THE BEST ORDER OF TOPICS 
IN 
A TWO-YEARS COURSE OF 
ANATOMY 
IN A 
MEDICAL SCHOOL. 
A Paper Read at the Annual Meeting of the Association of 
American Anatomists, in New York City, 
28th December, 1894. 
By FREDERIC HENRY GERRISH, A. M., M. D., 
Professor of Anatomy in Bowdoin College; Consulting Sur- 
geon to the Maine General Hospital, Portland; 
Fellow of the American Surgical 
Association, etc. 
[Reprinted from Science, 22 March, 1895.] 
PORTLAND, ME.: 
William M. Marks, Printer. 
1895. THE BEST ORDER OF TOPICS 
IN 
A TWO-YEARS COURSE OF 
ANATOMY 
IN A 
MEDICAL SCHOOL. 
A Paper Read at the Annual Meeting of the Association of 
American Anatomists, in New York City, 
28th December, 1804. 
•By FREDERIC HENRY GERRISH, A. I., M. D., 
Professor of Anatomy in Bowdoin College; Consulting Sur- 
geon to the Maine General Hospital, Portland; 
Fellow of the American Surgical 
Association, etc. 
[Reprinted from Science, 22 March, 1895, 
PORTLAND, ME.: 
William M. Marks, Printer. 
1895. THE BEST ORDER OF TOPICS IN A TWO- 
YEARS COURSE OF ANATOMY IN A 
MEDICAL SCHOOL. 
Teachers of anatomy differ so widely in their views as to 
the most useful arrangement of the various branches of the 
subject that it is desirable to clear the field as far as possible 
at the very beginning of our discussion by the elimination 
of those points upon which there is substantial agreement. 
I assume that there is no diversity of opinion on the places 
which should be occupied by histology and topography. It 
is to my mind perfectly manifest that the student cannot 
profitably or comfortably receive instruction in gross anatomy 
until he has learned the elements of histology: has become 
familiar with the characters of the various textures which 
make up the parts and organs of the body, and to which, of 
necessity, references are constantly made in macroscopic 
anatomy. By identically the same method of reasoning the 
conclusion is reached that topography should be taken up 
latest of all; for it cannot be in a high degree useful to the 
pupil to work at the relations in space which different organs 
sustain to each other, until he has acquainted himself with 
the facts of their shape, size, and consistency. To attempt 
descriptive anatomy without histological knowledge is compar- 
able to studying architectural structures in perfect ignorance 
of the qualities of building materials, such as stone, brick, 
wood, iron, and mortar; and to undertake regional, before 4 
being well grounded in systematic, anatomy is about as 
possible as reading sentences before acquiring words, or study- 
ing the relations of any other things without knowing some- 
thing about the things themselves. Besides, there is a marked 
advantage in the incidental, but searching, review of every 
preceding portion of gross anatomy involved in the pursuit 
of topographical; and all teachers recognize the vast impor- 
tance of such repetitions for the student, even if they do not 
admit that they themselves retain their familiarity with this 
science of innumerable details only by virtue of incessant 
review in one way or another. 
There is certainly room for difference of opinion concern- 
ing the most advantageous marshaling of the remainder of 
the topics with which we have to deal; but our decision should 
probably be in largest measure determined by the circum- 
stances in which it is necessary to pursue the study. If the 
pupil is to devote himself to anatomy only, no great objec- 
tion is to be raised to the order of subjects adopted in the 
text-books in most common use,—the order which, I think, 
the majority of teachers employ—beginning with osteology, 
and following in regular succession with arthrology, myology, 
angeiology, neurology, and splanchnology. Much can be said 
in support of this arrangement. The knowledge of vessels, 
their origins and terminations, can be of little avail, if there 
is not a precedent acquaintance with the muscles and other 
structures which they flush with nourishing blood, or drain 
of unneeded and effete material; and, so, before undertaking 
angeiology, we need especially to study muscles, which 
constitute so large a part of the human bulk outside of the 
great cavities, and in which are found so considerable a pro- 
portion of the tubes of supply and waste with which we have 5 
to deal in the practice of medicine and surgery. The nerves, 
too, cannot be studied to advantage without antecedent 
familiarity with the muscles, which are the objective point 
of their motorial function. In their turn, also, the active 
organs of locomotion are never learned unless there is a well- 
laid foundation of skeletal knowledge, upon which to build 
them ; forin absence of this basis, they are but impotent, flabby, 
almost shapeless masses of flesh, but little amenable to 
description, and quite elusive of comprehension. Arthrology 
is plainly out of the question without osteology, which should 
immediately precede it. The study of the viscera and organs 
of special sense concludes the series. 
