The lesson of a hairy alcoholic called Eugene

Clinical Anatomy - Essentials of Anatomy and Physiology. Fourth Edition - Essentials of Anatomy and Physiology. Sixth Edition - Anatomy and Physiology. Sixth Edition - Anatomy and Physiology - Human Anatomy and Physiology (and a Brief Atlas of the Human Body). Seventh Edition

February 23, 2007

Clinical Anatomy by Harold Ellis is a classic by anyone's standards. This 11th edition proves that it has stood the test of time and has served many thousands of medical students and junior doctors well for their clinical practice and examinations since it was first published in 1960. I was one of them. The text is a masterpiece of simplicity and wisdom that has been kept up to date over the years. There is clinically relevant embryology when it is indicated.

I looked hard for the odd thing to criticise and have come up with a few little ideas for the author. The convention for axial sections now that MRI and CT are so popular suggests that Figure 49 needs reorientating. We should now be talking of intravenous urograms and not pyelograms. In the section on descent of the testes, there should be mention of the role of calitonin gene-related peptide (CGRP), which has been shown to play a major role. But an indication that the author has kept up with the latest research is his reference to advances in our knowledge of the origins of the cranial root of the accessory nerve, something that hopefully other books will follow. Long may this book be published.

All the rest of the books under review have combined physiology with anatomy and are suitable only for paramedical, health and allied worker's courses or perhaps, sadly, for integrated medical courses in which anatomical detail may no longer be regarded by the course organisers as of prime importance. There may be such courses in the US, but there are few in the UK; thus these texts will not prove popular on this side of the Atlantic.

First we have two books with the same name - Essentials of Anatomy and Physiology . One is by Fredric Martini and Edwin Bartholomew in its fourth edition; the other by Rod Seeley, Trent Stephens and Philip Tate in its sixth edition. I could find no reference to the date of first publication of either of them, but it does seem strange and less than inspiring that the authors have chosen identical titles. Each could well alternatively be titled "Some Physiology and Short Notes in Anatomy". If these books are used by medical students, then we will wonder no more why there is a lessening of anatomical knowledge in modern doctors.

The Martini and Bartholomew version has amalgamated the glossary and index so that it runs to 40 pages and complicates any search. The book could be some 40 pages shorter if the photographs of people smelling roses, doing one-handed handstands, a mother and daughter on a beach and many others were excluded. On the accompanying CD, we are invited to "click on the hamburger" to advance the image of the digestive system. In the UK, we are trying hard to ban the image of fast foods. As an anatomist, I anxiously turned the pages in the search for some anatomy, and I was first rewarded on page 145 with a named bone, having been introduced in the preceding pages to Marfan's syndrome, hair loss and a profile on "Burn Nurse Specialist". There was a single paragraph on hip fractures, and no mention at all of the femoral triangle. The movements of the extrinsic eye muscle are either wrong or inadequate, and there is nothing on clinical testing of them. The anatomy in this very American text would be inadequate for undergraduate courses that take the science of medicine seriously.

Seeley et al's version of this title is at least somewhat lighter and loaded with modern readable molecular material in the early chapters.

Physiology colleagues assure me that the detail of these early chapters would be inadequate for a medical course. The anatomy, if anything, is even briefer and has less detail than the Martini and Bartholomew version of this title. Inaccuracies are evident. For instance, one boundary of the femoral triangle is seriously incorrect, and I could find no mention of the cavernous sinus even in the index, which I might add is in such small print that anyone over the age of 15 would need a magnifying glass. This is definitely not the text for an in-depth study of the science of medicine.

Next we have two more books with the same names, though one has a subtitle. Gary Thibodeau and Kevin Patton's version of Anatomy and Physiology is an enormous tome with an index in such small print that it is farcical to search for anything in it. Are they trying to save trees or produce a generation of students with profound eyestrain? The book comes with an excellent "Brief Atlas" with clear illustrations of surface anatomy, resin injected specimens and wet material. Brief it is indeed, but welcome. Most of the early chapters are at cellular and molecular level and seem informative and well illustrated. The serious anatomy starts after 255 pages but it is largely descriptive, with little reference to function.

Anatomical illustrations are generally excellent, and there is one on the inguinal region that particularly impressed me. After six editions, one might have thought spelling mistakes could have been eliminated from pictures of the trigeminal nerve with an "opthalmic" branch. But, again, there simply is not enough for an in-depth study of anatomy. There is no mention of the femoral triangle; prolapsed disc is dealt with in one sentence; there is no reference to locking of the knee; and the cruciate ligaments are not even named. A feature of this text is a series of plastic overlays in the first chapter that look appealing initially but further study shows limited usefulness and some real inaccuracies. The psoas muscle is the wrong shape, and the lumbar nerves seem to be coming out from the anterior surface of the vertebrae.

Gail Jenkins, Christopher Kemnitz and Gerard Tortora's Anatomy and Physiology has an additional note in the title to say that it is "From Science to Life". As with all these books under review, apart from Clinical Anatomy , the systems are covered one by one. It is an enormous book with its share of well-illustrated metabolic pathways and cellular physiology.

Each chapter has a clinical story that is prolonged and agonised over throughout the chapter. For instance, there is a hairy alcoholic character called Eugene in the second chapter, and a photograph of him appears seven times illustrating various stages of his inebriation. It was a minor relief to reach the next chapter to be confronted with Joseph's story. If it was converted to a textbook instead of a storybook, it might be half the size and possibly half the price. There are inaccuracies in the illustrations, the worst of which is the drawing of the femoral triangle that falls into the common student trap of showing the incorrect boundaries. The artistic quality of most of the illustrations is, however, generally high.

Finally, we come to a very slight variation on the title theme with Human Anatomy and Physiology by Elaine N. Marieb and Katja Hoehn. The format is very similar to the books reviewed above, which attempt to combine anatomy with physiology. It works through the systems one by one with enormous amounts of metabolic pathways and cellular-level physiology in the early chapters. There is less anatomy than the other books reviewed here, and once again the detail is totally inadequate for any stimulation of interest in the subject.

Description of the cranial nerves is brief, and any help with testing eye movements unhelpful. There is a cursory mention of the cavernous sinus, and no mention of basic topographical areas such as the femoral triangle, which I have used as a yardstick. Cadaveric specimen photographs within the book are of less than excellent quality, but the saving grace is a 129-page booklet (and a CD) that accompanies the book titled A Brief Atlas of the Human Body , which provides high-quality photographs of bones and various selected prosections of the body. It has a ring binder for easy use. The section on human embryology, though brief, has superb illustrations of early embryo development.

On the basis of horses for courses, or in this case books for courses, the conclusion must be that large tomes combining physiology with anatomy may have some specific roles to play in certain parts of the world but not for medical training in the UK.

Robert Whitaker is assistant to clinical anatomist, department of anatomy, Cambridge University.

Clinical Anatomy: Applied Anatomy for Students and Junior Doctors. Eleventh Edition

Author - Harold Ellis
Publisher - Blackwell
Pages - 439
Price - £32.99
ISBN - 1 4051 3804 1

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