomach on the right side, and to the upper membrane of the Kall, which is some∣thing the larger. That which remains of this propagation is spent upon the hollow part of the Liver, and the bladder of Gall. The second goes into the right kidney, and [unspec 2] the membrane thereof. The third, which is greater then either of the former, descen∣ding [unspec 3] to the first rack-bone of the loins, reaches into the right side of the mesentery and in∣to the Guts that are tyed thereto entring the center of the mesentery in com∣pany of an artery, and a vein. The remainder goes into the bladder, and in women into the right side of the bottom of the womb. But the outer branch of the left nerve,* 1.24 saving that in its descent it has offered sprigs both to the Pleura, or membrane investing the rib, and to the coat of the lungs, and that outwardly; as also to the purse of the heart, and heart it self inwardly, at that part of the Descendent Trunk of the great artery, where it first issues out of the heart, and is bowed to the back-bone, it sends forth three sur∣cles which returning to the said artery close together into one nerve,* 1.25 which is called sinister recurrens nervus, the left returning nerve, and in like manner as the right one, takes its progress upward, and is propagated into the muscles of the Larinx, or throttle After this it issues out a small sprig, which is distributed through the basis of the heart, and coat of it in manner of hairs. Afterward the remainder descends inclining it self oblique∣ly to the right, and goes to the upper orifice of the Stomach, in the right side where∣of it is diffused, as the right branch was before into the left side, being divided into many little branches in manner of a net. From this a surclo is carried down along the upper part of the stomach to the pylorus, or lower orifice, which when hath as it were inter∣woven with some sprigs, it goes into the hollow of the Liver.* 1.26 The inner branch first of all takes to it propagations from the intercostal nerves, and then passing through the midriff is divided into three. The first of them goes overthwart to the spleen, and in the way shoots out two sprigs; one, which is likewise sent into the lower membrane [unspec 1] of the Kall and part of the colick-gut, which is tyed thereto; another into the left side of the bottom of the stomach, and into the upper membrane of the Kall. The second pro∣pagation [unspec 2] goes into the left side of the Mesentery, and the guts of that place; sometimes also it issues sprigs, which run out with the seminary vessels through the processes of the Peritoneum, or rim of the belly to the testicles. The third goes to the left Kidney, and [unspec 3] the fat membrane thereof. The remainder of the branch passes to the left side of the bladder and of the bottom of the Womb. The use of this pair is manifest enough, [Use.] as being very notorious, when the outer branch bestows little boughs upon the middle bowels, but the inner upon all those of the lowest belly, and the right branch upon those of the right side, the left on those of the left. Besides this use it conduces by the returning branches also to the framing of the voice, by imparting the faculty of motion to the muscles of the throttle.

The seventh pair arises in the utmost part of the nowl bone,* 1.27 where the marrow of the brain is ready to go out of the skull, and so is counted the hardest of all the nerves, that have their original within the skull. But it arises in some roots separated from each o∣ther, which joyning together on both sides into one, it goes out of the skull through the fourth and fifth holes of the nowl-bone (which are planted betwixt that greatest one, which opens a way for the descent of the spinal-marrow, and that, at which the sixth pair goes out) and presently after its egress is involved in one common membrane with the sixth pair, whence some, not so diligently observing it, have believed that they were mixt one with another; and thus they descend together. When it comes to the root of the tongue, it distributes surcles into all the muscles thereof, sending over some also to certain muscles of the bone hyoides, and of the throttle, as also to those which take their beginning from the appendix called styloides.* 1.28 The use of this conjugation is to carry down the faculty of sense and motion from the brain, to the muscles of the tongue.

To these seven pairs, which are commonly so numbred,* 1.29 we add an Eighth which makes the nerves of smelling, by which a faculty is derived from the brain of apprehending the odors of things without. These are commonly affirmed to arise out of the mar∣rowy substance of the brain, in the basis thereof, near to the first pair;* 1.30 but the new dissecti∣on of the brain, and which is performed by turning it upside down, hath taught us, that they arise at the utmost sides of the brain, in that part which is above the holes of the ears, whereby it is manifest, that hitherto only one half of them hath been shewn. They are very sharp at their original, and distant one from the other, but going forward by de∣grees,

betwixt the uppermost and middle prominence of the brain, they grow thicker, and draw nearer one to another, and so at length they lye down above the sinus or cavities of the spongy bone within the skull. These are thrust into the mammillary processes of the brain: but Galen and Marinus (whom almost all Anatomists have followed) would not call them by the name of Nerves, although they altogether agree therewith in their colour, course, and use, because they neither have productions like the rest of the nerves, nor go out of the cavity of the skull: but truly they seem to me to commit no other a sophism, then they who have expelled the teeth out of the number of the bones because they are not invested on the outside with a membrane, as others are, although neither this makes any thing to the essence of the bones, nor that to the essence of the nerves.

Notes

• * 1.1

  The first pair of the brain.
• * 1.2

  Its original.
• * 1.3

  Progress.
• * 1.4

  Insertion.
• * 1.5

  The holes of the optick nerves.
• * 1.6

  Problemes.
• * 1.7

  The second pair. Its original
• * 1.8

  Branches.
• * 1.9

  The third pair. Its original. Branches.
• * 1.10

  An observa∣tion.
• * 1.11

  The fourth pair. Its original branches.
• * 1.12

  A note.
• * 1.13

  The fifth pair Its original. Its two parts.
• * 1.14

  The harder.
• * 1.15

  The soft part.
• * 1.16

  Its use.
• * 1.17

  The six••h piar Its original.
• * 1.18

  The lesser nerve.
• * 1.19

  The greater nerve, and its propagations.
• * 1.20

  The branches of the greater nerve.
• * 1.21

  The propaga∣tions of the outer branch of the right nerve.
• * 1.22

  The right re∣current nerve.
• * 1.23

  Whence the sympathy is be¦twixt the sto∣mach & he•• t. Propagations of the inner branch.
• * 1.24

  The outer branch of the left nerve.
• * 1.25

  Its propaga∣tions. The left recur∣rent nerve.
• * 1.26

  Propagations of the inner branch of the left nerve.
• * 1.27

  The seventh pair. Its original.
• * 1.28

  Its use.
• * 1.29

  The eighth pair.
• * 1.30

  Its original.