This arrangement is not altogether free from objections. 
For instance, even after one knows the skeleton and the 
muscles clothing it, he finds in his study of the arteries much 
that he cannot fully comprehend from lack of acquaintance 
with the viscera. But no method can be absolutely perfect: 
one needs to know all of his anatomy—the whole of every- 
thing—in order to understand any one organ perfectly. The 
problem, therefore, for us, as teachers, is to discover that 
plan which reduces to the minimum this necessity of know- 
ing a good deal of every department of our great science 
before entering upon the study of any one of them; and par- 
ticularly the scheme which makes this need least conspicuous 
in the earlier portion of the course, when everything is new; 
for, since the growth of one’s anatomical knowledge makes 
further acquisition in the same line progressively easier day 
by day, because he is all the time getting nearer to the goal 
of knowledge of the whole, the last part of the course is 
naturally that in which there is the least occasion for such 
help as can be derived from a wise order of topics. After 6 
all, however, the arrangement in question is useful,—perhaps 
as good as any other, provided that there is an observance of 
the condition which 1 have attached to my commendation of 
it; but without this provision it seems to me to be clumsy, 
obstructive, wasteful, and irrational. 
The condition is that the student is attempting nothing 
else than anatomy. Practically this is a state of affairs which 
never obtains in the schools, and is not in the least likely to 
occur; always physiology is studied synchronously, and 
usually, also., general chemistry—the latter a branch with no 
more claim to be regarded as a legitimate topic of medical 
study than have botany and zoology, and, in all fairness to 
student, school, and community, should be required as a pre- 
liminary to the medical course. We may confidently count 
upon finding the first-year student occupied equally with 
physiology and anatomy. Now, it is so obvious as to require 
no argument that the action of an organ can never be studied 
with complete satisfaction until its structure is well under- 
stood. Consequently, the anatomy of each part should be 
learned before its function is presented, in order that the 
pupil may work intelligently and be spared much difficult 
and unproductive effort. If the professor of anatomy does 
not aid him in this matter, the physiologist is driven to per- 
form the task, although it is outside of the proper sphere of 
his work, and involves the expenditure of much time which 
he needs for affairs in his own peculiar field. The physiol- 
ogy which we most require is a knowledge of the offices of 
the viscera, and the teachers of this branch necessarily 
devote the greater part of their instruction to the considera- 
tion of the action of these organs, which, according to the 
conventional order of topics in the anatomical course, are 7 
not touched until all other portions of systematic anatomy 
have been disposed of. As a result of this, in the early part 
of the course the anatomist is teaching a vast number of 
things which are of the smallest possible help to the student 
of physiology ; and, in almost the last part, he goes over 
ground which has been traversed long before by a suffering 
colleague, who has been forced into this unwilling usurpation 
by the unhappy arrangement of the anatomical schedule. In 
other words, a large and important (to my thinking, the most 
important) section of anatomy is not taught by the professor 
of this branch at a period when it is most urgently required 
by the student, and is presented by him long after it has been 
already learned. 
