Book Review

From Heredity to Anatomy

Gross Anatomy in the Practice of Medicine

N Engl J Med 1994; 331:887September 29, 1994

Article

Gross Anatomy in the Practice of Medicine
By Frank J. Slaby, Susan K. Mccune, and Robert W. Summers. 699 pp., illustrated. Philadelphia, Lea and Febiger, 1994. $49.50. ISBN: 0-8121-1664-X

This attractively produced book, which covers gross anatomy as it relates to the practice of medicine, reflects the current trend of integrating the basic and clinical sciences in teaching. The authors intend the book for use as a first-year gross-anatomy textbook in addition to a ready reference for advanced students as they progress through clinical training. After a six-chapter introductory section, the book presents the anatomy of five regions of the body: the upper limb; the lower limb; the thorax; the abdomen, pelvis, and perineum; and the head and neck. It then further divides each region into subdivisions covered by specific chapters. Throughout the book, there is less anatomical detail and more functional and biomechanical information than in more traditional anatomy textbooks.

“Clinical panels” and case histories provide correlations with illustrative clinical material and diagnostic strategies. The clinical panels present various conditions and syndromes with pertinent anatomical features, such as meningitis, duodenal ulcer, and anteroinferior dislocation of the head of the humerus. The case histories showcase deductive clinical reasoning and the contribution of anatomical knowledge to the diagnostic process. Clinical terms for anatomical structures abound and are often preferred to the nomenclature in Nomina Anatomica. For the most part, eponyms such as Colles' and Sibson's fasciae are carefully defined, but others -- such as the marginal artery of Drummond and the pores of Kohn -- are not.

The book is profusely illustrated with black-and-white figures and color plates selected from more than 35 previously published textbooks and atlases; the largest number come from atlases by C.D. Clemente and E. Pernkopf. The reproduction and color quality in some instances surpass those of the parent books. Similarly, the quality of the numerous radiographs and the accompanying explanations is good. As carefully selected as the figures are, however, they do not always relate well to the accompanying text in terms of placement, nomenclature, or level of detail. The anatomical details in the text are so scant that beginning students will have a hard time understanding the figures if they rely solely on the information contained in this book. Ambiguities are increased in some instances by lettered or numbered structures that appear in figures but that the accompanying caption or text does not identify. Unfortunately, this lack of anatomical detail also makes certain sophisticated, clinically based discussions difficult to understand. For example, the discussion of the kinesiology of gait is not supported by adequately detailed illustrations of skeletal anatomy.

Though the writing style varies, the book is generally easy to read. There is, however, an interesting dichotomy between the regional anatomical approach used by the authors and the way in which the regions are presented. Most textbooks of regional anatomy facilitate dissection by moving from superficial to deep structures or from larger body units to smaller subdivisions. Yet in this book, sections on the superficial nerves and veins of the leg appear after the discussions of the bones, muscles, and all deeper neurovascular structures. Similarly, the discussion of the concept of the mediastinum follows the presentations of the lungs and heart. The format used here is more akin to that of systemic anatomy textbooks, which present separate topics (such as the circulatory system, the nervous system, and so on); this style favors lists rather than integrated descriptions of critical relations (the structures supplied by a neurovascular unit rather than the route of the unit relative to the surrounding tissue, for example).

Other organizational choices are more difficult to understand. For example, both the cutaneous innervation of the head and neck and the cervical sympathetic trunk are discussed in the chapter on the nasal and orbital cavities, rather than in more predictable locations such as the section on the superficial face or the introductory chapter on the autonomic nervous system. Key words in the text are in boldface type, but this organizational aid is used inconsistently. In the discussion of the blood supply of the thyroid gland, the superior and inferior thyroid arteries are in regular type, whereas the thyroid ima artery and the superior, middle, and inferior thyroid veins are in bold.

The authors' desire to create a textbook of gross anatomy in which the functional and clinical importance of structures is paramount is laudable. Unfortunately, the book is so lacking in anatomical detail that beginning students will not be able to understand or fully appreciate the correlations presented in the book. Nor is it likely that the level of anatomical detail will be adequate for most medical school courses in gross anatomy. This book may, however, serve as a useful aid for advanced medical students in honing their physical diagnostic skills.

John H. Lillie, M.D.
University of Michigan Medical School, Ann Arbor, MI 48109