Color Atlas of Anatomy, 4th edition, by Johannes W. Rohen, Dr.med., Dr.med.h.c, Chihiro Yokochi, M.D., and Elke. Lütjen-Drecoll, Dr.med., with the collaboration of Lynn j. Romrell, Ph.d., 486 pages, Stuttgart: Schattauer/Baltimore: Williams & Wilkins, 1998.
Although I had been aware of the Rohen-Yokochi Atlas since its first publication in 1983, I had not examined it thoroughly until I was invited to review its fourth edition. Had I paid this much attention to the Atlas when its earlier editions appeared, I would have incorporated it into my teaching a long time ago, and would have urged it on my students as a primary and preferred resource to guide them in their dissection and assist them in visualizing anatomy. The Atlas is an outstanding scholarly, educational, and artistic achievement, deserving not only of professional recognition and praise but widespread use by students and teachers of anatomy alike. In the remainder of this review, I shall provide justification for these extravagant remarks and try, hard as it is, to point out some minor shortcomings to which the authors might pay attention when they prepare the next edition.
The overall content and organization of the Atlas, and that of its nine chapters, is designed to support the learning of anatomy through cadaver dissection. Owing to the comprehensiveness and quality of its images, however, the atlas can also serve as a valuable substitute for dissection when cadavers are not available, or when dissection is beyond the scope of an educational program.
This is a photographic atlas of dissected cadaver specimens. Its educational value is assured by several notable features. These include: the uniformly high quality and the comprehensiveness of the dissected specimens, the sequence in which these dissections are assembled in each chapter, the radiological images and schematic sketches that accompany the dissections, the strategic layout of the individual and facing pages, the attention paid to the accuracy and selectiveness of the labeling, and--not least of all--the sheer pleasure the book imparts through the beauty of its images and the overall professionalism of the entire presentation.
The dissections were prepared in the Department of Anatomy, University of Erlangen-Nürnberg, at Erlangen, Germany, and the Department of Anatomy, Kanagawa Dental College, Yokosuka, Japan. The preserved specimens are of a surprisingly even quality, displaying varying shades of a light ochre to a deep-bronze palette, with bone and connective tissues retaining an ivory to pearly white color. The contrast in the specimens is excellent; even the finest branches of the nerves and arteries (meticulously dissected) are readily discernible and stand up to the scrutiny of a magnifying lens (as may be verified on dissections of the cranial nerves, for example). Vessels are enhanced in many specimens by the injection of colored contrast medium. Color is also applied to the surface of various structures, using admirable restraint and excellent judgement (e.g., posterior roots of lumbar nerves, p. 216; lymph vessels of posterior body wall, p. 312). Applying the color to the specimen, rather than to the photograph (as is usually done in atlases), enhances the 3-dimensional quality of the specimens. The same purpose is achieved by placing black paper tags beneath fine branches of nerves, rendering them identifiable even on large specimens (e.g, medial branches of posterior rami in a dissection of the entire back, p. 213). The imaginative use of colored probes inserted into openings, passages, and spaces likewise enhances appreciation of their 3-dimensional relationships as they are depicted on the 2-dimensional page.
As in most atlases, the first part of each chapter dealing with a body part begins with the relevant bones. In this atlas, however, the systemic approach is carried through to other organ systems. The second part of each chapter focuses on relationships and takes a regional approach; it proceeds, like a dissection, from superficial to deep structures. This organization parallels that of many textbooks, and is ideal for supporting courses of study that take either a systemic or a regional approach; in either case, it reinforces learning by helping the student gain a mental image of the anatomical entities, before enhancing that conceptualization with anatomical relationships. An outstanding example is the chapter on the abdomen. \
Knowledge gleaned from the dissections is enhanced by explanatory schematic drawings, always appropriately paired with the specimens (e.g., some of the cranial nerves, pp. 70, 77; upper portions of the digestive system, p. 272). Progressive stages of a dissection are illustrated in the second part of each chapter. For instance, the steps for studying the stomach, its associated mesenteries and peritoneal spaces are outstandingly illustrated. As a rule, the chapters conclude with anatomical and radiological sections. Radiological images are used sparingly, appropriately, and always to good educational purpose throughout each chapter.
