Description of the Vermiform Appendix from the “De Fabrica” of Vesalius*

DESCRIPTION OF THE VERMIFORM APPENDIX FROM THE “DE FABRICA” OF VESALIUS* By SAMUEL W. LAMBERT, M.D. NEW YORK HARLES SINGER, in his fabrica spectare negligat quae in par- “Evolution of Anatomy,” tum aliarum constructione sedulo in- says: “Curiously enough quirimus. the vermiform appendix is not mentioned in the [Vesalian] text, thoughC it is clearly portrayed at least three times in the figures.” This statement was used recently to bolster up a claim that Vesalius must take second place to van Calcar, the artist, in re- ceiving credit for producing the epoch- making “De fabrica humani corporis libri septem.” As a matter of fact, both author and artist should receive equal credit. The physician and surgeon of today can readily understand the pic- torial presentations in the “De fabrica,” even though woefully ignorant of Greek and Latin. This fact explains to a large extent the misunderstanding in this particular instance. The vermiform appendix is mentioned by Vesalius under the name: “the blind intestine,” and in at least three places in the Characterum indices of the “De fabrica.” This appendix is Or Englished: marked with the letter “O” on figures 6, 7 and 8 of Book v (Fig. 1). O. This intestine is called blind by me for I do not especially enquire whether In the Characterum index on page anyone else wishes that another part 362 of Book v of the first edition (1543) of the large intestine be given this it is said: name. Such a one may be so far un- O. Hoc intestinum mihi caecum nuncu- familiar with names that he may neg- patur, non admodum contendenti an lect to examine into the reason for quis eo nomine aliam crassorum intes- them or into the formation of the tinorum partem donari velit: modo is intestines and the structure of other non adeo nominum sit studiosus ut parts concerning which we enquire illorum occasione ea in intestinorum carefully. * Edition of 1555, pp. 563, 610 and 611. And in the second edition (1555), also lar body in men and still more in dogs, issued under the supervision of Vesa- the belly of which I remember describing lius himself, this statement is short- before, posseses an under-layer of its ened in the Characterum index on own especially for furnishing a support page 563 to: for the particular vessels [running] to it ([which]) irrigate the cavity of that intes- O. Appendiculus iste admodum tenuis et tine with a viscous humor. Not the du- vermis in modo convolutus caecum in- odenum alone but also all the rest of the testinum nobis appellatur. intestines are steeped on the inner surface with the same viscous and slippery humor, Or translated: as Rhazes has said, not without sense, O. This little appendix, markedly slen- these [intestines] may [in places] either der, curled in the manner of a worm, be contracted or be quiescent in the shape is called by us the blind intestine. of earthen vessels.4 Also on figure 10 of Book v, the appen- Desc ri pti on of the Lar ge Inte sti nes dix is marked with an “F,” and also But since most of these things are com- on Folio G of the Epitome1 with a mon also to the large intestines, these too Greek xi, and in both instances it is must now be examined closely. And thus named in all three Characterum indices the ileum, lying below the position of the as “caecum intestinum,” the blind in- right kidney, is received wholly by the testine. large intestine, although this is many In the text itself, Vesalius devotes times larger in lumen than that of the nearly a page to a discussion of the small intestine; not, indeed, as one might “blind” intestine. This description oc- say, directly into the beginning of this large intestine itself, but into the left cupies parts of pages 610 and 611 of side of this near its beginning. For this the “De fabrica” of 1555 which is ex- first part swells out like a large ball pre- tended from the similar statement on senting two openings in its left side. One, page 500 of the first edition of 1543.2 indeed, continuous with the ileum and more distant from the beginning [of the TRANSLATION3 larger intestine]. The other, quite smaller The duodenum in point of fact receives and nearer to the first part [of the whatever nerves it has from those which colon], leads in man into that intestine run to the lower opening of the stom- which I doubt not is called ™</>Xo/x or ach and to the right side of its fundus. blind, by the older professors of dissection. From these the duodenum appropriates to itself that which is especially implanted Of Wha t Nat ure Is th e Bli nd Int est in e ? in it, as for instance the passage carrying Meanwhile, I am not unaware of the opin- yellow bile to the intestines. ion which many men entertain today concerning the blind intestine. [These are] Gla nd s of th e Int est in es assuredly deceived because this intestine The same intestine and also that glandu- [placed as it is] between larger ones has 1 Vesalius also published, in the same year also been described somewhere by Galen: (1543) as the first edition, a short resume that it is just as if some spacious sack of his major work but in a larger format which might indeed be another stomach, with fewer pages, which is known as the had been described by him and by other Epitome. anatomists who have followed him. Since, 2 The help of Walter H. Buell, former in- however, I suggest that in man this, which structor and acting head master of Hotch- should be called “blind,” is shorter than kiss School, in correcting this translation is gratefully acknowledged by the author. 4 This seems to be an attempt to describe 3 Pages 610-611. peristalsis. S.W.L. all other intestines and most curved of all smaller than man. The older (anatomists) and is seen to be for the most part more and those who have dissected men have, contracted and narrower and rolled in without doubt, endowed this appendix coils as a large worm rather than like to with the name of the blind intestine. an intestine at all. As I describe the blind In the next place the description of [intestine] it is seen scarcely to take the Galen for the dog in which [animal] the place of an appendix to the intestines and blind intestine is longer than in man [appears] just as if it ought to belong least might perhaps be adopted here. Now it of all among the larger intestines. And is usually found in the dog empty as in hence it may be that when they see that I man. Nay more, we know also that the point out this slender little part in man as true dormice and squirrels have this in- the blind intestine and say that the first testine quite naked so that it may com- part of the colon is sufficiently large (for pare easily in size with their stomachs, the function Galen mentions), then our and is observed in dissection swollen with frocked and stupid Rabbis5 interrupt me faeces. And hence it is certain that this with a quotation from Galen and main- slender appendix in man is blind. Since, tain shamefully that this first part of the forsooth, it coincides in direction and site colon is by no means a bag of sufficient and form (not necessarily in size) * with size or, as they themselves say, it [this the blind intestine of those animals and little intestine] is without function [or- possesses by nature one opening (whence bum] and one eyed [monoculum]. On the indeed it was first called blind). More- contrary, thou shalt find some who boast over, if Galen, assuredly the greatest ob- that they choose the contradictory doc- server of nature, should ever have exam- trines concerning the blind intestine be- ined the intestines of man, he would have cause they do not believe, with the described far differently this appendix, Greeks, that there is one orifice to the also that protruding first part of the colon blind intestine but that there are two in and the junction of the ileum with it, as the middle near each other. If they have well as the form of the colon. If, indeed, seen these, or may be right to imagine man had been given by nature another them; these orifices are really those that blind organ, Galen at least would have enter in the protruding first part of the discovered that appendix, however much colon and one is the end opening of the anything in man may vary in position ileum, the other [is] the first part of that from the same in the dog. For even if which I call blind. Nor is this really why both are placed in the right side, never- we should not believe that this slim small theless the blind [intestine] of man ex- portion not attached to the mesentery but tends from the left side of the first part coiled in circles on itself and hanging of the colon rather than from an origin by the aid of fibrous bands, is in man the on the right, and differently in dogs, as blind intestine. However great the size Galen has reported. Further, if I should and use Galen may assign to it, these [fea- agree with some whose bodies having been tures] are seen [not] to belong to it in dissected by me have testified that this the least degree.

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