Anatomists describe the things that they can see and examine. There are many ways they can do their work, all of which are affected by:
- Their reasons for finding out about it, and …
- The ways they examine it – which are, whether or not they’re consciously aware of it, shaped by
- The philosophical beliefs that support their research
- The types of research they choose to use
- And their choice of research materials and methods.
This has been clearly evident since the 19th century arrival of the ‘Age of Science and Technology.’ This period in history has been associated with a firming philosophical belief that systematic empirical enquiry, in tandem with continual advances in research technology, is the best way of obtaining reliable knowledge (a belief that is disputed by many humanities scholars). Regardless of its self-proclaimed superiority, this way of thinking has been incredibly useful to humanity. It definitely has been, and still is an extremely valuable way of obtaining knowledge that has enabled the development of experimental sciences and laboratory medicine.
This ‘then new’ approach to knowledge development unsurprisingly lead to some major advances in the fields of medicine, surgery, and anatomy. The invention of ether anesthesia, for instance, meant surgeons no longer needed to rush through their work. They could now take their time and do a better job of it, while their patients were peacefully asleep. The realization that germs (rather than vaporous ‘miasmas’) are dangerous led to the development of antiseptic surgery. This reduced the risk of post-operative infections and made surgery far less perilous for those who received it.
As surgery became more scientific and safer, surgeons wanted to access some more detailed and reliable anatomical information than they’d had in the past. This would help them accurately locate and distinguish between, the body’s interior ‘parts’, and also help them upgrade their knowledge of pathology. They knew that their work would have been unnecessarily risky without it.
The development of effective whole-body embalming meant that anatomists no longer needed to ‘race the clock’ to beat the depredations of rotting. They too could now take their time and examine whatever they were looking at properly. These recently discovered (physiochemical) embalming processes helped prevent the body’s soft (fascial) membranes from being ruined – which naturally happens fairly quickly after someone has died – allowing them to remain intact, and to be examined in detail.
Fascia soon began to attract some serious scientific attention, helped along by French anatomist and pathologist Marie-Francois Xavier Bichat’s observation that,
“The membranes have not hitherto been a particular object of research among anatomists. This kind of organs, disseminated as it were through all the others, contributing to the structure of most of them, and having rarely a separate existence, have never been separately examined by them. Their history has been associated with that of the organs over which they are spread. The pericardium and the heart, the pleura and the lungs [etc.]… For description, this is doubtless the best and most simple progress; but in following it, anatomists, struck with the different structure of the organs, have forgotten that their respective membranes could possess any analogy; they have neglected to establish any relation between them, and this leaves an essential chasm” (1813, p. 21).
The newly developed tissue-preserving fluids contained chemicals (e.g., alcohol, formaldehyde) that, along with lengthy exposures to air in the dissection laboratory, dried and condensed the cadaver’s soft connective tissue (which I personally equate with the term fascia). As a result, the fascial tissue became unnaturally dense and opaque, hence was much easier to see. Without doubt, this artificial accentuation of the fascial tissue contributed to the discovery of many previously unspecified sections of fascia (or fasciae).
“The advent of tissue fixatives, and especially formalin, which preserve and accentuate areolar tissue, was a great stimulus to the regional naming of fasciae … and the habit of attaching a specific local term to any aggregation of connective tissue, sizeable enough to dissect” (Warwick & Williams, 1973, p. 490).
Most of these newly identified fasciae were named for their physical appearance, topographic location in the body, tissue type, perceived propriety, or function (see Adstrum & Nicholson, 2019, for more details). Many were also named eponymously, after an influential member of their profession (Adstrum, 2015). Cribriform fascia (fascia cribosa), for instance, is a small section of fascia in the groin that is perforated by several blood and lymphatic vessels. This means that it has some tiny holes in it, hence looks a bit like a sieve, or cribrum in Latin. It was also eponymously named (Hesselbach fascia) after Franz Hesselbach, the German anatomist and hernia surgeon who was the first person to specifically describe it.
The resultant expansion in regionally named fasciae, together with the extensive use of synonyms (including eponyms), and the publication of anatomy texts in a variety of vernacular languages (rather than just the traditional Latin), contributed to a manyfold expansion in the fascia-relating terminology that was used in 19th English-language medical dictionaries and textbooks. Interestingly, the words aponeurosis and fascia were frequently considered to be synonymous (Adstrum & Nicholson, 2019).
By the mid-century, fasciae were generally classified in two groups, distinguished by the type of tissue they are made of and their relative proximity to the skin. A typical example of this distinction can be seen in Henry Gray’s explanations that: (i) fibro-areolar fascia is “found immediately beneath the integument over almost the entire surface of the body [so is] generally known as the superficial fascia;” and (ii) aponeurotic or deep fascia is “a dense inelastic and unyielding fibrous membrane [constituted from dense aponeurotic tissue], forming sheaths for the muscles, and affording them broad surfaces for attachment” (1858, pp. 186-187).
- Adstrum, S. (2015). Fascial eponyms may help elucidate terminological and nomenclatural development. Journal of Bodywork and Movement Therapy 19(3):516-525.
- Adstrum, S., & Nicholson, H. (2019). A history of fascia. Clinical Anatomy 23(7): 862-870.
- Bichat, X. (1813). A treatise on the membranes in general and on different membranes in particular. (J. G. Coffin, Trans.). Boston: Cummings and Hilliard. (Original work published in 1800)
- Gray, H. (1858). Anatomy: Descriptive and surgical. London: John W. Parker and Son.
- Warwick, R., & Williams, P. L. (eds.). (1973). Gray’s anatomy (35th ed.). London: Longman.
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