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Topographical and Pathotopographical
Medical Atlas of the Human Body
Scrivener Publishing
100 Cummings Center, Suite 541J
Beverly, MA 01915-6106
Publishers at Scrivener
Martin Scrivener (martin@scrivenerpublishing.com)
Phillip Carmical (pcarmical@scrivenerpublishing.com)
Topographical and Pathotopographical
Medical Atlas of the Human Body
Z. M. Seagal
This edition first published 2020 by John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
and Scrivener Publishing LLC, 100 Cummings Center, Suite 541J, Beverly, MA 01915, USA
© 2020 Scrivener Publishing LLC
For more information about Scrivener publications please visit www.scrivenerpublishing.com.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or other-
wise, except as permitted by law. Advice on how to obtain permission to reuse material from this title
is available at http://www.wiley.com/go/permissions.
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ucts visit us at www.wiley.com.
ISBN 978-1-119-61433-3
Cover image: 3D Illustration, Pepe Gallardo | Dreamstime.com & Abstract Background, Pokaz |
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Cover design by Kris Hackerott
Set in size of 11pt and Minion Pro by Manila Typesetting Company, Makati, Philippines
10 9 8 7 6 5 4 3 2 1
Contents
Preface ix
Part 1: Ultrasonic Topographical and Pathotopographical
Anatomy
1 Topography and Pathotopography of the Head 3
2 Topography and Pathotopography of the Neck 25
3 Topographical and Pathotopographical Anatomy of the Chest 43
4 Topographical and Pathotopographical Anatomy of the Abdomen 61
5 Topographical and Pathotopographical Anatomy of the Retroperitoneal Space 91
6 Topography and Pathotopography of the Pelvis 103
Topographical anatomy of the pelvic organs 103
Topography of the female pelvis 104
Topography of male pelvis 107
Ultrasonic topographical anatomy of male pelvis 108
7 Topography and Pathotopography of Lower Extremity 123
8 Conclusion 153
v
vi Contents
ix
x Preface
Topographic clinical anatomy changes with the disease and recovery during iatrogenic
manipulations, surgical and therapeutic treatment. That is why some of these points are
described in the atlas.
Our atlas of topographic and pathotopographic anatomy is a full-colored handbook
for students and doctors in almost all specialties. It covers all the organs and tissues of
the human body. Its fundamental and practical importance is that topography and patho-
topograpy are presented for the first time in vivo. These sections (ultrasound topography
and pathotopography, transillumination topography and pathotopography) are of great
practical importance both for early diagnosis and for providing the right treatment, includ-
ing proper surgical tactics. They are important for surgeons in planning and performing
numerous surgical operations. The author of the atlas has a unique museum of operative
surgery at the Academy, which is visited by doctors and students from all over the world.
Some exhibits from this museum are presented in our atlas. They are normal and patho-
topographical surgical anatomy, electrified stands and steps of surgical intervention on the
complex of formalin preparations. This three-track museum is dedicated to typical and
atypical surgical interventions, as well as the author´s operations with use of the author´s
original tools and techniques. Nothing like this currently exists in the world. It is reflected
in the atlas and has great educational and practical importance both in surgery and med-
icine. There are more than a hundred complexes in the museum which were developed
and collected on the operations on various organs and tissues in surgery, dentistry, pediat-
ric surgery, thoracic surgery, urology, and other areas and organs. Thus, surgical anatomy
became particular for practical doctors of various specialties. In modern medicine, major
problems are late diagnosis, false positive and false negative diagnostic results, and stage
and size of acute pathology, which can lead to wrong treatment, mortality and disability of
patients, and also to recurrence of the disease, ineffective treatment, wrong prognosis and
incorrect prevention of post-operative complications in the short term and the long term. A
gold standard of diagnostic and treatment, unfortunately, does not include appropriate and
effective control of the diagnosis and treatment, which needs to be developed.
Comparative analysis of СT scan, MRI and pathotogram, including vital transillumi-
natory and ultrasound ones, revealed benefits of our vital monitoring method, which is
reflected in the atlas. It provides more information and specifics on malignant and benign
tumor, on degenerative, dystrophic, inflammatory processes, traumas and its complications.
