BIBLIOGRAPHICAL NOTICES.
Surgical Anatomy. By Joseph Maclise, Surgeon. With colored
plates. Part III. To be completed in foufparts. Philadelphia :
Lea & Blanchard: 1850.
The 1st and 2d parts of this work have already gained for it
a high reputation as a treatise upon Surgical Anatomy : it is, there-
fore, unnecessary to give any detailed account of the contents of
this part, in order that we may commend it to our readers. Every
one who is conversant with the medical literature of our coun-
try, is conscious that there is an imperative demand for works of this
class, and will congratulate the American public upon the appear-
ance of Mr. Maclise’s labors in their present form and dress.
The importance of this kind of knowledge, the difficulties under
which it is usually obtained, and the facility with which it is forgot-
ten, afford cogent reasons for pressing the usefulness and value of
this work upon every student of medicine.
Although we cannot admit for one moment that there is any au-
thority in Anatomy equal to the dead subject and the scalpel, and that
for these there can never be a substitute, nevertheless, since so few
appeal to this source of knowledge, and since (of these few) some
approach it with preconceived notions from books ; we cannot but
rejoice that there are some sources of authority that are in accord-
ance with nature and the truth. If a large number will teach Ana-
tomy from books, and a still larger number learn it from the same
source, we rejoice to know that Maclise’s Surgical Anatomy will in-
culcate more truth and fewer errors than most of its predecessors.
This 3d part contains sixteen plates relative to Inguinal and
Femoral Hernia, with instructive commentaries upon each. We
hail those upon Inguinal Hernia with most pleasure, because we
conceive that greater error exists among teachers and students upon
this form of hernia than upon any other. Every one, whether an
Anatomist or Surgeon, must recollect the time and labor expended
upon this subject in the lecture-room, and the apparent paradoxes
and contradictions with which it was surrounded. The very fact,
that the subject of Hernia is a “ pons asinorum ” to students, is an
evidence that there is an obscurity connected with its demonstra-
tion. The parts concerned are not so numerous or minute as those
of the eye or brain, and yet these latter are learned with compara-
tively little patience and trouble. Though the points to be studied in
hernia are few in number, and can be seen without microscopes,
the student generally leaves the lecture-room with a degree of per-
plexity which cannot in justice be attributed to the subject, and
which is only removed by his own personal dissections.
This obscurity arises from the application of a defective nomen-
clature, a kind of adherence to the description given by some great
authority, and in making dissections to suit a description.
Anatomical nomenclature probably never can be altered : we
can never expect a perfect uniformity of terms, nor is it necessary
that there should be, any more than that we should all speak the
same language. But, it is extremely important that students should
he taught something more than mere names, that they should not be
confused with long Latin synonymes, before receiving clear ideas
of facts : they should learn that terms are but conventional and
representative, whether invented by Camper, Scarpa, or Sir Astley
Cooper. These are the views and feelings of Mr. Maclise when
he speaks of the difficulty and perplexity with which this impenetrable
fog of surgical nomenclature besets the progress of the beginner.
We have no hesitation in saying that no one is able to make a
proper demonstration of the anatomy of hernia, unless he can make
an intelligent beginner clearly understand it without the use of tech-
nical terms.
How often has an hour been wasted in endeavoring to prove that
Sir) Astley Cooper called this or that the Cribriform Fascia ; as if the
great idea to be taught was, that the dissection presented to their
view was in accordance with that of Sir Astley ; as if the truth was
not the same, no matter upon what plan the dissection is made, pro-
vided it is not forced by knife-handles or pointers.
How unfortunate would it be for a student if this fond adherence
to terms should affect the prescribed text-books of any medical
school; one with an air of confidence and certainty will say, this
is the “ cribriform fascia,” another with a tenacity equal to the
other’s boldness, “ that is the cribriform fascia; Sir Astley told me
so.”
“Strange there should such a difference be
Twixt tweedle dum and tweedle dee.”
A sentiment which seems to have actuated Mr. Maclise in his
work is thus expressed by him : “ But when we ^iew nature as she
is, and not fashioned by the scalpel, we never fail to find an easy
explanation of her form.” This follows a description of the inferior
edges of the internal oblique and transversalis muscles. Our readers
may recall, among the dim memories of inguinal hernia, something,
called the crural arch, and, perhaps, they may recollect seeing the
same pictured forth with beautiful regularity, in some drawing or
painting of the subject, about the lowrer part of the belly.
Now, Mr. Maclise says nothing about the crural arch in this con-
nexion, and hence, therefore, some may not consider the work as
orthodox; especially as they know that Colles, or Scarpa, or Cloquet,
or Lawrence, says there is a crural arch. This reference to authority
and not to the dead subject, at once settles the matter in their
minds. But let the reader peruse the following passage, and judge
for himself.
“ The arched inferior border of the transverse muscle, f, Plate 30,
expresses by its abrupt termination that some part is wanting to it;
and this appearance, together with the fact that the fibres of this part
of the muscle blend with those of the internal oblique and cremaster,
and cannot be separated except by severing the connexion, at once,
suggests the idea that the cremaster is a derivation from both of these
muscles.
“ Assuming this to be the case, therefore, it follows that when the
dissector removes the cremaster from the space l A, he himself
causes this vacancy in the muscular parietes of the groin to occur,
and at the same time gives unnatural definition to the lower border
of the transverse and oblique muscles. In a dissection so conducted,
the cord is made to assume the variable positions which anatomists
report it to have in respect to the neighboring muscles. But when
we view nature as she is, and not as fashioned by the scalpel, we
never fail to find an easy explanation of her form.
