Put flesh on any skeletal information

Oxford Textbook of Functional Anatomy. Second Edition - Clinical Anatomy. Second Edition
February 24, 2006

Available separately: Volume one (Musculoskeletal System), 231pp; Volume two (Thorax and Abdomen), 243pp; Volume three (Head and Neck), 224pp. £25.99 each, ISBN 0 19 262816 X, 262817 8 and 262818 6

Over the past decade, a plethora of anatomy textbooks has emerged, each new one claiming that it is ideal for undergraduate courses, for the membership of the Royal College of Surgeons examinations, or both.

Some years ago, there would have been a vast difference in the amount of knowledge required for the undergraduate vis-a-vis the MRCS candidate. But now, with the increased emphasis on clinical significance for preclinical students and the extraordinary lessening of anatomical knowledge seemingly required to pass the anatomy parts of the Intercollegiate MRCS, the two requirements are merging.

Another major change is the disappearance of cadaver dissection in many centres, which has led in turn to a paucity of dissection manuals. Those centres that do still allow the preclinical students to dissect have usually developed their own manuals to suit their courses.

The Oxford Textbook of Functional Anatomy has stood the test of time. When it first appeared in 1986 as both a textbook and a dissection manual, it was an immediate challenge to the "Cunninghams" that previous generations of medical students had used. The volume, naturally most popular in Oxford but used throughout the world, rapidly became the most useful text to have beside your dissection table. There was plenty of room for writing mnemonics and other lists alongside the text. I still have three battered volumes that I refer to for the excellent illustrations and potted embryology.

This new second edition is as good as ever. The emphasis on dissection has gone, but most of the excellent illustrations - a mixture of drawings, radiographs and clinical photographs - are still there. In addition, clinical significance is now stressed, so that instead of simply showing cruciate ligaments in the knee, we are shown how to test them. Good-quality computerised tomography (CT) and magnetic resonance imaging (MRI) images abound. The simplified embryology is still there, as are the sensible questions at the end of each chapter. The quality of the pencil drawings, particularly of bones, is a testament to medical artistry at its best - and long may it survive in this era of soulless computer diagrams.

As a reviewer, I am sure that I am not alone in turning immediately to look at topics about which I have a bee in my bonnet. In doing so, I was disappointed to see that in the section on prolapsed discs there is no reference to the fact that it is the next nerve root down that is compressed and not the root emerging at the level of the prolapse in the lumbar region. When discussing eye movements, the authors talk of rotation of the eyeball when they mean simple up, down, in out movements. They chose to ignore torsion (true anterior/ posterior rotation) that is so important when the head is tilted.

I would assume that anyone buying this series would purchase all three volumes, and therefore I doubt if the very similar introductory chapter is needed in each volume.

Nevertheless, I thoroughly recommend this book and will do so to my students. It deserves to succeed in this new format.

Illustrated Clinical Anatomy is a new textbook that is attempting to catch some of the limelight. In view of the number of books already available, it will need to offer something special to break into the market. The authors'

aims are sincere enough in that they are adhering to an accepted core curriculum directed at both undergraduates and surgical trainees. They have adopted the already popular format of putting clinical information in blue blocks, although they seem uncertain of the colour themselves as shown by the appearance in the preface of the query "[?blue]" that I suspect has been left in by mistake at the proof stage.

The book is compacted into 390 pages by packing text and illustrations in a tight, but not sardine-like fashion. At times this economy shows: the autonomics of the head and neck are covered in just one page, and anyone wanting a full understanding would need to refer to another text.

But certainly the overall immediate impression of the book is very favourable. The clinical and imaging illustrations are excellent. I am less impressed with the computer-generated images. Although they are clear, many are also lifeless (figures 4.6 and 4.7 of the lungs are downright boring).

They need some shading and highlights to bring them alive. There is no acknowledgement to any artist for these, so I do not know which of my medical artist friends I might be offending.

However, on closer inspection, I can see that this book is full of errors and confusing illustrations and statements. When reading through it for the first time, I found 30 significant errors of fact and some 24 statements or illustrations that could be made much clearer. For instance, we are told that sperm is stored in the seminal vesicles, that a portosystemic anastomosis is in the lower part of the anal canal instead of the lower rectum and that the C1 nerve supplies skin, to quote just a few of the incorrect statements.

Illustrations are misleading when they show inconsistent colouring of the pulmonary trunk, the S4 nerve to the pelvic floor in the perineum and an ovarian artery seemingly coming from the lateral pelvic wall. Most of us have learnt to spell varicocele and hydrocele correctly and not with an extra "o". Figure 6.4 shows an extraordinary coeliac trunk. Answers to the multiple-choice questions are not always accurate. The deep perineal pouch is not bounded superiorly by the urogenital diaphragm but rather by the superior fascia of the urogenital diaphragm; a question on the nerve supply of the diaphragm does not make it clear whether it is asking for the motor or sensory supply; and we are told that the knee can rotate only when the knee is flexed. What about physiological locking when it is extended?

A few errors are inevitable in a new book, but there are too many here to be acceptable. The authors will need to put a considerable amount of work into corrections before the next reprint. Until then, I would have reservations in recommending the book to my students.

Robert Whitaker is assistant clinical anatomist, Cambridge University.

Oxford Textbook of Functional Anatomy. Second Edition

Author - Pamela C. B. MacKinnon and John F. Morris
Publisher - Oxford University Press
Pages - 698
Price - £54.99
ISBN - 0 19 262819 4

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