The Strange and Short Life of “The Anatomical Basis of Medical Practice”

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A Moment in History

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.

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The Anatomical Basis of Medical Practice - Book Cover
Click on the image for a larger version

The title of this article paraphrases the title of a paper authored by Edward Halperin, MD, MA., and published in “Academic Medicine,” the Journal of the Association of American Medical Colleges in February 2009. More information in the "Sources" section of this article. I have also used other sources to complete this "strange tale."

"The Anatomical Basis of Medical Practice" was published in 1971 by Williams & Wilkins. A large and heavy book, it is one of the many anatomy books written for medical students. This one however, stirred a controversy because of the "tongue-in-cheek" writing style of the authors and mostly because of the photographs of female nude models in seductive poses pretending to depict surface anatomy. The pictures were taken by a famous photographer, Peter Gowland.

Initial reviews were positive, as stated in the British Journal of Surgery, where the book is praised saying: "one only wishes that such a book was available when one was a student in the dissecting room."

Other reviews were more negative, as Dr. Edward A. Edwards in 1972 states: "...I feel compelled to say that the numerous photographs of comely young women, while enticing, no not well demonstrate the muscles and bony points the legends suggest as their purpose." He also says: "The book is marred by a waggishness expressed in facetiousness and in long digressions...."

Soon negative reactions to the book took place, many of them from anatomy professors who saw the illustrations as "out of place" and "not needed". Interestingly only a small percentage of the total images were of the "Playboy" style, while the rest of the images, photographs and sketches are of high educational quality.

Estelle R. Ramey, Emeritus Professor of Physiology and Biophysics at the Georgetown University School of Medicine, in a letter to the Association of Women in Science stated “In effect, the entire book is a calculated insult to women and men alike. It demeans the whole profession of medicine and is openly contemptuous of middle-aged women whose breasts are not so round and may even be rotting with cancer.” The AWIS as a whole threatened to boycott Williams and Wilkins Publishing, and as a result, the book was pulled off the market.

The story gets more interesting. Because of public pressure, angry letters to the publisher, and boycotts, the publisher agreed to stop all promotion, marketing, and sales of the book. Many assumed that they pulled the book off the market when, apparently because of low sales, they just let the initial run sell out by December 1972 and never republished it.

I do agree that the book transgresses the lines of decorum and respect for women that exist today. At the time of its publication the feminine movement was starting, and I think the authors tried (and failed) to have a humorous approach to what is at best, a difficult subject.

The book itself is a great book on anatomy and superficial anatomy, notwithstanding the images and comments. Since it was published and because of its scarcity, it has become a rare book, and as Dr. Halperin states “a minor collector’s item.” When published, this book sold for US$23.00. In 2009, at the time Dr. Halperin published his paper, the book was valued between US$ 89.00 and US$ 300.00; today (2025,) the book is valued between US$ 575.00 and US$1,000.00 in Abebooks.com.

"The Anatomical Basis of Medical Practice" by Becker, R; Frederick; Wilson, James W; and Gehweiler, John, A. is one of the many books in my library and it has become known as “the green book” among my colleagues because of its bright green cloth hardcover. The image in this article is from the book in my library.

Sources:
1. “The Pornographic Anatomy Book? The Curious Tale of The Anatomical Basis of Medical Practice" Halperin, E. Academic Medicine: February 2009 - Volume 84 - Issue 2 - p 278-283
2. "The anatomical basis of medical practice." By R. Frederick Becker, Ph.D., James W. Wilson, Ph.D., M.D., and John A. Gehweiler, M.D. 11 × 8¼ in. Pp. 907 + xv. Illustrated. 1971. Edinburgh: Churchill Livingstone.
3: "Five centuries of gender bias in anatomy" Elisabeth Brander — December 9, 2021
4. " The Anatomical Basis of Medical Practice (NSFW)" September 10th, 2012
5. "The Anatomical Basis of Medical Practice" by Becker, R; Frederick; Wilson, James W; and Gehweiler, John, A. 1971. The Williams & Wilkins Company
6. "The Anatomical Basis of Medical Practice" Book Review by Edwards, E. Ach. Surg. 1972;104(2):227

The Strange and Short Life of “The Anatomical Basis of Medical Practice”

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