Topographic Anatomy

TOPOGRAPHIC ANATOMY (from Greek to-pos-place, grapho-I write) studies the location and interrelationship of healthy organs and parts of the body by regions in known space, proceeding from the surface inward. Surgical anatomy considers the form and position of pathologically altered, displaced organs or those in pathological conditions. Thus, topographic anatomy represents a special discipline, equally important and necessary for both therapy and surgery. Older authors until the middle of the 19th century combined topographic (applied) and surgical anatomy, since the latter was closely connected with practical surgery, and the development of the latter made the study of anatomy necessary. It is not surprising, therefore, that the first anatomy of the human body in English belonged to the pen of the surgeon Thomas Vicary of the 16th century. In the 17th, 18th and 19th centuries, applied anatomy and partially descriptive anatomy developed and were taught by outstanding surgeons of Western Europe and Russia. Thus, in England, where applied (surgical) anatomy reached its greatest development, as early as 1697 "Anatomy of human bodies" with numerous illustrations, published by the surgeon Cowper (W. Cowper, 1666-1709), appeared. It is interesting to note that departments of anatomy in England were also occupied by surgeons; thus, Astley Cooper (A. P. Cooper, 1768-1841) in 1813 took the chair of comparative anatomy, Cheselden in 1717 was professor of anatomy and surgery in London at St. Thomas school, Henry Thomson from 1753 to 1780 taught anatomy and surgery at London hospital, John Hunter (1728-1793) was an outstanding surgeon and famous anatomist, John Chiene, professor of the Edinburgh school from 1866 to 1870, specialized in anatomy as applied to surgery, to his pen belongs a course of lectures on surgical anatomy (Lectures on surgical Anatomy, Edinburgh, 1878), etc. Similar to England, in France Petit (J. Petit, 1674-1760) taught a course in anatomy and surgery in Paris (1700), Velpeau (1795-1867) published a large surgical anatomy with an atlas; anatomy and surgery of that time had such representatives as Chassaignac (Ch. Chassaignac, 1805-1879), Sabatier (1732-1811), Chopart (1743-1795), Farabeuf, etc. In Italy Scarpa (1752-1832) held the chair of anatomy and surgery in Pavia, Civinini (F. Civinini, 1844) taught anatomy and surgery, etc. Germany occupies a modest special place in this respect, but even here the famous surgeon Volkmann (1830-1889) was an outstanding anatomist. In Russia, such a representative was Ilya Buyalsky, who published his "Anatomico-surgical Tables" in 1828. Thus, until the middle of the 19th century, topographic anatomy, as an independent discipline in the modern sense of the word, did not exist and was formed only through the work of Pirogov (1810-81). Pirogov, for the first time in his work "Anatomia chirurgica truncorum arterialium atque fasciarum librisarum" (Dorpat-Liv.-Lpz., 1837-38), drew the attention of surgeons and anatomists to the importance of fasciae for topography. Having applied the method of sawing frozen corpses, "ice" sculpture, Pirogov in 1853 created an atlas that became famous, which he later (1859) provided with text ("Anatomia topographica sectionibus per corpus humanum congolatum triplici directione ductis illustrata", v. I-IV, Petropoli, 1853). Through the work of Pirogov, a new era in the development of topographic anatomy began. His followers, using the method of saws, established a large number of practically important facts (such as the form and position of organs), which could not be discovered by dissection alone. Among Pirogov's followers in Germany, Braun (W. Braune) must be mentioned, who published "Atlas der topographischen Anatomie nach Durchschnitten an gefrorenen Cadavern" (Leipzig, 1872). Under his guidance worked a large number of students who enriched topographic anatomy with very valuable data (the list of works by Braun and his students is given in his obituary-Archiv fur Anatomie, p. 253-56, 1892).-Thus, by the beginning of the 20th century, topographic anatomy as a descriptive science, the subject of which was the interrelationship and position of healthy organs and parts of the body by regions, had exhausted itself, and therefore it was quite natural and logical to approach the study of the distribution of tissue and systemic masses in the body, the location of organs and parts of the body from the point of view of their development, to the study of anatomy of typological variability-typological, or typological anatomy. In other words, the historical method had to be laid at the foundation of research and anatomical classification, understanding by the latter the attraction of data of genesis, comparative anatomy, degree of differentiation, and social factor (profession, habits, nutrition, etc.) to the analysis, which is capable of changing to one degree or another the form and position of an organ or part of the body ("Actively changing the external environment in the process of labor, man at the same time changes his own nature"); in addition, knowledge of age anatomy was required, determining age differences in the location of organs. Methodology of topographic-typological anatomy. 1) Layer-by-layer dissection of the corpse with the help of a scalpel and forceps; depending on the object of dissection, the corpse is processed in a corresponding way, for example, for the study of fasciae it is densified by injection of a 10% solution of Zinc sulfurici into the interfascial spaces; vessels (arteries and veins) are better injected with a contrast substance that allows radiography. Nerves for studying their intratrunkal architecture are subjected to maceration in a 3% solution of Acid acetici, etc. 2) Saws are made with a hacksaw on a frozen at 16° or fixed (by injection with a 1% solution of Acid chromici) corpse at a distance of 1-2 cm from each other. 3) Radiography of cavities, organs, vessels, nerve sheaths after preliminary filling of the latter with a contrast substance. 4) Dissection of animal corpses for the purposes of comparative anatomical research. 5) In a living person, relationships are studied by somatometry, somatoscopy, radiography and fluoroscopy. 6) Research data are processed by the biometric method. For convenience of description and study, topographic anatomy identifies independent, more or less significant regions. The boundaries of the regions are skin folds, muscular or tendon protrusions (for example, Poupart's ligament), visible contours, easily palpable bony protrusions or conventional lines drawn between two points. Scientific research work in the USSR is carried out in the departments of topographic anatomy and operative surgery, and abroad in anatomical institutes and surgical clinics. Teaching of topographic anatomy abroad was carried out until the middle of the 19th century by a surgeon who presented a course of descriptive anatomy. At the end of the 19th century, topographic anatomy (surgical anatomy) is taught, with rare exceptions, as a course by an associate professor, which is conducted by a clinical surgeon. In Russia, since 1846 (the date of the organization of Pirogov's Institute of Practical Anatomy), the course of topographic anatomy is conducted by a professor of operative surgery. In this respect, the USSR is ahead of the Western European schools, especially at the present time, when in one of the medical institutions (Tiflis) the course of topographic anatomy and operative surgery is conducted not only on corpses, but a special institute with an experimental department and clinic is being created. To assist the student studying the course of topographic anatomy, educational museums have been created, containing topographic-anatomical preparations. Such museums exist in Leningrad (Voen.-med. academy, 1st Med. institute), Moscow, Kharkov, etc. Abroad there are no special topographic-anatomical museums, but rich collections of topographic-anatomical preparations are kept in anatomical institutes, surgical museums, for example the museum of J. Hunter (England), the museum of Dupuytren (France), etc.