In the atlas there are clinical data reversible and irreversible of regional blood circulation
disorder with focal pathology (adenoma, cyst, breast and thyroid cancer, vessel stenosis,
intestinal paresis, etc.). Methods like PET, MRI and X-ray are highly sensitive but they
cannot guide a doctor live during an operation in tumor topography. Maintenance of the
surgery with these methods is not possible, which leads to iatrogenic complications: bleed,
damage of lactiferous duct, and false results, and also causes an increase in the extent of the
operation, recurrence and other complications. Pathotopograms mentioned in the atlas are
important to determine surgical access, to visualize normal and changed lymph nodes, and
to know the required extent of the operation. Ultrasound pathotopograms of focal arthritis
and rheumatoid arthritis mentioned in the atlas revealed new specific differential signs of
pathology, which is of practical importance in the treatment and prevention of iatrogenic
rheumatic complications and in screening studies.
Our work is devoted to the memory of patients who have died from the lack of scien-
tific achievements, lifetime pathotopograms and a new diagnostic technology. One might
Preface xi
be surprised at the very possibility of such support in the pre-operative diagnosis, sur-
gery and postoperative treatment. But this technological support not only accompanies,
but also helps the surgeon to choose between conservative and other tactics of treating the
patient. We hope that this full-color book will prolong life in patients and improve the skill
of doctors and students in diagnosing and preventing diseases. Between the doctor and the
patient should stand medical equipment, but it should not block them from each other. A
doctor armed only with a scalpel is dangerous for the patient. A doctor armed with modern
and original technology is dangerous for his illness.
Managers of our pathotopographic, transilluminative and ultrasound technology already
operate in urgent and scheduled medicine. Our atlas and devices will be used by future
doctors. Now is the time to speed up and implement rational innovations, and so it is nec-
essary to start with the government, rather than finish with it. Three periods of illness – pre-
operative, surgery and post-operative, as well as three periods of life – childhood, maturity
and old age are inseparable from each other, because they are associated with one person,
one illness. As in life a wise mentor is needed during treatment, surgery and the post-oper-
ative period; this cannot be accomplished without the wise, lifetime functional pathotopo-
graphic results presented in our atlas. Flexible new medical technologies presented to the
reader put them in a position to guarantee the patient’s vitality.
Part 1
ULTRASONIC TOPOGRAPHICAL AND
PATHOTOPOGRAPHICAL ANATOMY
1
Topography and Pathotopography
of the Head
The deep facial area contains the internal wing muscle, mandibulum,
and submandibular salivary gland; the oral cavity contains the tongue,
peripharyngeal space, and posterior veil of the soft palate, as well as the
3
4 Topographical and Pathotopographical Medical Atlas of the Human Body
Linear fracture is associated with the external bone lamella of the area of
intact bone, with the intracranial space, and the hypoechogenic track.
Under conditions of tamponade of the fourth ventricle of cerebrum
with transition to the pons cerebelli, a blood clot is revealed in the
vicinity of the clinoid plate at the pyramid apex of the temporal bone.
The intraventricular blood clot can be pathotopographically associated
with the left lateral ventricle, whereas liquid blood is observed at the
lumen of the right lateral ventricle.
8
7
6
6
4 13 4 4
4
8
9
14
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5
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3 Figure 1 Layer-by-layer topography of the head. 3 2
1
1. v. brachiocephalica; 2. v. jugularis anterior sinistra;
3. v. jugularis anterior dextra; 4. v. angularis; 5. Plexus cervicalis;
6. v. supratrochlearis; 7. v. nasofrontalis; 8. a. angularis; 9. v. temporalis
superlicialis; 10. n. supraorbitalis; 11. n. auriculotemporalis; 12. Plexus
cervixalis; 13. m. depressor labii inferioris; 14. m. dieastricus (venter anterior).
Topography and Pathotopography of the Head 5
6
4
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Figure 12 Maxillary artery with medial meningeal artery and superficial temporal artery.
1. Superficial temporal artery and auriculotemporal nerve; 2. Internal maxillary artery; 3. Facial nerve; 4. Medial
meningeal artery; 5. Exterior carotid artery; 6. Inferior alveolar nerve; 7. Lingual nerve; 8. Submental artery and nerve;
9. Buccal nerve; 10. Suborbital artery.
Topography and Pathotopography of the Head 15
9.8
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4 cm/s
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PLATE XXIII
“One man cowers upon the ground ... whilst the second, kneeling at the side of
him, holds his pointing stick at arm’s length....”
Any fully initiated men may make use of a pointing-bone or stick,
but when the grievance concerns the tribe in general, the operation
is performed by the magician or medicine man. Women do not
generally carry these sticks, but the Aluridja, and no doubt others
also, allow their gins to charm their yam-sticks, with which they then
“kill” their antagonists. A charmed yam-stick is believed to paralyse
the arms of any person, whom it touches, when appealed to by the
owner; consequently one of this kind is chosen for duelling whenever
possible.
