The 12th century establishment of the first European universities heralded a widespread reawakening of interest in intellectual activity that, for the next couple of centuries, generally meant re-examining antique classical texts and testing their doctrinal accuracy. This was not a time for new ideas and ground-breaking scientific experiments … yet it paved the way for this to happen, in the period known as the European Renaissance.
At that time, and the next several centuries in Europe’s history, illness and disease were commonly attributed to a mix of secular (e.g., diet, climate) causes as well as the supposed spiritual sins, wrath of God, and adverse astral influences that upset the body’s humoral balance. Physicians drew on classical Hippocratic-Galenic medical theory to diagnose the causes of the bodily imbalances (e.g., by carefully observing their patients, palpating their pulses, inspecting their urine), and their prescribed treatments (e.g., bloodletting, purging, herbal medicines) were intended to help rectify said imbalances. The more physical aspects of treatment (e.g., blood-letting, scarification, pulling of teeth, treatment of war wounds, amputations and surgeries) were usually performed by barbers and surgeons … who were now, understandably, being required to learn more about anatomy than many of their predecessors had been able to.
By the late medieval or Middle Ages period (1300-1500 CE), medicine and anatomy were being taught in several Western European universities, and it was soon realised that human anatomy is best taught in conjunction with human dissection. Anatomical instruction became a normal part of the medical curriculum, and Italy’s University of Bologna was recognised at being one of the best places to go to study it.
In 1315, Mondino de Luzzi (1270-1326), an Italian physician, anatomist, and professor of surgery at the University of Bologna who has been widely credited with restoring anatomy as a distinct discipline. Mondino is reputed to have ‘performed’ the first public human dissection on an executed criminal since Herophilus and Erasistratus had done so relatively frequently at the school of anatomy in Alexandria (c. 250 BCE). His doing this was significant, as it eventually lead to dissection being routinely included in most European medical schools’ anatomy curricula – from then through to now.
Mondino’s anatomy dissection lectures – and the ones that followed them elsewhere in Italy and Europe – were typically performed by a three-member team: the professor, or lector (e.g., Mondino), who sat in a prominent position away from the corpse, where he could easily be heard as he read from the textbook set in front of him; the sector, usually a surgeon or barber, dissected the body; and the demonstrator, or ostensor, used a wand to point out the anatomical features of interest that the lector was describing. These infrequent dissection demonstrations were intended to illustrate and reinforce Galen’s – and his predecessors’ (including Hippocrates, Aristotle, Herophilus, and Erasistratus) – classical anatomical ideas as they were written in the lector’s textbook. In other words, they were an “illustration of authority” that was methodically paired with the textbook, rather than a means of investigation (O’Malley, 1964, p. 16).
These dissection displays were performed for small groups of spectators. They usually lasted four days, often well into the nights, and were scheduled in the coldest months of the year. This pattern was pragmatic because, in the days before effective tissue preservation, there wasn’t much time before the corpse putrefied and was corrupted by decay. The dissection was performed as quickly as possible and followed a set pattern – abdomen first, as its contents rotted the fastest, successively followed by the thorax, head, and extremities. We presently have no way of knowing whether the lectors had time to talk about – and if so, how much – the relatively flimsy membranes (e.g., pleura, pericardium, dura and pia mater) that they knew covered the body’s various organs, muscles, nerves and blood vessels, or their collagen-reinforced aponeurotic, ligamentous, and tendinous counterparts. Even though these ‘fascial body parts’ were mentioned by Galen, they could easily have been overlooked when the dissectors were racing the clock with their work.
Mondino also wrote the first ‘modern-day’ anatomy textbook and dissection manual, Anathomia corporis humani (c. 1316), that was wholly devoted to the subject of anatomy. While this book was nominally based on Mondino’s dissections, it essentially reiterated Galen’s and Avicenna’s writing (O’Malley, 1964). Anathomia was widely liked, as it met the needs of that time, and many editions of it were published during the following 200 years.
Mondino’s new way of conducting human dissection was continued long after his death, and played an important role in the anatomy education of several other famous anatomists – including Nicola Bertuccio (d. 1347), Henri de Mondeville (c. 1270-1320), Guy de Chauliac (1300-1368), and Jacopo Berengario da Carpi (c. 1460- c. 1530). What these anatomists knew about fascia, and the language they used to describe it, has yet to be established by suitably qualified medical historians – who can access their books, and have the linguistic skills to translate them from the old languages in which they were originally written into modern-day English.
Despite this, I think it is fair to surmise that their knowledge would be congruent with, and have remained largely unchanged from, the ways the body membranes, aponeuroses, tendons, and ligaments were classically alluded to by their Greek, Roman, and Islamic medical forebears. That is, they probably
- Knew about and discussed these fascial body parts
- Had names for some of them, so they could distinguish between them
- Knew the body’s organs were enveloped by membranes
- Knew (as Avicenna had written) that membranes
“are formed of extremely minute interwoven filaments which are extremely delicate. Their object is (a) to form the external covering for other structures and thereby (b) preserve the form and outline of these structures, (c) to support the members [i.e., body parts or organs], (d) by means of their fibres to bind together the nerves and ligaments with the members , for instance they hold the kidneys in position, (e) to impart sensation to members which are themselves insensitive, since by providing a sensitive covering they enable the member to be aware of anything befalling it” (Gruner, 1929, p. 101).
Whether or not they routinely applied the word fascia to the naming of any of these structures is presently unknown, although I personally think it is unlikely that they did so. My view is based on this word’s non-inclusion in Jacopo Berengario da Carpi’s Anatomia Carpi (1535) (which I was able to check, thanks to archive.org’s ‘word find’ facility). The term fascia also does not appear to have been used in English-language medical writing prior to 1615 (McConchie, 1997; Adstrum and Nicholson, 2019), much of which was a reiteration of information (including the names of body parts) that had earlier been recorded in Greek, Arabic, or Latin.
Tudor barber-surgeon Thomas Vicary (1490-1561), for example, was the author of the first anatomy textbook published in English (1586); a compact dissecting guide, that was popular with students of anatomy who were not proficient in Latin (Thomas, 2006). The information compiled within it reflects how the body had been classically described by “familiar but obsolete sources, going back to Galen” and does not appear to report any of his own (i.e., original) research findings (Thomas, 2006). Vicary accordingly described the body as being constituted from eleven homogeneous, or “simple members” [structural elements] that, according to his spelling of these words, are – Bones, Cartilages, Nerves, Pannicles [membranes], Lygamets [ligaments], Cordes [tendons], Arteirs [arteries], Veynes [veins], Fatnes [fat], Flesh, and Skinne” (1586, p. 6); all of which he goes on to explain in more detail.
In this context, Vicary (ibid) defines a pannicle (fascial membrane) as a “Skinne that covereth the inner members” [internal body parts] (pp. 10-11). Some examples might include: the pannicles that invest the “Lyver… the stomacke and the Intrails” (p. 43); the “Pericranium… that covers the bone of the head” (p. 13); the “Duramater” and “Piamater” that envelop the brain and spinal cord; and the “Mediastinum” and “Pleura” that coat parts in the thorax (p. 40). He does not, however, seem to make any mention of pannicles investing muscles, and does not specifically use the word fascia.
If you’re interested, you can read some more about anatomy and fascia in my newly released book, The Living Wetsuit.