McMinn's Color Atlas of Human Anatomy, 4th edition, by p.h. Abrahams, M.B., B.S., FRCS (Ed), FRCR, R.T. Hutchings, and S.C. Marks, Jr., D.d.s., Ph.D., 352 pages, London: Mosby, 1998.
Except perhaps for Basset's Stereoscopic Atlas of Anatomy (published in 1963, on color film mounted in reels), McMinn's Color Atlas of Human Anatomy was, to my knowledge, the first bound atlas that presented anatomy through realistic color photographs of cadaver specimens. Its first edition, published in 1977, apparently revealed the potential of this approach, and several atlases have since followed in its wake.
The objective of the first edition was to bridge the gap, for the student in the dissecting room, between textbook descriptions and the reality of the body. The unique aspect of this approach was that it displayed, in their natural size, preserved, dissected specimens, in many of which the cavities and spaces had been injected with color contrast media. Particularly impressive were the corrosion casts that had been prepared by d. h. Tompsett, using special methods that he had developed, for the Royal College of Surgeons of England. The specimens and casts were, and still are, housed in the Anatomy Museum of the College (along with the specimens that John and William Hunter collected in the 18th century) and remain in active use in the courses taught by the College for preparing candidates for examinations equivalent to those of surgical boards. Over twenty years ago, I gained first-hand experience with these specimens as a visiting professor at the College. Therefore, I welcomed the publication of mcminn's Atlas; it has provided access to a unique and valuable anatomical resource for students worldwide.
Photographs of these specimens still form the core of the 4th edition. Some, however, have been replaced and--although the total number of pages is still more or less the same--the contents of the Atlas have been expanded by the addition of new dissections, clinical imaging (radiology as well as endoscopy), surface anatomy, explanatory sketches and notes pertaining to anatomy and clinical medicine. The Atlas is now published in both hard and soft cover, the latter with a substantially smaller page size. Of the original authors, only r.t. Hutchings remains; he has been responsible for photography throughout. drs. Abrahams and Marks have clinical backgrounds in medicine and dentistry, respectively, as well as being teachers of anatomy.
The stated objectives of the authors are to emphasize clinical anatomy and make the Atlas more user-friendly. They succeed in these intentions to varying degrees. Many of the clinical images are well-paired with the anatomy specimens, and effectively demonstrate applied anatomy (e.g., dissection of the nasolacrimal duct paired with a macrodacryocystogram, p. 55; surface anatomy of the forearm paired with a superficial dissection, p. 122). In some cases, however, the clinical images are hard to relate to the anatomy [e.g., laparoscopic view of inguinal hernia, p. 194; a similar view of the gall bladder paired with a specimen showing the stomach and greater omentum, p. 197; endoscopic view of the glottis paired with radiological (MR) and anatomical sagittal sections of the larynx, p. 50], and they are likely to disorient and frustrate the student.
A similar problem arises in relation to some of the clinical notes which appear "pasted on" the pages among the images. Whereas comments about ulnar nerve compression behind the medial epicondyle, or about breast cancer, are well-paired with appropriate anatomical specimens, I could not see the reason for the clinical notes pasted on a number of other pages. A note about cavernous sinus thrombosis (p. 51), for example, occurs on a page where none of the images or labels actually show the sinus. Furthermore, the clinical notes often include information that seems premature or too complex for students of anatomy. For instance, associated with a neck dissection showing the carotid arteries, there is a clinical note about carotid artery bruits: "Extra sounds (extra to what?) heard through the stethoscope.... Early detection of narrowing of this essential artery is often accomplished by color Doppler ultrasound." (What is that, and to what purpose should the student track it down at this stage?)
Since the key requirement for learning is the establishment of logical relationships or linkages, unanchored clinical images and notes may encourage memorization of these vignettes by a novice student, rather than promoting the facility for anatomical reasoning. Indeed, one wonders whether an atlas is the appropriate place for clinical vignettes. After all, understanding of the structural organization of the human body is, in itself, the most clinically-relevant knowledge a course of study in anatomy can promote, and a well-organized atlas--even without clinical vignettes--is an appropriate tool for gaining such an understanding through dissection.
McMinn's Atlas offers many resources that could support such an endeavor. It is organized according to the major parts of the body from head to toe. Although the specimens do not illustrate comprehensively successive stages in dissecting a particular body part, they are logically organized and many page pairs tell an instructive story through their composition. Superimposed on this framework is a classification of the pages by color icons, which suggest the relevance of the page to medicine, physical therapy, and ATLS and ACLS courses (the latter acronyms are not explained). The icons are intended to support user-friendliness, as are the simple line drawings of many of the dissected specimens. Structures are labeled with numbers in both the photographs and the sketches; the number sequence is determined by an alphabetized list of the terms, rather than by an ordered sequence of structures in the image. Since a page may contain three or four such lists of terms, labeling each list with the same letter as the corresponding image would facilitate navigation through a busy page.
a feature that runs counter to the authors' intention of enhancing user-friendliness is a tendency to overlabel the images. This is manifest in two ways. First, the images of surface anatomy often bear labels not only for the visible and palpable features, but also for some deep structures that are not accessible by palpation. For example, the vocal folds are indicated on the skin of the neck (p. 36). Likewise, on page 28, the "parotid duct emerging from the gland" is labeled on the face of a living subject. (Paradoxically, the duct is not shown in the companion image of a cadaver specimen). An anatomical note pertaining to the surface anatomy image gives the landmarks for the duct, but the number identifying the first landmark, the tragus, is some distance above and in front of the actual tragus. The numbers on the skin that are meant to indicate the course of the duct are off the line described in the note. But apart from the labeling errors, the rationale for adding such information to the surface anatomy image remains unclear; it does not provide the basis for either dissection or the physical exam.
The second manifestation of overlabeling relates to the sheer denseness of the information. An image of the infratemporal fossa (approximately 2 inches by 3 inches in the softcover edition) contains 44 numbers crowded in its central area. In larger images, structures are labeled that cannot be seen properly, and are peripheral to the main points that can be learned from the image. Judicious attention to labeling and the pairing and sequencing of the images would have greatly improved the user-friendliness and educational value of many of the excellent images that are presented in the atlas. The newly-added dissections are of good quality, and are worthy companions to many of the specimens that have been retained in the atlas through its successive editions.
In summary, the authors have set themselves ambitious objectives by focusing the atlas on clinical anatomy. The challenge of organizing the large volume of information they include in the atlas is considerable. a more deliberate focus on providing support for a structured course of study which explores the body through dissection may, in fact, have promoted the authors' objectives more effectively and lessened the risk of fragmenting and crowding the material. A return to the objectives of the first edition, therefore, may encourage students more effectively to make use of the excellent anatomy that can be gleaned from the rich resources on which the atlas is based.
Cornelius Rosse, M.D. D.Sc.
Professor
University of Washington
Seattle, Washington