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Archive for the ‘Anatomy’ Category

Anatomy has always fascinated humans, not only because of our interest in the delivery of children but also because of the importance of understanding anatomy in healing wounds and caring for the sick. Mankind’s interest in anatomy is ancient because it has been learned from archeological evidence that even brain surgery was performed with considerable success as early as 7000 BC in Europe, 3000 BC in Africa, and 2000 BC in the pre-Incan civilizations.

Although anatomic representations and the study of anatomy have been noted in almost every culture, occidental medicine traces its origin to philosophers in the golden age of Greece and the Arabic physicians, who studied, instructed, and wrote about anatomy and attempted to relate it to function and disease. They also named observed structures, and their students expanded this knowledge by discovering and naming yet other structures. Students of anatomy during the Middle Ages—even as late as the 18th century—used Greek and Latin, the lingua franca of learned men. Hence, most of the structures named during those centuries of discoveries were named in those languages, a practice continued into modern times.
The earliest written treatise on anatomic studies was set down by the Greek physician Alcmaeon approximately 2500 years ago. He discovered and dissected the optic nerves, tracing them back to the optic chiasma, and deduced their role in binocular vision. He also discovered and described the auditory tube, suggested that the brain is responsible for intelligence, and studied the ramifications of blood vessels.
Writing at about the same time, the Greek philosopher Pythagoras also suggested that the brain was the center of intelligence. He believed that the physical and emotional well-being of an individual was related to the ratio of the four humors: phlegm, yellow bile, black bile, and blood. These four humors were related to the four elements: water, fire, earth, and air, respectively, whose properties were moist, dry, cold, and hot. A healthy individual would possess a proper combination of these fluids, whereas a disproportionate ratio would be responsible for a diseased state of the body and/or mind. This belief in humors became a basic tenet of Hippocratic medicine. Unfortunately, Aristotle’s writings lent credence to this line of thinking; thus, it persisted well into the Middle Ages. Aristotle, however, did make major contributions to the study of anatomy by correctly describing many organs and structures of the human body. He may also have been the first anatomist to illustrate his descriptions with drawings.

Shortly after the decline of Athens, the Greek scholars of Alexandria, especially Herophilus, pioneered in the teaching of anatomy by the use of human dissections. For his work in this field, Herophilus is considered the founder of anatomy, and his dissertations (all lost) encompassed many areas of the subject. The next four centuries saw a decline in anatomic studies until the advent of Galen, possibly the greatest physician of his age. His writings on anatomic structures were so precise and well researched that they constituted the solid bases of medicine for longer than a millennium.

He believed that P.2 structure and function were closely interrelated, and his painstaking studies of the spinal cord illuminated his theories, which survived into the early 19th century. Soon after Galen, the Roman Empire collapsed and Europe entered its Dark Ages. During this period, it was the Persian physicians, chiefly Avicenna writing around 1000 AD, who were responsible for keeping the scientific perspectives of medicine and anatomy alive.

A major landmark of anatomic history occurred in 1224, when Frederick II proclaimed that to be permitted to perform surgery one must have studied anatomy by dissecting a human body. Although this edict established anatomy as a discipline unto itself, no major advance occurred for another 350 years. The next important achievement came with Leonardo da Vinci, whose brilliant anatomic illustrations added new emphasis to the functional appreciation of structure. He, more than anyone before him, was able to display the results of his dissections and simplify the complexities of the human body. Hence, the study of human anatomy returned to Europe, flourishing during the Renaissance. This enlightened period of humanistically oriented culture permitted questioning of secular dogma.

The teachings of the ancients were at last openly opposed by the Belgian physician Andreas Vesalius, who applied strict scientific discipline to his anatomic observations. He single-handedly revised the discipline of anatomy and wrote a treatise that was the forerunner of modern anatomy textbooks. Within a generation or so of Vesalius, another great anatomist, William Harvey, wrote about the blood vessels and the heart. His work, the cornerstone of the study of the structure and function of the circulatory system, revolutionized medicine, physiology, and anatomy.

The invention of the microscope around this time opened new vistas in anatomy, permitting the marvelous discoveries of Wirsung, Malpighi, Purkinje, Golgi, Cajal, and Ehrlich. Discussion of theseanatomists is outside the scope of this brief historical survey, but interested readers are encouraged to refer to books dealing with the history of medicine or anatomy.

Modern anatomy textbooks approach the subject from a systemic, regional, or surgical point of view. A systemic anatomy textbook, as the name implies, treats the body as if it were organized into neat, self-contained systems, such as the skeletal, muscular, nervous, and circulatory systems, each of which is detailed in the text. Such an approach is valuable, especially in a reference textbook, because it describes each structure in a continuous fashion.

Textbooks that treat the subject in a regional manner divide the body into specific areas, such as upper extremity, lower extremity, thorax, and head and neck, and discuss the contents of each region (i.e., osteology, myology, nervous, and vascular elements). Descriptions do not exceed the boundaries of the region, regardless of the fact that many structures (e.g., vessels, nerves, and muscles) are not wholly contained within that specified area. Textbooks of surgical anatomy are based on such a regional approach, with emphasis on surgical techniques, approaches, and normal anatomic variations.

The head and neck comprise a highly specialized region of the body. The structures contained within this region are closely interrelated because they are compacted into a small, complicated area. Other regions of the body, where interrelationships are less complex, lend themselves to a systemic approach. The head and neck region does not. Consequently, the present textbook is written from a regional point of view because the authors continue to believe this approach is more likely to promote better student understanding.

The regional method synthesizes morphologic features for the reader by correlating relationships as the reader progresses through the various anatomic divisions of the head and neck. Furthermore, this approach aids not only those who have constant access to a laboratory situation but also those who do not. And, finally, this approach eliminates the need to synthesize the final product from its component parts, thus assisting the student in mastering the intricacies of this fascinating region of the body.