“ In the foetus, prior to the descent of the testicle, the cremaster
muscle does not exist. (Cloquet, op. cit.) From this we infer,
that those parts of the muscles, ef,* Plate 30, which at a subsequent
period are converted into a cremaster, entirely occupy the space l h.
In the adult body, where one of the testicles has been arrested in
the inguinal canal, the muscles e f, do not present a defined arched
margin, above the vacant space l h but are continued (as in the
foetus) as low down as the external abdominal ring. In the adult,
where the testicle has descended to the scrotum, the cremaster ex-
ists, and is serially continous with the muscles e f, covering the
space l h; the meaning of which is, that the cremasteric parts of the
* Internal, oblique and transversalis.
muscles e f, cover this space. The name cremaster therefore must
not cancel the fact that the fibres so named are parts of the muscles
e f. Again, in the female devoid of acremaster, the muscles
ef present of their full quantities, having sustained no diminution
of their bulk by the formation of a cremaster. But when an external
inguinal hernia occurs in the female body, the bowel, during its de-
scent, carries before it a cremasteric covering at the expense of the
muscles ef, just in the same way as the testicle does in the foetus.
(Cloquet.)
“ From the above-mentioned facts, viewed comparatively, it seems
that the following inferences may be legitimately drawn :—1st, that
the space l h does not naturally exist devoid of a muscular cover-
ing; for, in fact, the cremaster overlies this situation ; 2d, that the
name cremaster is one given to the lower fibres of the internal ob-
lique and transverse muscles which cover this space ; and 3d, that
to separate the cremasteric elongation of these muscles, and then de-
scribe them as presenting a defined arched margin, an inch or two
above Poupart’s ligament, is an act as arbitrary on the part of the
dissector as if he were to subdivide these muscles still more, and,
while regarding (he subdivisions as different structures, to give them
names of different signification. When once we consent to regard
the cremaster as constituted of the fibres originally proper to the
muscles, ef, we then are led to the discovery of the true relations
of the cord in respect to these muscles.”
There is another point upon which we consider Mr Maclise to
have added much that is valuable to teachers and students, and
this is expressed in plates 31 and 33, exhibiting the fascia trans-
versalis as far as it relates to the anatomy of parts concerned in her-
nia, a point concerning which there is such a diversity of expression.
This diversity of opinion arises, as we have said already, from a want
of reference to the dead subject, and a dependence upon authority
''for truths which we should acquire or make our own by study. Let
the reader refer for instance to the plate of Sir A. Cooper exhibiting
his fascia transversalis, and that which is called the internal abdom-
inal ring, and he will there see represented a dissection which is well
calculated to give a most erroneous idea, and which is a most fruit-
ful source of error on this subject. There is pictured an oval hole
in the fascia which was made by the dissector, and which is under-
stood by the ignorant to be so in nature, which Sir A. C. never
meant to teach. In this point and in many others we consider Mr.
Maclise’s drawing far superior to any others, for the simple reason
that it represents the truth.
The “ internal spermatic fascia,” (Cooper) and “infundibuliform
fascia,” (Cloquet) is shown to be continuous with, but a prolongation
of, the fascia transversalis. This is not only true in nature where
no hernia exists, but also where inguinal hernia does occur, unless the
case is an exception, and the hernia is the result of force and the tissue
actually ruptured. If the work of Mr. Maclise be read and studied
by those who cannot or will not read nature, they cannot fail to get
rid of the erroneous impressions which result from early educa-
tion, and learn that the internal abdominal ring is not a hole or
fenestrum.
The plates illustrating the descent of the testicle are equally well
calculated to teach the truth as it is in nature, and the laws by which
she is governed. They show how the testicle descends, pushing
before it, and enveloping itself with, every lamina which constitutes
the parietes of the abdomen ; the modifications which these laminae
undergo in becoming the investments of the cord and testicle ; and
that in every oblique inguinal hernia, the bowel pursues the same
course.
The work is equally satisfactory with reference to Femoral Hernia.
The plate exhibiting the crural ring and the description, the descent
of the bowel and the manner in which it receives its coverings, are
shown in a clear and instructive manner; and we have no doubt
that many will in their hearts confess that this work of Mr. Maclise
has taught them what they never knew before concerning the ana-
tomy of hernia.
How simple does the subject of hernia become when treated of
by a philosophical anatomist, who is not only familiar with facts
and details, but with the causes which produced them! How in-
delible is the truth acquired by reason compared with that acquired
by memory. When in the first place we are taught the true anatomy
of the parietes of the abdomen in general, and then the descent of the
testicle, and the particular relation of these parietes to the cord and
testicle, and that when the bowel descends, it follows the course of
the cord (in oblique inguinal hernia,) and that whatever is true of
the cord and its coverings, is true of the protruded bowel,—we then
distinctly see the reason of things, and the connection of one fact
■with another, that rupture is not a rupture; that this term is
calculated to give rise to the idea of holes with defined edges;
whereas, there is no such thing in nature, not even at the external
abdominal ring; and whenever such an opening is presented to us,
we recognize it at once as the result of an injury, or as a false dissec-
tion.
Such works as thishre calculated to bring about the correct teach-
ing of a Philosophical Anatomy.
We extend to this number, therefore, as we have to those which
preceded it, a hearty welcome, and commend it to our readers as a
faithful exponent of the science of which it professes to treat.
Nothing will be believed now, but that which one can see for
himself; and fortunately the laborers in this field are sufficiently
numerous to present the science of anatomy in a new light, with no
claims but those based simply on facts and their philosophy.