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Everything Old is New Again: A Victorian Book on Anatomy Goes Digital

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Sir Astley P. Cooper, engraving of painting by Sir Thomas Lawrence

“It’s impossible to improve upon perfection,” goes the adage. When Sir Astley Paston Cooper, Bart. (1768-1841) published his final work, On the Anatomy of the Breast, in 1840, he said, perhaps, everything that he had to say on the subject. This first comprehensive study in the anatomy of that organ is still seen as a thorough and modern investigation. A century-and-a-half later, some researchers are confirming Cooper’s original assertions. In 1997 authors NS Sarhadi, J Shaw-Dunn and DS Soutar reported:

Cooper in 1840 described mammary branches from the 2nd-6th intercostal nerves, and noticed that the nipple was supplied by branches which lay close to the surface of the gland. Eckhard (1850) divided the mammary branches into superficial branches to the skin and nipple, and deep branches to the glandular tissue and nipple, but many later authors ignored those findings. After the second World War, cosmetic surgery of the breast made further research critical, as surgeons strove to design operations which would retain its shape and preserve postoperative sensation. Craig and Sykes (1970) described mainly anterior branches from the 3rd, 4th and 5th intercostal nerves passing through the glandular tissue of the breast and along the line of the ducts to the nipple, while Farina et al. (1980) concluded that the nipple was supplied solely by superficial lateral branches of the 4th nerve. Using improvements in dissecting technique learned from microsurgery, Sarhadi et al. (1996) found that the nipple was innervated by the lateral cutaneous branch of the 4th intercostal nerve, by two branches, one passing superficial to the gland, and the other through the retromammary space, and by variable lateral and medial additional branches from the 2nd-5th nerves. These branches came to lie superficially and formed a subdermal plexus under the areola. This account is uncannily close to Cooper's original description; it is a reassuring, if sobering, conclusion that his early account remains one of the most reliable.

Abstract from Clin. Anat. 1997:10(4):283-8.

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On the Anatomy of the Breast (1840) [overview of open book]

The Archives and Special Collections at Thomas Jefferson University houses a first edition of Cooper's two volume text and atlas and has selected this still relevant work as its first rare book to be digitized and is now available on the web. As an initial component of the new institutional repository, Jefferson Digital Commons, what was once a scarce book, too fragile to handle and requiring a trip to a rare book reading room, is now is accessible to a world-wide audience. We hope that students and researchers, as well as radiologists and professionals in diagnostic imaging, will find this electronic version of value to their further understanding.

Sir Astley Paston Cooper received his baronetcy after performing minor surgery on King George IV in 1820. He was already a known medical figure having attained hospital posts in London as demonstrator of anatomy (at 21 years old) and surgeon a decade later. He learned anatomy from the great John Hunter (1728-1793).

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Plate X: Comparative Anatomy: The Mammary Gland of the Porpoise.
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Plate VI: The Female Breast: Ducts and Glandules.

In the book, John Hunter and His Pupils (1884), authored by Jefferson’s Dr. Samuel D. Gross, Cooper was described as “One of the most illustrious of Hunter's pupils, and one who shed more substantial light upon the surgical profession than any other man of his age…” According to the historian Fielding Garrison, “He dissected every day of his life, even when traveling, paying large fees and liberal doucers to the body-snatchers. With these, his experiences were such that he once stated before a House of Commons committee that ‘there was no person, whatever his worldly place, whom he could not dissect if he would.’”

Remembered today for Cooper’s fascia, Cooper’s hernia and other eponyms, Garrison asserts that “Cooper was one of the first surgical teachers to substitute practical demonstration upon an actual case for the old didactic theory-mongering of the past.”

On the Anatomy of the Breast is illustrated (by John Holt) with colored lithographs of the structures described in the text. The subjects include human (female and male) breasts and comparative anatomies of other mammals, among them the rabbit, ewe, rhinoceros and porpoise. Milk from the lactating mammaries of various species were also analyzed and contrasted. After citing a detailed chemical report on porpoise milk Cooper added, “Professor Owen informs me that some milk which he obtained from a porpoise felt like butter upon the tongue.”

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