Fascia in 18th century England

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The Age of Enlightenment in 17th and 18th century Europe was a period marked by a surfacing interest in the pursuit of knowledge acquired through observation, experiment, and rational reasoning. For the anatomy profession, this shift probably began a bit earlier - in 16th century Italy - with Vesalius’s then radical exhortation to learn from physically observing the body, rather than relying on what Galen and others had written about it many centuries ago.

The new, overtly empirical, way of working lead to many valuable anatomical discoveries. William Harvey (1578-1657), for instance, an English physician and anatomist based, developed his ground-breaking anatomical account of the circulation of blood throughout the body by the heart (1628). Other anatomists – including, for example, Marcello Malpighi (1628-1694), Nicholas Steno (1638-1686), Antonio Valsalva (1666-1723), Giovanni Batista Morgagni (1682-1771), Xavier Bichat (1771-1802), William Hunter (1718-1783), and John Hunter (1729-1793) – made significant contributions to the developing sciences of physiology, morbid anatomy (pathology), microscopic anatomy (histology), medicine, and surgery … as well as anatomy.

The experiential nature of 18th century anatomy is depicted beautifully in Wendy Moore’s biographical account of the life of John Hunter, the famous, Scottish-born English anatomist and surgeon (and younger brother of William Hunter, an equally famous anatomist, obstetrician, and anatomy teacher – pictured above). In Moore’s words,

?“Anatomy was invariably a sensory experience. As well as the all-pervading odour of decay, the crackle of dried membranes and the need for intense visual inspection, students were urged to feel the textures of the different parts and even taste the body fluids. Without sophisticated methods of scientific analysis, at a time when even microscopes were relatively primitive and visually unreliable, anatomists were forced to rely on their innate senses.”?(Hunter, 2005, p. 78)

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The Oxford English Dictionary (OED Online) currently - though perhaps incorrectly - suggests that ?fascia made its first appearance in an English-language medical publication in 1788, when a certain “H. Watson” used the term fasci? to describe, “tendinous expansions…[that] support the muscles.”?We now know (as my previous two articles show) that this honour is probably owed to the Helkiah Crooke (1576-1648) – a prominent surgeon, anatomist, and Court Physician to King James I of England who used the terms fasciam and fasciam latam more than a century earlier (1615, 1631). ?

Crooke was not alone in mentioning fascia prior to Watson’s 1788 lecture. William Cowper, for instance, employed this term in both of his books (1694, 1698). His treatise on muscles (1694) described the muscles of the “cubit” (forearm) as enclosed by the Fascia lata (p. 3), identified the “external tendon” of biceps brachii as Fascia Tendinosa (p. 147), and recognised the deep fascia investing the thigh and leg as Fascia Membranosa (p. 177).?His subsequent commentary on the eightieth and eighty-first Tables (1698) explained that Fascia Lata or Fascia Membranosa of the leg contributed to the annular ligament at the ankle, “like a Bandage that retains [the] Tendons in their proper Situation.” Fascia-relating words were used by others – including Le Clerc (1727), Hunter (1771), and Simmons (1780). Some examples of this are quoted at the lower end of this article.

?Mr. Henry Watson ?- the “H. Watson” OED refers to - was at that time a Fellow of the Royal Society, a senior surgeon at Westminster Hospital, and a professor of anatomy at the Royal Academy. On the 19th of February 1788, he delivered a lecture (published in 1790) in which he reported on two cases involving patients who had inexplicably developed a painful flexion contracture of one of their arms following phlebotomy. Watson used the word fascia 15 times while describing, and reflecting on, the surgical operations he performed in an attempt to discover the cause and cure of his patients’ afflictions. He thought, for example, that an area of “deep seated fluctuation” on the anterior aspect of one of his patient’s arms “had probably been occasioned by the tension of the fascia; for by cutting through this tendinous expansion, she was greatly relieved” (p. 256). Elsewhere he tells of dividing the biceps tendon “to a little below where it sends off the fascia, that envelopes the muscles of the fore-arm” (p. 263). He also used the plural form of this term to explain that “[in] the human body, several of the muscles supply tendinous expansions, or Fasci?, so disposed as not merely to embrace soft parts, but also to cover hard ones, such as bones, and their articulations” (p. 268). Watson eventually attributed his patients’ debilitating conditions to an accidental fascial puncturing, caused by a lancet during a blundered bloodletting procedure.

By the time the 18th century came along, the term fascia had become an established part of English medical writing. The medical lexicographers (medical dictionary writers) of the day, however, generally adopted a fairly loose view of it, and failed to consistently define it. They most frequently interpreted this term to mean a type of surgical bandage -?e.g., fascia heliodori (T-bandage), fascia spiralis repens (spiral roller), and dividens fascia (a neck bandage). Fascia and fasciae were sometimes, but not always, recognised as anatomical expressions. They were just as likely to be acknowledged as objects of architectural, astronomical, or ornithological interest.

On the increasing number of occasions that this term was used by that period’s medical writers, it was often embedded in the Latin name for a membranous (or muscular) body part – as in fascia lata, fascia lumborum, fascialis (the sartorius muscle), and musculus fasci? lat? (the tensor fasciae latae muscle) (Adstrum, 2015; Adstrum & Nicholson, 2019).?It was also used to generically refer to any one of several types of tissue – e.g., aponeurotic fascia, membranous fascia, tendinous fascia: and, for good measure, a small assortment of fibrous body parts – including, for example, aponeuroses, membranes, fibrous sheaths (Adstrum & Nicholson, 2019).

