‘CHIRURGUS MENTE PRIUS ET OCULIS AGAT QUAM MANU ARMATA.’
‘CHIRURGUS MENTE PRIUS ET OCULIS AGAT QUAM MANU ARMATA.’
LANDMARKSMEDICALANDSURGICAL.
1. In clinical teaching, we often have occasion to point out, on the surface of the living body, what may be called ‘medical and surgical landmarks.’ By ‘landmarks’ we mean surface-marks, such as lines, eminences, depressions, which are guides to, or indications of, deeper-seated parts. This practice is not only most useful but absolutely necessary; because many, even advanced students of anatomy, are not so ready as they ought to be in their recognition of parts when covered by skin. Students who may be familiar enough with bones, muscles, blood-vessels, or viscera in the dissected subject, are often sadly at fault when they come to put this knowledge into practice in the living.
For instance, ask a student to put his finger on the exact place where he would feel for the head of the radius, the coracoid process of the scapula, the tubercle of the scaphoid bone in the foot; ask him to compress effectually one of the main arteries; to chalk the line of its course; to map on the chest the position of the heart and the several valves at its base; to trace along the walls of the chest the outline of the lungs and pleura; to point out the bony prominences about the joints, and their relative position in the different motions of the joints; test him about the muscles and tendons which can be seen or felt as they stand out in relief or remain in repose; let him introduce his finger into the several orifices of the body, and say what parts are accessible to the touch:—questions such as these, even a good anatomist, unaccustomedto deal with the living subject, might possibly find himself at a loss to answer.
2.Object in view.—Our main object, therefore, is to induce in students the habit of looking at the living body with anatomical eyes, and with eyes too at their fingers’ ends. The value of this habit cannot be too highly estimated. Is it not of the utmost importance to an operating surgeon that he should have in his mind’s eye the various structures of the body as they lie grouped, connected, and working together? Should he not try at least to see them with the same clearness and accuracy as if they were perfectly transparent?
Moreover, the habit of examining the living body with ‘anatomical eyes’ and ‘surgical fingers’ teaches the eye and the hand to act together, and trains that delicate sense of touch which every surgeon should possess.
This habit is within easy reach of any one who has carefully dissected for himself, and learned what to feel for. Plates will not give him this knowledge. Let a student examine his own body with a skeleton before him. Better still that two should work thus together, each serving as a model to the other.
Teachers of anatomy should follow the example of Sir C. Bell, who was in the habit of introducing, from time to time, a powerful muscular fellow to his class, ‘in order to show how much of the structure of the body, such as the articulations and the muscles, might be learned without actual dissection.’[A][1]
At the same time, it is only fair to say that ‘landmarks’ cannot always be defined with precision. A considerable latitude must be allowed for natural variations in different persons. In some, their anatomy stands out beautifully clear; in others, it is masked by obesity. Selecting, therefore, for study a moderately lean person, let us begin with the head.
[A]The references throughout are to Notes at the end of the book.
[A]The references throughout are to Notes at the end of the book.