Surely this state of affairs is, to say the best of it, deplor- 
able, and should not be permitted to continue, if it can be 
abolished without injustice to the interests of the science to 
which we dedicate so much of our lives. Each one of us 
should bear constantly in mind that he is not merely an 
instructor in a special branch, but is, besides this, a member 
of a faculty, the purpose of which is to give to medical students 
the most complete, well-rounded, professional education 
possible with the available means. On the old lines, which 
schools have followed far too long, and which are not yet 
abandoned by all institutions, every professor discoursed to 
the entire class—a higgledy-piggledy arrangement (perhaps 
derangement would be the more appropriate designation for 
so lunatic a scheme) which would not be tolerated for a week 
in a common-school of the lowest grade. Gradually faculties 
are becoming converted to the idea that a grading of the 
course is essential to the best results; and those branches 
which are natural stepping-stones to others are completed 8 
before advanced studies are undertaken. But much still 
remains to be done before the most useful system is formu- 
lated, and the part of this work which most concerns us is 
the proper adjustment of our topics to the needs of our col- 
leagues who teach physiology. The plan which I am about 
to propose is designed especially to attain this end, and will 
be seen, I trust, to be the most advantageous in other respects, 
also. It is devised in the spirit which should actuate every 
individual in a body which is formed to accomplish a given 
purpose : each one is bound not simply to do those things 
which will make his department a success, but to do them in 
such a way as to promote the interests of every other chair. 
There should be perfect coordination in teaching,—the 
faculty should work always as a “ team,” if a popular expres- 
sion may be used. In no other way can the highest results 
be achieved. 
In the first place I would have the anatomist ascertain the 
exact order of topics in the course of his physiological col- 
league. Let us suppose that the latter purposes, after a 
little time spent in necessary preliminary considerations, to 
conduct his class into the realm of the circulation. The 
anatomist will precede him by a day or two with the study 
of the organs by means of which circulation is performed. 
The structure of the heart will be presented with as much of 
detail as is requisite for the ready comprehension of its 
action, and this will be followed by the physiological anatomy 
of the blood vessels: the materials of which they are composed, 
the arrangement of these, and the variations in their propor- 
tions in the large, medium, and small vessels respectively: 
the physical qualities of the walls; the style of division and 
union : how the great arterial trunks branch and divide until 9 
the most diminutive twigs terminate in capillaries, and how 
the venous radicles begin in the midst of the tissues and by 
successive and innumerable conjunctions form larger tubes 
until the great tap-roots of the system are reached; in short, 
all those points which aid in the understanding of the func- 
tion of these organs. He makes no attempt at this stage of 
the course to present the systematic anatomy of the arteries 
and veins; perhaps not a single vessel of the great multitude 
is called by name, except those which, being attached to the 
heart, must be specifically designated in order to make the 
description of that organ intelligible. He does not undertake 
to describe the relations in space which the heart and prin- 
cipal vessels sustain to the parts by which they are surrounded; 
for he knows that these relations might be very different 
without essential modification of their action, and that, there- 
fore, they need not be introduced at this period of the curri- 
culum. Thus, the students are well equipped to receive 
instruction on the circulation from the professor of physi- 
ology, and the latter is free to devote his energies entirely 
to the work which alone he should be expected to undertake. 
This example is no more striking than any other; but it 
serves well to illustrate on the physiological side the benefits 
coming from the adoption of the order which I advocate. 
In this manner the course proceeds; and no portion of the 
field is entered upon by the physiologist, which has not been 
explored and surveyed as far as structure is concerned by the 
anatomist in company with the same set of pupils. After 
the study of the viscera, including the cerebro-spinal centres 
and the organs of special sense, comes the consideration of 
the remaining branches of systematic anatomy, beginning with 
the skeleton and proceeding in the conventional order. 10 
That much advantage accrues to the class in physiology 
by the execution of this plan seems to me to be perfectly 
clear. That any anatomical sacrifice is made by it I do not 
believe. On the contrary, a distinct benefit is gained even 
in anatomy; for the learning of the function of an organ 
immediately after the study of its structure serves to emphasize 
and deepen the impression made by the earli r lesson, and 
quickens with a living interest what otherwise might remain 
in the mind only as dry and arbitrary fact, if, indeed, it did 
not lapse altogether from memory because of its lack of 
significance. 