When a man has been condemned to death, the person or
persons, who are to administer the fatal charm, are nominated. The
“pointing” apparatus are produced, and with them the men take up a
kneeling position a little distance away from the camp. Facing the
doomed man’s habitation, they lift the bone, or stick, to shoulder
height and point it at the victim. The long piece of hair-string, which
is attached to the instrument, is tightly tied around the charmer’s
arm, above the elbow. This is done to endow his system with the
magic influence of the pointing-stick he is holding; and that magic, he
believes, passes into the destructive words, which he is uttering:
“May your skeleton become saturated with the foulness of my stick,
so that your flesh will rot and its stench attract the grubs, which live
in the ground, to come and devour it. May your bones turn to water
and soak into the sand, so that your spirit may never know your
whereabouts. May the wind shrivel your skin like a leaf before a fire,
and your blood dry up like the mud in a clay-pan.”
There is a great number of different methods employed in
administering the fatal charm of the pointing-stick, all of which,
however, are after much the same principle. A common practice
amongst the Aluridja is for the man, about to use the stick, to leave
the camp and seclude himself behind a tree or other obstacle. He
squats upon the heel of one foot which he has tucked under his
body. He points the bone or stick straight at the man who is to die,
or, it may be, merely in the direction he imagines he would strike
him. Whilst administering the curse, he holds the object in the hand
of his outstretched right arm.
Both the Arunndta and Aluridja often work in pairs after the
following style: One man cowers upon the ground, with or without his
pointing-stick in his hand, whilst the second, kneeling at the side of
him, holds his pointing-stick at arm’s length over the former man’s
back, and directs it towards the person who is about to receive the
evil charm. Vide Plate XXIII.
To make their charm more effective, and the death-penalty more
certain, central Australian tribes not uncommonly tie the claws of a
bird of prey, the eagle-hawk by preference, to the pointing
instrument. It is believed that by this trick the evil magic works like
the grip of a bird, by clutching the doomed one’s chest and crushing
it. If by accident the unfortunate fellow becomes cognizant of this,
and it happens that, as actually is frequently the case after a big
feast, he suffers from indigestion, he naturally interprets the
symptoms of his indisposition as being due to the invisible, tightening
girth, which the charm has laid about him. The fatal termination
arrives at a much earlier date in consequence.
A man who discovers that he is being boned by an enemy is,
indeed, a pitiable sight. He stands aghast, with his eyes staring at
the treacherous pointer, and with his hands lifted as though to ward
off the lethal medium, which he imagines is pouring into his body
(Plate XXIV). His cheeks blanch and his eyes become glassy, and
the expression of his face becomes horribly distorted, like that of one
stricken with palsy. He attempts to shriek, but usually the sound
chokes in his throat, and all one might see is froth at his mouth. His
body begins to tremble and the muscles twitch involuntarily. He
sways backwards and falls to the ground, and for a short time
appears to be in a swoon; but soon after he begins to writhe as if in
mortal agony, and, covering his face with his hands, begin to moan.
After a while he becomes more composed and crawls to his wurley.
From this time onwards he sickens and frets, refusing to eat, and
keeping aloof from the daily affairs of the tribe. Unless help is
forthcoming in the shape of a counter-charm, administered by the
hands of the “Nangarri” or medicine-man, his death is only a matter
of a comparatively short time. If the coming of the medicine-man is
opportune, he might be saved.
The medicine-man of Australian tribes is not so much an individual
who has the knowledge of medicinal values of herbs and of surgical
practices as one who is the recognized sorcerer, capable of rebuking
the ills wrought by an enemy or evil spirit (Plate VIII). He attains his
distinction either by heredity or by accidental, but maybe exemplary,
craftiness. In the former case, he is looked upon as a favoured son,
who has inherited from his tribal and ancestral fathers the magic art
of neutralizing the evil charm of a spirit or enemy, which manifests
itself in prostration or disease; at the same time he is the official
power of the community, who alone can outwit the evil spirit, control
the elements, and keep pestilence away from the camp. This
hereditary art is recognized as a concrete matter, which is believed
to have been deposited within the body of the particular individual by
spirit-ancestors or nearer spirit-relations; this matter might have
taken the form of a special variety of wood, small bones of animal or
man, and a number of sacred stones, all of which the made
medicine-man carries about with him in his abdomen, more or less
replacing the ordinary entrails originally occupying the cavity. Each
tribe has a number of these medicine-men, whose rank is gauged
according to age and the principle they have lived up to. For
instance, in the qualification of the early medicine-men of the
Adelaide tribe, it was deemed necessary that the candidate should
taste human flesh at least once is his life. In the central Australian
tribes a medicine-man should not eat of kangaroo which has been
feeding upon new green grass; if he does, some of his mystic
powers will leak out of his body, and he will immediately drop in the
estimation of his tribal admirers. If the offence is repeated a number
of times, he is disrespected entirely as a professional sorcerer. There
are, of course, a great number of restrictions, which the
conscientious practitioner observes most punctiliously.
