Structure and function as seen in the foot. 1949.

Abstract

Frederic Wood Jones (Fig 1) was born and educated in London. He studied at the University of London, from which he received his medical degree in 1904. After his internship, he spent the next year as a medical officer for a company in the Cocos Keeling Islands in the Indian Ocean. Here he had the opportunity to emerse himself in the study of comparative anatomy. On his return to England, Wood Jones was appointed as an anthropologist to the Egyptian government working on a survey of sites in Nubia and the Sudan. In 1909, he returned to England to become the chairman of anatomy at the Women’s Medical School in London. At this time he received the degree of Doctor of Science in Zoology. During World War I, Wood Jones served in the army medical corps. He became a Fellow of the Royal College of Surgeons and in 1925 was made a member of the Royal Society. After World War I, he moved to Australia where he held academic positions in Adelaide and Melbourne. He then held academic positions at the Peking Union Medical College in Beijing and the University of Hawaii. In 1937, he returned to England to the University of Manchester, and in 1945 he became Professor of Human and Comparative Anatomy at the Royal College of Surgeons and later became the curator of the Hunterian Collection.Fig 1.: Dr. Frederic Wood Jones (Reprinted with permission from Br Med J 2:873, 1954.)Wood Jones peripatetic career provided him with a broad experience in human and comparative anatomy. He wrote extensively on the results of his observations, following in the footsteps of his mentor, Sir Arthur Keith. The classic selection is taken from his small monograph on the anatomy of the foot. 2 This book takes its form from the monograph on the hand published more than one hundred years earlier. 1 Wood Jones proposes and supports the thesis, that it is the foot, rather than the hand, which separates the human from the subhuman. He shows the importance of the foot and its anatomic structures. INTRODUCTORY, DEALING WITH THE STUDY OF THE FOOT Frederic Wood Jones, D.Sc., M.B., B.S., F.R.S., F.R.C.S. Sir William Collins Professor of Human and Comparative Anatomy in the Royal College of Surgeons of England For the most part we have but little pride in our feet and it is a pity that this is so. There is, no doubt, much to be said by way of justification for such an attitude and probably there are few who have any real regrets that their feet are hidden from the sight of their fellows by being encased within their boots. Our lives would not gain much in aesthetic pleasure did we all go bare-footed as do some of the happier sections of mankind, for the booted foot of the so-called higher races has a justifiably shamefaced appearance when deprived of its wonted covering. Once babyhood is passed, there is little that is particularly pleasing in the appearance of most people’s feet. It is very much the other way with our hands. Many take real delight in the appearance of their hands and find aesthetic pleasure in regarding the hands of others. All this is readily understandable when the criterion is merely one of aesthetics. But it is justifiable from no other point of view. That anyone, knowing anything about evolutionary progress or even having regard to the simplest facts concerning animal types, should praise the perfections of the human hand at the expense of the human foot is an absurdity. But regrettably, even the human anatomist is rather given to treating the foot as a sort of poor relation of the hand. He is rather apt to suggest, by his method of treating the subject, that the foot is something that should be like the hand but which, because of its lowly functions, falls short of attaining to its perfections. Even the zoologist, whose range of the animal kingdom should permit of a wider view, has tended to convey the same idea in his schemes of classification. He has decided that the Sub-order of the Primates in which Man is included should be designated as Bimans, since it contains the animal distinguished by the possession of two hands. That a ridiculously simple and primitive appendage such as the hand should be thus lauded is illogical. An appendage, built on the basal plan prevailing in the manus of the tortoise and singularly like that of a lowly marsupial in its general make-up, confers no distinction on Man other than that of a priceless heritage from remote ancestors wise enough to let well alone and so refrain from converting this simple thing into something more specialised. All that can be said for Man and his hand is that he is lucky that his phylum sprang from so lowly a stock as to have possessed this precious birthright and that, having it, they did not tamper with it. But it is very different with the human foot. Man’s foot is all his own. It is unlike any other foot. It is the most distinctly human part of the whole of his anatomical make-up. It is a human specialisation and, whether he be proud of it or not, it is his hall-mark and so long as Man has been Man and so long as he remains