Incidentally, too, there results great profit of a practical 
kind, which is lost in following the common order. Students 
usually know less about visceral anatomy than about any 
other section of the science. This comparative ignorance 
depends upon three causes. The first is the fact that the 
ordinary text-books are far less accurate in the description 
of the viscera than in that of other parts — a statement 
which it is unnecessary to substantiate in this learned pres- 
ence. Second, the study of the viscera is much more diffi- 
cult than that of other parts. In their best estate they 
present appearances which are liable to be misleading even 
to the most careful and experienced observers, as witness the 
conspicuous errors which for generations passed muster 
regarding the form of the liver and the position of the 
stomach,— points still misstated in some of the text- 
books of the day. But another obstacle is often more 
serious than this. If the organs are fresh, much that is 
valuable can be learned from them ; but when they are the 
seat of advanced putrefactive changes, as often happens 
when the muscles and associated parts are still useful for 11 
somewhat prolonged examination, they must be removed 
speedily, without affording the slightest opportunity for care- 
ful observation. Third, as the subject of the viscera is 
usually placed last in the study of systematic anatomy, it is 
more likely than anything else to be slighted. We all doubt- 
less know from observation, and some of us probably from 
personal experience, that the enthusiasm of a novice in a 
study rarely is sustained to the end. In fact, it may be said 
without incurring the imputation of exaggeration that a 
large majority of students in any class flag very noticeably 
towards the close of the term, however eagerly they may 
have started out. Unquestionably most medical men, young 
or old, know more about osteology than about any other 
branch of anatomy. The reasons of this are not far to seek : 
the skeleton is less perishable than the soft parts and hence 
the opportunities for the study of it are vastly greater ; and, 
what seems to me to be of quite as deep significance, it is 
generally the first branch of our science which the student 
attacks. It is his memorable, first step inside the mighty 
and mysterious domain of medicine, and, consequently, 
every detail makes a powerful impression on his plastic mind. 
Although he sees that his book contains much besides 
osteology, this is the first and, by inference, the most impor- 
tant of its contents. The common people sometimes speak 
of a skeleton as an anatomy ; and the young student almost 
deludes himself with the notion that he knows the bulk of 
anatomy, when he has acquired a very general conception of 
the bones. Of course, his ideas are silly and childish, and 
have to be corrected; but we must take human nature as we 
find it, and, if possible, turn its very weaknesses into useful 
channels. Now, without having the smallest disposition to 12 
belittle the advantage of an accurate knowledge of the 
skeleton, it has long been a conviction with me that visceral 
anatomy should be ranked first in the list of topics,' consid- 
ered from the purely utilitarian point of view: that the sub- 
ject of which our students generally know least is precisely 
that of whicli they ought to know most. They come to us 
in order to be equipped as practitioners. Whatever may be 
their callow aspirations, however much they may be dazzled 
and charmed by the brilliant performances of surgery, we 
and all of our colleagues know that the enormous majority 
of them must be general practitioners, doing almost no sur- 
gical operations, except the strictly minor; haying a great 
many obstretric cases ; seeing a multitude of sick infants, a 
good many ailing women, and not a few acutely ill adults of 
both sexes. What is the greatest anatomical need of such 
men? Is it not undeniable that, for one case demanding in 
them a knowledge of bones, muscles, blood vessels, or 
nerves, they have at least a score in which they must know 
something definitely about the structure of lungs, heart, 
stomach, bowels, liver, kidneys, uterus, or brain ? If, then, 
visceral anatomy far surpasses all other portions of the field 
in importance to the enormous majority of practitioners of 
the healing art, it should be placed first chronologically in 
the course of systematic anatomy, so that it shall be taught 
at the time when the learner’s mind is most eagerly receptive 
and most faithfully retentive — provided, of course, that this 
assignment of position does not conflict with the rights of 
other things. Unless my argument has utterly miscarried, 
it is established that the proposed order not only does not 
sacrifice anything on the physiological side, but is even of 
conspicuous advantage to it: and I have been unable to 13 
discover any way in which it can affect unfavorably the 
welfare of any department whatsoever. There is no occasion 
for anxiety lest the postponement of osteology will result in 
its being ignored or slighted. The facilities for its study are 
so comparatively abundant, the conventional conception of 
its importance is so deeply-rooted, and the natural and inevi- 
table attraction which it exercises on the student is so strong 
as to insure the bestowal upon it of a sufficient share of his 
attention.* 
With me the order advocated is not merely a theory : it is 
a long accomplished fact. For about fifteen years I have 
had the plan in practical operation, and have not yet observed 
a single thing which has caused me to regret the change from 
the ancient system. It appears to me now, as in the begin- 
ning, to be the most rational, economical, facile, attractive, 
and useful succession of topics. During this prolonged trial 
of the order I have had as fellow-members of the Bowdoin 
faculty in the chair of physiology three gentlemen, of whom 
two, Drs. B. G. Wilder and C. D. Smith, are members of this 
Association, and can testify as to the usefulness of the plan. 
