In 1606, 42 years after Andreas Vesalius died following a shipwreck, the Union Jack began (by royal decree) to be flown from the main masthead of all English and Scottish ships. Nearly a decade later, in 1615, the word fascia appears to have made its way into English language medical writing (Adstrum, 2015; Adstrum & Nicholson, 2019). This happened in an anatomy textbook that was written by a man who, amongst other things, served as a Court physician to James the 1st of England – the king who commanded the creation of this new flag.
Even though this anatomy milestone has, until now, been barely commented on, it is significant for researchers (including myself) who lack the linguistic ability to decipher anatomy texts that were originally written in Greek, Arabic, Sanskrit, and Latin. For those of us who can only speak English, it is next to impossible for us to authoritatively discover what the ancients knew about fascia, and the words they used to discuss it. My own research has therefore been limited to books that have been written in, or translated into, English. Fascia’s finally being written about in English anatomy literature is a ‘big deal’ … as it means that fascia researchers can finally access and study some valuable primary source material.
Prior to 1615, anatomists knew about and differentiated between the body’s membranes and aponeuroses from bones, cartilage, ligaments, and tendons. Yet it seems unlikely that any of these ‘body parts’ were then known as fascia by English anatomy writers.
Tudor barber-surgeon Thomas Vicary (1490-1561), for instance, was the author of the first anatomy textbook written in English (1548) – a compact, pocket-sized dissecting guide, that was popular with students of anatomy who were not proficient in Latin (Thomas, 2006). Even though this book was produced at around the same time as Vesalius’s Fabrica (1543), Vicary’s book doesn’t relate to Vesalius’s new, scientific anatomy concepts. It is instead, according to Thomas (2006), a fairly basic compilation of “familiar but obsolete sources, going back to Galen.”. Despite its derivativeness, this book is still useful and well worth looking at, as it gives us some insight into the ways the body (including the elements many of us now regard as ‘fascial’) were anatomically conceptualised by some of our ancient forebears. [A 1599 imprint of this book can be viewed by the public for free at https://archive.org/details/englishmanstreas00vica]
Vicary described the body as being constituted from eleven “simple members” (basic body elements) – bones, cartilages, nerves, pannicles (membranes), ligaments, cordes (tendons) arteries, veins, fatness, flesh, and skin (1586). He defined a “pannicle”, or “cote”, as a “Skinne that covereth the inner members” (internal body parts). Some examples might include: the pannicles that invest the “Lyver… the stomacke and the Intrails”; the “Pericranium… that covers the bone of the head”; the “Duramater” and “Piamater” that envelop the brain and spinal cord; and the “Mediastinum” and “Pleura” that coat the organs in the thorax. He does not, however, make any particular mention of pannicles covering the muscles.
Vicary explained that the body’s pannicles are interconnected; as might be observed in the continuity between the pannicles in the mouth and the stomach, and those that surround the spinal cord and brain. Lastly, pannicles might contribute to the constitution of several other body parts; such as the “Midriffe” (diaphragm), “Wombe”, “stomacke”, “Mesenterium”, and “Bladder”.
According to Vicary, pannicles are “properly woven [from] Thræds, Nerves, Veynes, and Arteris” [sic]. They might exhibit different qualities. For example, the pannicle in the “Pallet of the mouth”, he explains, is “carnous” (fleshy); where its counterparts that cover the heart and lungs are respectively “strong” (tough) or “nervous” (sinewy). Vicary’s nervous pannicles (which translates to sinewy membranes) have all in due course been acknowledged as fasciae, but Vicary made no specific mention of fascia itself.
Fascia is a non-specific anatomical term that broadly refers to the body’s soft connective tissue parts. It is probably a Latinized version of an ancient Greek word ταινία (taenia) – a word that was then applied to a variety of objects, including bandages and ribbons, which exhibited a thin, strip-like appearance. This term is still used by anatomists, as in taeniae coli, sometimes known as “fasciae of the colon,” and taenia thalami and taenia of the 4th ventricle (flat bands of brain tissue) (Adstrum, 2015; Adstrum & Nicholson, 2019). In Roman times, the singular, feminine, Latin noun fascia, and its plural fasciae, were applied to a variety of band-like textile items and garments, including, for example, bandages, headbands, and puttees (Adstrum, 2015). There is no evidence one way or another that lets us know if the ancient Romans or Greeks bracketed either word (ταινία or fascia) with anatomical meaning.
The word fascia appears to have eventually entered English medical discourse in 1615, when Helkiah Crooke, an English surgeon and anatomist … and Court Physician to King James I of England … referred to the “Fasciam or the swathe-band” (thoracolumbar fascia) covering the kidneys during his explanation that, “the particular partes of the body are almost every one covered with their peculiar [specific] membranes or coats”; including “the Lungs, the Liver, the Guts, the womb, the bladder …” (p. 922) (Adstrum, 2015; Adstrum & Nicholson, 2019).
This was possibly the first direct mention of fascia by an English-language, medical writer (Crooke, 1615, p. 922).
In the absence of contrary evidence (Vicary, 1586; McConchie, 1997), Crooke was one of the earliest, if not the first, English writer to use fascia as an anatomical word. It is possible that it was used by others, but as yet I have not found any written record of this.
In the revised and expanded second edition of Crooke’s anatomy textbook (1651; first published in 1631) Crooke spent a considerable amount of attention to describing what he terms the body’s “almost infinite” membranes. This book contains so much information about membranes that I cannot do it justice within this short article, so I shall talk about it some more in my next one.
If you are interested, you can read some more about anatomy and fascia in my recently published (2021) book, The Living Wetsuit
And, if you haven’t already done so, please connect with me at linkedin.com/in/sueadstrum