Man it is by his feet that he will be known from all other members of the animal kingdom. He may speak slightingly of feet of clay and imagine his form to be divine with perhaps the exception of his feet, but with all his conceit he must not ever forget that it is, in fact, his feet that confer upon him his only real distinction and provide his only valid claim to human status. We may, therefore, assume that we have every guarantee that the foot is a proper subject for examination for its own sake. If on occasion, during this examination, we are led farther afield, it will be because some of the principles seen in the anatomy of the foot are of more general application and are worthy of notice on this account. We will refrain from treating the foot as an imperfect hand, for to do so is destructive of all proper understanding of its structure and function; nevertheless the anatomy of the corresponding parts in the fore limb will need repeated notice. Such comparisons as are made between the two members will be limited to those that seem to be more or less instructive from a functional point of view. As an intellectual discipline in morphology, there is no doubt that the establishment of homologies between the bones, ligaments, muscles, and other constituent parts of the hand and foot is an attractive study. It is one of the most delightful bypaths of comparative anatomy and, as such, has had a wealth of patient work devoted to it. The subject is of interest to every medical student, but it is one that should not be developed with any idea that it might possibly be a fitting question by which to test the medical student’s knowledge of human anatomy. For in some ways an overdeveloped sense of the basal unity of the structure of both hand and foot may destroy a just appreciation of the fact that functionally the two members are so fitted for their own proper roles that fundamental dissimilarity is more evident than is any underlying likeness. As an academic study the establishment of homologies has much to recommend it: but for the man who would treat the disabilities of the human foot it is far more important that his knowledge of the part should be of that intimate kind by which each bone, ligament, joint, and muscle is known as an individual entity and not by reference to corresponding structures in other parts. The hand is the hand and the foot is the foot and no basal archetypal similarity in plan can ever make them, as functioning parts, in any way alike. It is probably the experience of most teachers of anatomy that the student is generally better acquainted with the intimate structure of the hand than he is with that of the foot. There are many reasons, inherent in the method of study, that may account for this. But whatever the reason may be, the result of this state of affairs is the same—it becomes natural to translate into the foot those items of real knowledge that have been gained from the study of the hand. Since the action of, say, the extensors and flexors of the fingers is so readily demonstrated and appreciated, it is an easy transition to the assumption that the action of the corresponding muscles of the toes may be inferred from the knowledge gained from the dissection and examination of the hand. No such assumption could be more destructive of any proper realisation of the functions of the foot. It would be an exaggeration to say that it were better for the surgeon who would treat the disabilities of the foot had he never learned of the structure and function of the hand : but there is a very real element of truth in such an over-statement. Every detail of the structure and function of the parts of the foot must be studied and realised for its own sake ; none may be inferred justly from a study of the corresponding details in the hand. The hand is a tactile, testing, grasping organ ; the foot has long since become an organ, the functions of which are the support and propulsion of the body in bipedal orthograde progression. Although it is impossible to study the structure of the foot in an intellectual way without certain references to its homologies with the hand, no attempt is made here to undertake the task with that archetypal thoroughness that distinguishes such classics as Richard Owen’s work “On the Nature of Limbs.” The great Cheselden described his own work on human anatomy as being “adorned with the comparative” and the compilers of many modern textbooks have had pride in the generally useless and commonly erroneous tags of morphology appended, by way of leaven, to the necessarily rather dull lump of description of structures as displayed in formalin-hardened cadavera. These things have their uses. They may help towards a real appreciation of the meaning of the arrangement of parts comprised within a whole. They may provide an explanation for the form, position, and even the existence of certain structures. But they must not be permitted to intrude to the extent that they provide a false security for assumptions as to function by analogy, no matter how perfect the analogy may appear to be.