The first chapter presents general anatomy and illustrates such topics as the general organization of the body, the structure of bone, ossification, types of joints, and shape classification of muscles; it serves as a useful introduction as well as a resource for later reference. This chapter is preceded by a brief introduction, Diagnostic Imaging Methods, which the authors seem to have judged too short to be called a chapter in its own right. Its value would be enhanced by beefing up its contents.
That the authors are experienced teachers of anatomy is illustrated by the composition of any particular page and, when appropriate, that of the facing page: when the contents dictate it, the two facing pages complement one another and "tell a story". Of the many examples, I cite pages 156 and 157, depicting the larynx, which includes a laryngoscopic view of the glottis. Further evidence of the authors' teaching experience is their decision to present the chapters dealing with the upper and lower limbs sequentially, rather than separated by chapters on the trunk, as is the practice in some other atlases. Comparisons between the upper and lower limbs are key to their understanding.
Labeling is accomplished by fine leaders (changing from black to white, depending on the background); the numbers associated with the leaders are placed outside the black background of the image. This method allows the attention to focus on the specimen rather than on the numbers and is very effective. For instance, as many as 53 labels are assigned to one specimen (p. 165), and yet the placement of the numbers and leaders allows unhindered inspection of every detail in the complex dissection. When there is one image on the page, the numbering is sequential from top to bottom; when there is more than one image, the first image dictates the sequence and identical structures in the other images are assigned the same numbers. Numbering in these images cannot, of course, be sequential, and the term list cannot be alphabetized. The authors have settled for the educationally most effective choice: identifying corresponding structures with the same numbers. Although such features may seem trivial, they nevertheless reflect the thought and meticulous planning that has been invested in the presentation.
Is there room for improvement? Attention should be paid to the titles of the pages, which help to focus on content and place the image in the appropriate anatomical context. For instance, some dissections of the wrist and palm of the hand are on untitled pages, which now come under the heading, "Sections Through Upper Extremity". The same is true for the dorsum of the foot which is not distinguished from the "Anterior Crural Region".
The terminology has not been appropriately updated, as may be judged from the naming of the joints of the ribs and the fibular nerve. Likewise, the terms 'ventral' and 'dorsal' in place of 'anterior' and 'posterior' have not been altered to conform with the latest edition of Nomina Anatomica. Consistency in the use of the terms 'extremity' and 'limb' would be helpful, opting for the adoption of 'limb' in preference to 'extremity'.
Although the authors are conscious of limiting the number of pages, filling some gaps in the contents would benefit the Atlas. Serous sacs, the pericardium and pleura in particular, are not dealt with adequately. The concept of the sacs is largely overlooked and the specimens do not illustrate them adequately. Nerves of the lower limb, particularly the lumbar and sacral plexuses, deserve more detailed coverage. Additional images of the liver, pancreas, deep veins of the lower limb, relationships in the cubital and popliteal fossae would seem sensible additions. Asking for more is usually a good gauge of the quality of what has already been provided. It is certainly true in this instance.
In conclusion, the Color Atlas of Anatomy by Rohen, Yokochi and Lütjen-Drecoll combines many good features that characterize other good atlases as well; in addition, however, it avoids the shortcomings which can be identified in comparable publications. Its greatest strength is the focus it maintains on its educational objectives through the unparalleled quality of its images, the judicious limitation of its subject matter, the avoidance of distracting information, and the uncluttered and well-planned presentation, which is self-explanatory to a large extent. Students will want to have their dissections look like the specimens in the Atlas. Indeed, one hopes that in years to come, they will fuse the images remembered from the Atlas with the memory of the cadaver they have dissected, and make them their own. One also hopes, therefore, that Professor Lütjen-Drecoll, who joins the senior authors in this edition, will uphold, through its future editions, the high standards this Atlas has established.
Cornelius Rosse, M.D. D.Sc.
Professor
University of Washington
Seattle, Washington