The third, Dr. Henry Hastings Hunt, has within a month 
ceased from his labors, and been borne to his honored grave; 
but I feel justified in giving his testimony emphatically in 
its favor. 
* It would be foolish to disparage the cultivation of any portion of the 
field of human anatomy: the more thoroughly the physician knows 
every part of it, the better equipped will he be as a practitioner. Vastly 
more blunders than are ever recognized depend upon ignorance of easily 
known facts of structure. But the tremendous insistence upon the 
supreme value of osteology, which characterizes the method of some 
teachers of anatomy, seems to me to demonstrate a lack of sense of 
proportion, which, while easily enough accounted for by the student of 
medical history, who appreciates also the dominating (sometimes 
almost domineering) influence of habit and suggestion upon the mind, 
is none the less peculiarly unfortunate in its effect. 14 
My plan, slightly detailed, is as follows : Beginning with 
some explanations of a general character, and the definition 
of certain terms which are so technical that the novice can- 
not be expected to know them, I give the names, both English 
and Latin, and the limits of extension of all of the superficial 
parts ; for I have learned that it is not safe to count on any- 
body’s knowing what an anatomist or surgeon means by 
various terms applied to parts which are visible without 
dissection, and have vernacular appellations. Histology is 
then presented in an elementary way, and the student is 
taught the essential truths about the simple tissues. The 
different kinds of membranes are discussed, and the structure 
of glands in general is naturally given the next place. The 
student is now fairly equipped for the study of the viscera, 
and these are taken up in whatever order the physiologist 
of the institution prefers. In one important particular my 
course at this period differs from visceral anatomy as pre- 
sented in most of our books: the brain and spinal cord, the 
noblest and most interesting of all entrails, are included 
in the company of the viscera, and not, as ordinarily in the 
text-books, with the nerves. After this come in regular, 
conventional style the bones, ligaments, muscles, arteries, 
veins, lymphatics, and nerves ; and, last of all, topographical, 
or, as I prefer to call it, relational anatomy. 
In this scheme no separate place is assigned to embryology, 
a subject usually treated in obstetrical and physiological 
works, as well as in anatomical. By agreement with my 
colleague in physiology, its systematic presentation is made 
by him ; but all through my course the facts of development 
are introduced, not only to inform the student upon points 15 
of practical moment, but also to illustrate and enforce many 
features of adult structure. 
At the end of his first year in the school the student is 
required to pass a satisfactory examination in histology, 
splanchnology, and osteology, and he is not permitted to 
enter upon second-year studies until he has so passed. At 
the end of his second year he is examined on the remainder 
of systematic and all of relational anatomy, failure excluding 
him from his third year. 
It will be observed that I have confined my remarks 
strictly to the subject announced, and have refrained from 
discussing the relative merits of various methods of impart- 
ing instruction, as by lectures, recitations, demonstrations, 
and so forth. I wish it to be understood, however, that, if 
any expression of mine has seemed to imply that the old-time 
method of teaching by lectures holds the first place in my 
esteem, 1 have unwittingly done an injustice to a cherished 
conviction ; for the lecture system, as an exclusive, or even 
principal, method of instruction, has long seemed to me to be 
the worst which has been devised.