Every medicine-man of any standing at all has his own history of
qualification, which he does not hesitate to make known to the public
at opportune moments. Old Kai Kai, the leading Nangarri of the
western Arunndta on the Finke River, relates how he, as a young
hunter, became detached from the rest of the party, and, after
tracking a wounded kangaroo for a whole day, he eventually
abandoned the pursuit to make for a rock-hole in the stony James
Ranges. It was nigh on sunset when he arrived at the hole, tired and
thirsty. He threw his wommera and spears upon the ground, and
eagerly lay over the cool fluid to still his parching thirst. But when he
sipped the water a tadpole entered his mouth, and, before he could
spit it out, it slipped down his gullet and dropped into his abdominal
cavity with a bump that caused him much pain. When he recovered,
he again tried to soothe his burning lips, but met with a similar fate.
Several times more he tried, but in vain; as soon as his burning lips
touched the surface of the water, a slimy tadpole slipped into his
mouth and fell into his stomach with a painful thud. In desperation he
made a final attempt to carefully approach the water’s level, when he
beheld what he took to be the image of his face and body reflected
from below. Horror overcame him, however, for the image was that
of another man! And, as he looked again, he noticed that the body of
the image was transparent, and inside of it there were just as many
rounded pebbles as he had swallowed tadpoles! He collapsed at the
side of the waterhole and slept like a dead man, for how long he
could not say. When at length he woke up, he found himself among
the reeds of the flowing sheet of water on the Finke River, which the
white people call Running Waters. He now quenched his thirst. And
when the recollections of his experience at the rock-hole came back
to him, he realized that the man who had looked at him through the
water had been a spirit, and he could still feel the pebbles he had
placed inside of him. Now it was obvious to him that he had been
ordained a Nangarri, and he returned to his camp, where his
relatives were anxiously awaiting him.
Having been called to the side of a “boned” patient, the Nangarri
allows a number of the relatives to be present when he applies his
weird method of treatment. At first he cuts some ridiculous antics,
during which he mumbles or chants some almost inaudible verses.
The patient is, in the meantime, laid flat on the ground. The Nangarri
approaches the sufferer from the foot end and, throwing himself
upon the ground, crawls right on to the chest of the former, biting the
skin of his patient at several places as he crawls on to the body.
Having “located” the seat of the trouble, the “doctor” slips on to the
ground, and, picking up a fold of the skin with the underlying fatty
tissue between his fingers over the vital spot, applies his lips, and,
perhaps, his teeth, too, to it. He sucks, bites, and kneads the skin,
frequently lifting his head and spitting blood on to the ground. The
patient is all the while groaning with pain; if he becomes
unmanageable, he is called to order by the Nangarri. At length the
climax arrives. The Nangarri withdraws from the patient, his cheeks
visibly inflated, and, conscious of the expectant eyes of all present,
he empties the contents of his mouth into his hands, which he holds
like a receptacle in front of him. The fluid, consisting of saliva and
blood, is allowed to trickle to the ground or into the fire. Then a
triumphant chuckle announces that the malignant element has been
discovered! With feigned exaltation, the great healer steps towards
the awe-stricken relatives, holding between the index-finger and
thumb of his right hand an article, such as a small stick, a bone, a
pebble, a meteoric bomb, or a talon, which he avows is the cause of
the “boned” man’s affliction, and, having now been skillfully and
permanently removed, the unhappy fellow has nothing more to tear.
The good news is immediately conveyed to the prostrate form on
the ground. The effect is astounding. The miserable fellow, until that
moment well on the road to death, raises his head to gaze in
wonderment upon the object held by the Nangarri, which, in all
seriousness, he imagines has been extracted from the inside of his
body. Satisfied with its reality, he even lifts himself into a sitting
position and calls for some water to drink. The crisis has now been
passed, and the patient’s recovery is speedy and complete. Without
the Nangarri’s interception, the “boned” fellow would have fretted
himself to death for a certainty, but the sight of a concrete object,
claimed by the recognized authority of the tribe to be the cause of
the complaint, signifies recovery to him, and with its removal comes
a new lease of life. The implicit faith a native cherishes in the magic
powers of his tribal medicine-man results in cures, which exceed
anything recorded by the faith-healing disciples of more cultured
communities.
CHAPTER XX
WARFARE