Atlas of Human Anatomy, 2nd edition, by Frank H. Netter, M.D., Consulting Editor: Arthur F. Dalley II, Ph.D., 525 pages, East Hanover, NJ: Novartis, 1997.
"Anatomy itself does not change, but the way we look at it has," said Frank H. Netter, M.d. in a Newsweek interview in 1989, just before the publication of his Atlas of Human Anatomy, a volume based on a large compendium of illustrations he had been producing steadily during the preceding six decades.
He has indeed influenced the way generations of health professionals look at anatomy. His images, projected from slides, had become indispensable visual aids in anatomy lectures long before they found their way into the hands of students, bound between the understated black covers of Netter's Atlas.
In the long history of anatomical illustration, Netter has introduced an entirely new and individualistic style that is instantly recognizable--more so, in fact, than the work of any other medical artist. Netter's art invents an enhanced, or heightened reality, for neither the dead nor the living organs or body parts look like Netter's illustrations, as a comparison with atlases that are based on photographs will demonstrate at a glance. His depiction of the world of anatomy is one that takes delight in rendering detail, and bounds over with exuberance and inventiveness; it is not so much a baroque as a rococo view of the human body. His images are laden with painterly tactile values which invite a feasting through the eye. The illustrations entice the viewer to explore the image, and their aesthetic appeal banishes any preconceived notions of the gruesomeness so often associated with displays of anatomy. Yet, it is anatomy, in the strict academic sense; perhaps best appreciated by experts rather than novices. Indeed, whichever atlas anatomy teachers recommend to their classes as a primary aid to dissection, all must hope that at least a proportion of the class will see Netter's, because it will provide a perspective unlike that of any other source.
It is reassuring, therefore, that Netter's Atlas will be perpetuated in hardcopy (as well as in the parallel cd-rom format) nearly ten years after the first edition. a new edition has been prepared under the consulting editorship of Arthur f. Dalley II, Ph.D. It is to the credit of the consulting editor, as well as the Novartis Medical Education project team, that the second edition remains faithful to the first; it is unmistakably Netter's anatomy. The sequence and organization of the first seven sections dealing with major body parts remain unaltered, and a newly added eighth section presents cross-sectional anatomy rendered in the Netter style by Carlos Machado, M.D. Apart from updating some of the anatomical terms and rearranging some leaders, there are, in fact, no apparent changes in the plates pertaining to the head and neck, the back and spinal cord, and the thorax (internodal fasciculi of the conducting system have been deleted from plate 213); five plates concerned with variations of the vasculature have been deleted from the abdomen, and, in just over a dozen plates of the pelvis and perineum, the pelvic and urogenital diaphragms have been modified in accord with descriptions of the urethal sphincter muscle published in the 1980s.
Unfortunately, some of the modified depictions of the deep perineal muscles introduce errors by including the bulbourethral glands (which are posterolateral) in the same coronal and sagittal sections as the urethra (plates 343 and 357, as well as 329, a sagittal section of the abdomen). Also, the newly added muscles remain unlabeled in most of the redrawn plates. The upper limb section includes plates that, in the first edition, were of less than ideal quality; these have evidently been redrawn without any change in the anatomy (e.g. plates 396, 398). The quality of these plates is a testimony to Dr. Machado's technical accomplishments and his identification with the Netter style, attributes that bode well for changes that might be made in other plates in the future.
The source on which the eleven transverse sections of Section VIII are based is not identified. The levels of the sections are appropriately selected and the detail is well-rendered, although they are smaller than similar sections in preceding parts of the Atlas. Comparisons are inevitable:
Plate 230 shows a section at T8 (seen from above) drawn by Netter, and plate 516 at T7, seen from below, drawn by Machado; plate 327 at t12 (seen from above) drawn by Netter, and plate 518, at the same level, seen from below, by Machado. a Netter remains a Netter; as excellent as the Machado illustrations are, the mechanical texturing of the muscle and mucosal folds in the intestine, as well as the use of highlights, give away the fact that these plates were not rendered by the old master. Furthermore, the texture of the spleen in plates 517-519 is inaccurate (Compare to plate 327).
There are some other errors that have been perpetuated from the first edition. The most notable one is in plate 329 (which has been modified in other respects): the two laminae of the greater omentum (gastrocolic ligament) are shown as encircling the transverse colon and continuing to the posterior abdominal wall as the transverse mesocolon; an embryological impossibility. Would we forgive a medical student if he or she drew it on the blackboard? While there are excellent illustrations of the pleural and pericardial sacs (plates 182, 186, 200, 201), others imply an equivalence between the pleura, on the one hand, and the fibrous plus parietal pericardium on the other (plates 180, 230, 516, 524, 525). Only fat is shown in plates 180 and 230 (as well as in some others) where the fibrous pericardium ought to be, and the pericardium is seen only as a serous membrane. The illustrations should distinguish between the fibrous pericardium and the serous membranes that are associated with its external and internal surfaces.
Since aesthetics is a chief asset of the Atlas, it must be noted that some of the plates have lost their luminosity and crispness in the second edition (e.g.: 14-19, 76, 78, 103, 124, 125, 232, 233, 317, 318). While this might be perceived only by a critical observer with an eye for such nuances, it would be regrettable if the artistic standards set by Dr. Netter would be relaxed in future editions.
In the last analysis, however, the Atlas is an outstanding publication. It retains a focus on gross anatomy, uncluttered by extraneous information and diversions, yet it includes some well-selected applied anatomy and explanatory illustrations. The book is of a sensible size, and is admirable both for the clarity of its layout and the quality of the overall presentation. Even though some students may find the number of labels and leaders overwhelming at first in some of the plates, the leaders do not detract from the illustrations and the terms are logically grouped and arranged. While many of the plates present anatomy that is too complex to be retained as a mental image or a template to support anatomical reasoning, there are numerous illustrations that have become classics and are used in college-level as well as postgraduate anatomy courses. In anatomy curricula for the health professions, Netter's Atlas would perhaps be most effectively coupled with textbooks that present simple drawings of anatomical entities which make one point, are readily comprehended, and can provide the conceptual foundation for the enhanced anatomical reality as seen through Dr. Netter's eyes.
Cornelius Rosse, M.D., D. Sc.
Professor
Penelope Gaddum-Rosse, Ph.D.
Associate Professor Emeritus
University of Washington
Seattle, Washington