Medical anatomy, or, Illustrations of the relative position and movements of the internal organs

Front matter

UNITED STATES OF AMERICA

FOUNDED 1836

WASHINGTON, D. C.

Preface

Descriptive and surgical anatomy are well taught in our medical schools, but the practical teaching of medical anatomy, or the knowledge of the relative position of the internal organs, is neglected. Indeed, on the present plan and with the existing means, it is impossible to teach that subject, which is as important for the physician as surgical anatomy is for the surgeon.

When a body is prepared for the dissecting-room, the arteries are injected from the arch of the aorta, to the injury of the great vessels. The superficial dissection of the body precedes that of the internal organs ; and by the time those parts are reached, they have lost that freshness which is so necessary for their successful study. Generally, indeed, they are then in a state of decay, and their relative position has been altered.

It is impossible, therefore, that the relative anatomy of the internal organs can be taught in the dissecting-room: but the deadhouse affords all the materials for their study.

It falls to the teacher of pathology to make the post-mortem examinations ; and it would he easy for him to give practical demonstrations of the contents of the chest and abdomen in health as well as in disease. It ought, therefore, to be one important duty of that officer to teach the topographical anatomy of the healthy viscera on the dead body. Afterwards he might take the pupils into the wards or the out-patient room, and indicate to them, on the living body, the varying position of the organs during the healthy exercise of their functions. He would at the same time train them to a knowledge of the physical signs furnished by the healthy viscera. Under his tuition, the student ought to be as familiar with the position and movements of the organs as if he saw them stripped of their parietes and exposed to view.

Until this be done, it is self-evident that the teaching of clinical medicine must be imperfect.

The student naturally rivets his attention upon the subjects of his coming examination to the exclusion of everything else. He knows that his acquaintance with the anatomy of the limbs and the head and neck will be carefully tested, and that anatomy he studies. He also knows that he will not, as a rule, be examined on the bearings of, say, the great vessels, the heart or lungs in relation to the walls of the chest, or on the movements of those parts during life, or on the signs of their healthy functions. The result is, that the student does not seek to acquire, and has not the opportunity of acquiring, that kind of knowledge of which I have just spoken.

If the examiner were to require the candidate to point out accurately, on the exterior of the living body, the corresponding position and the movements of the internal organs, and the signs by which they are distinguished in health, the teacher would speedily discover the method whereby he could convey the desired information, and the pupil would eagerly avail himself of it.

This work, which consists of a series of illustrations of medical anatomy, is founded upon the Author’s paper in the Provincial Medical Transactions for 1844 on the situation of the internal organs. That paper, in the preparation of which he received important aid from his friend, the late Dr. Hodgkin, was the result of numerous observations made by himself in the wards, and, more especially, on the dead body.

In 1848, Conradi published a valuable memoir on the position and size of the thoracic and abdominal organs. In that work, which has been translated into English by Dr. Cockle, with a view to publication, Conradi gives the topography Of the internal organs as laid down by the Author in the paper just referred to. He then describes his own numerous researches by means of percussion on the living body, and compares them seriatim with the Author’s observations on the dead.

Those researches substantiate in the main the anatomical conditions defined by the Author.

The illustrations in the earlier and larger portion of this work represent the parts exactly as they were found after death. The front, the sides, and the back of the frame, from the surface to the deepest parts, are depicted in succession.

In making these drawings, the Author employed mechanical aids, described in columns 1 and 85, by means of which he has been able to represent with precision every organ, with its external and internal relations, at each stage of the dissection.

This volume thus presents the exact topography of the parts contained in the body, from its circumference to its centre.

Accurate representations of the exterior and interior of the dead body give, however, no adequate idea of the movements and varying position of those parts during life. At the time of, and after death, indeed, the heart and great vessels and the lungs shrink upwards, the diaphragm ascends, and the stomach and liver and the subjacent organs are partially raised.

In looking, therefore, at all drawings that are literal transcripts from the parts contained in the body after death, due allowance must be made for those changes that take place during and after the departure of life.

To supply, as far as possible, this deficiency, and to represent and describe the organs in motion as they are during life, the later portion of the work is devoted to the movements of respiration, and to the movements, structure, and sounds of the heart.

The part relating to the movements of respiration developes and illustrates the papers by the Author on the “Mechanism of Respiration” in the Philosophical Transactions for 1846, and on the “Movements of Respiration in Health and Disease” in the Medico- Chirurgical Transactions for 1848.

The description of the movements, structure, and sounds of the heart is derived from numerous original experiments, observations, and dissections made by the Author during the last seven or eight years. The peculiar methods employed by him in pursuing those inquiries are described in columns 73-77, 83, 84, and 88.

These researches have been a work of great labour and deep interest to the Author. He believes that they represent important physiological truths, and he trusts that they may be useful to those who are engaged in the study of the vital phenomena of respiration and circulation.

59, BROOK STREET,

January, 1869.

Table Of Contents

COLUMN

Commentary on Plates L, II., III. (Front views) 1 , 2

Explanation of Plate I. . . . . . . . . . . . 1, 2