Little wonder this word was used rather broadly, and inconsistently so, by anatomists - as may be seen in the following examples (the bolding is mine):

In a surgery textbook

“The two Abductors of the Leg are the Fascia lata [a muscle] and the Poplit?us … The Fascia lata [the fibrous sleeve of a limb], or the Membranosus, is as it were a kind of large Band, which covers all the Muscles of the Thigh. It proceeds from the outward edge of the Os Ilium, is ty’d by a large Membrane to the Top of the Perone or Fibula, and sometimes descends to the end of the Foot” (Le Clerc, 1727, p. 43).

?In a treatise about the anatomy of teeth

“[Temporalis] is covered with a pretty strong Fascia, above the Jugum… This Fascia is fixed to the bones around the whole circumference of the origin of the Muscle… This Muscle arises from all the bones on the side of the Head, that are within the line, for insertion of the tendinous Fascia” (Hunter, 1771, p. 19).

?“[From] the lower edge of this [Digastricus] tendon, some fibres seem to go off, which degenerate into a kind of Fascia that binds it to the Os Hyoides” (ibid, p. 26).

?In an anatomy textbook

“In our description of the?bones, we had frequent occasion to speak of the grooves which serve for the lodgement of tendons; and in some of them, we saw the tendons sliding upon a thin layer of cartilage. We find them secured in these grooves by a strong tendinous theca (sheath,) of fascia, as it is differently called. We likewise observe such a fascia wherever a tendon is inserted … Many of the long muscles are likewise surrounded by a fascia or sheath, of the same kind. The chief use of these sheaths to the muscles seems to be, to strengthen their action, by keeping them … in their proper places. But, besides those which belong to particular muscles, we find other more general expansions of the same kind, spread over a great number of muscles, affording origin to many of their fibres, dipping down between them, separating them from each other, and, by adhering to the adjacent bone, preventing them swelling too much outwardly when in action. Of this kind is the membrane that is spread over the muscles of the arm, and likewise that other which covers the muscles of the thigh, which is commonly called the fascia lata” (Simmons, 1780, pp. 256-258).

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“This muscle is covered by a pretty strong fascia, which some writers have erroneously described as a part of the aponeurosis of the occipito-frontalis.?This fascia adheres to the bones, round the whole circumference of the origin of the muscle, and, descending over it, is fixed below to the ridge where the zygomatic process begins… This fascia serves as a defence to the muscle, and likewise gives origin to some of its fleshy fibres” (ibid, p. 306).

In a dissection manual

“… we find the [popliteal] artery covered by irregular fibres of the fascia.”... “Upon laying aside the true skin and superficial celular [sic] membrane from the back part of the knee-joint, we have first to observe... the strong fascia which covers the muscles and great vessels and nerves. We find a strong layer of fibres coming down obliqely [sic] from the outside, derived from the fascia lata of the thigh... [behind the knee] “a strong fascia of interwoven fibres is extended” (Bell, 1798, p. 108).

If you are interested, you can read some more about anatomy and fascia in my recently published (2021) book, The Living Wetsuit … and at www.sueadstrum.com

?And, if you haven’t already done so, please connect with me at linkedin.com/in/sueadstrum

References:

• Adstrum, N. S. (2015). The meaning of fascia in a changing society. University of Otago, NZ. (PhD thesis)
• Adstrum, S., & Nicholson, H. (2019). A history of fascia. Clinical Anatomy 23(7): 862-870.
• Bell, C. (1798). A System of Dissections explaining the Anatomy of the Human Body, the manner of displaying their parts, and their varieties in disease. Edinburgh: Mundell and Son.
• Cowper, W. (1694). Myotomia reformata: Or, a new administration of all the muscles of humane bodies. London: Sam Smith and Ben Walford.
• Cowper, W. (1698). The anatomy of humane bodies, with figures drawn after the life by some of the best masters in Europe. London: Sam Smith and Ben Walford.
• Crooke, H. (1615). Mikrokosmographia: A description of the body of man. London: William Iaggard.
• Crooke, H. 1651. Mikrokosmographia: A description of the body of man together with the controversies and figures thereto belonging (2nd ed.). London: John Clarke. [Orig. printed in 1631 for Michael Sparke]
• Harvey, W. (1628). Exercitatio anatomica de motu cordis et sanguinis in animalibus. Frankfurt. [An English language version of this book, translated by C. D. Leake, may be accessed at https://archive.org/details/exercitatioanato00harv/page/n21/mode/2up ]
• Hunter, J. (1771). The natural history of the human teeth: Explaining their structure, use, formation, growth, and diseases. London: J. Johnson.
• Le Clerc, C. G. (1727).?The compleat surgeon: Or, the whole art of surgery explain’d in a most familiar method. London: J. Walthoe, R. Wilkin, J. and J. Bonwick, and T. Ward.
• Moore, W. (2005). The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery. London: Bantam Press.?
• "fascia, n."?OED Online, Oxford University Press. Accessed 17 March 2022.
• Simmons, S. F. (1780). The anatomy of the human body (Vol. 1). London: J. Murray.
• Watson, H. (1790). The history of a contraction of the fore-arm and fingers, with some remarks and reflections on bleeding in the arm. Medical Communications 2: 251-276.