The following comments provide the views of an anatomist working in the clinical arena of Terminologia Anatomica, with specific reference to the cardiovascular system.

As explained in the ‘History of International Anatomical Terminology’, which appears in pages 157–162 of this book, a standardized terminology prepared in Latin in 1895 ‘was introduced and adopted in many countries and to a large extent dispelled the confusion existing up to that time’. On the basis of the account of the subsequent history provided, which is replete with descriptions of long meetings failing to produce consensus, the initial confusion must indeed have been extensive. The purpose of the current terminology is not entirely clear to me, though it certainly provides comprehensive lists of the parts of the human body. One of the initial aims was to provide a listing in Latin that ‘would be translated into the vernacular of each nation’. The new listing now contains the list published only in Latin and English. This presumably reflects the fact that English has replaced Latin as the universal language, which begs the question, therefore, whether the original Latin list is still necessary. This, however, is a minor criticism. Much work has been invested in the current version of Terminologia Anatomica. The important question is whether it continues to serve a useful purpose. It may well be that, unlike the initial Basle Nomina Anatomica, the current version has worldwide approval, but to what extent is it used by anatomists, and is it consulted at all by the clinicians who diagnose and treat the disorders of the various parts of the body? If my own experience as a paediatric cardiac morphologist is representative of that of other anatomists working primarily in the clinical arena, I would venture to suggest that the usage is not nearly as extensive as would be hoped for by the committee that has invested so much time to produce and modify the listings. If further revisions of the terminology are in progress, then one would hope that note will be taken of the problems currently existing in the use of anatomical terms by clinicians. These problems are exemplified by short comments in the ‘History’, which report the agreement, by a majority, to accept the upright posture as the ‘official’ anatomical position for descriptive purposes, while recognizing that the positional adjectives dorsal, ventral, cranial and caudal are nevertheless necessary for certain structures in the trunk. To the best of my knowledge, however, most structures towards the back of the body are described by clinical anatomists as being ‘posterior’. The use of the term ‘posterior’ poses special problems in relation to the heart. Anatomists have traditionally described the heart as if it were positioned on its apex, the ‘Valentine’ orientation, rather than naming its components as they relate to the adjacent thoracic organs or to the upright posture. Until relatively recently, clinicians have slavishly followed this pattern. Modern imaging techniques, however, which show the heart as it lies within the body, have necessitated a change to the positional terminology in the clinical context. The descriptions suggested in the Terminologia have not entirely adapted to this change. Hence, although the diaphragmatic surface of the heart is correctly described as being inferior, the artery that courses along this surface is said to be the posterior descending coronary artery. It is questionable whether this artery should be described as descending as it runs horizontally towards the ventricular apex, but it is clearly positioned inferiorly rather than posteriorly. Atheromatous blockage of this artery produces the electrocardiographic pattern known as inferior myocardial infarction, as the leads used to obtain the electrocardiogram are interpreted as being placed on the subject in orthostatic bodily attitude! Another problem with the Terminologia is that, while it lists the various parts requiring description, it does not define them. In most instances, of course, this is unnecessary, since structures such as the aorta or pulmonary trunk create no problems. But what of the septomarginal trabeculation? Is this the moderator band, or is it the extensive muscular strap that reinforces the septal surface of the right ventricle? And why is no mention made of the alternative term ‘septal band’, which is how this structure is described in many centres diagnosing and treating children with congenitally malformed hearts? It could, with some justice, be argued that anatomists cannot set the rules for those dealing with pathology, but surely the international committee should be discussing these issues with, for example, those responsible for producing the Standardized Nomenclature for Pathology. A case could also be made for discussions with international committees that are currently attempting to unify the description of diseased organs, particularly those that are congenitally malformed. The aspirations of those continuing to seek a unified nomenclature for the components of the body, nonetheless, are to be applauded. It is unfortunate that the task seems to remain as difficult, and the solution perhaps as remote, as was the case at the end of the 19th century. Perhaps one way forward would be to delegate responsibility for the naming of the parts of each of the subsystems to sub-committees containing, amongst others, anatomists who work in the clinical field, or else clinicians with a special interest in anatomy. It is still the anatomists who provide the initial exposure of those hoping to become doctors to the mysteries of the human body. Anatomists providing such instruction, who have also received a clinical training, however, are becoming increasingly rare. It is crucial that the initial anatomic information provided should be clinically relevant, accurate, and described in logical fashion. In my experience, at least with regard to the cardiovascular system, this is not currently the situation. A well-constructed system of anatomical terminology, with appropriate definitions, would provide the foundation of a valuable resource. The current version of the Terminologia is another step along the path towards this goal, but cannot yet be viewed as the finished product.