Dissecting Anatomy: Past, Present, Future

by Yathu Maheswaran, Features Editor


 

In the early years of medical education, an inimitable experience will be studying anatomy. For many students, human anatomy can be as fascinating as it is arduous to learn. At the same time, it can be glorious in providing a consistent linguistic basis of medicine, but inglorious when we consider past stigma towards dissection and how cadavers were historically acquired. It is something that we rarely consider nowadays, but an important aspect in the history of Medicine. The time afforded to learning anatomy – with the purpose of mastering the structure and function of the human body –  has persisted since its initial inclusion in medical curricula. Nevertheless, our understanding of human anatomy, its pedagogy and its significance to students and educators have evolved with changing cultural, societal and professional tides.

The Mummies and Fathers of Anatomy

The earliest document featuring anatomy can be attributed to Ancient Egypt. The processes of embalming and mummification would have required some anatomical knowledge (we hope!) (1).

Figure 1: Egyptian Mummification

Figure 1: Egyptian Mummification

Hippocrates, our oath-maker, operating in Ancient Greece founded a medical school on the Island of Cos. He acknowledged the importance of anatomy and praised it as the foundation of medicine. Perhaps confusingly to us, however, is that he refused to dissect humans. As a result, his anatomical knowledge is fraught with error. Following Hippocrates, the Father of Modern Medicine, came Herophilus who was a disciple of a student from Cos and is regarded as the father of scientific anatomy. In contrast to Hippocrates, he was an advocate of dissection, and the School of Alexandria, where he practiced, is believed to be the first place where dissection was regularly performed (1,2). Not everyone was convinced of dissection’s utility, including one of Herophilus’ own students (3). It is a view held even today.

From Greece to Alexandria and eventually Rome, Medicine bloomed and anatomical understanding slowly grew. The Greek physician Galen found himself summoned to Rome and achieved great success. In the Galen era, medicine was primarily textual, with only a small component of learning dependent on demonstration with living models (2). Dissections were prohibited in Rome, but this could not quash ideas about the importance of scientific understanding. A view held by prominent statesmen, was that superstition and religion were obstacles to the teaching and understanding of anatomy (1). This would go on to play a greater role in the lead up to the Renaissance.

Anatomy in the Dark and Middle Ages

In the Dark Ages that eventually followed, medical knowledge and expertise shifted to Arabia. A number of Islamic scholars translated existing works, reviewed medical knowledge of the day and formed their own theories. As a result, anatomical knowledge continued to progress and the nomenclature derived from Arabic names would later define the work of anatomists in the 14th Century (1). Although Europe would re-emerge as a locus of medical development, this would not have occurred without the efforts of academics in Arabia.

Up until the Renaissance, there was a constant struggle between anatomists wishing to undertake human dissection, and religious authorities who viewed this as human desecration. In the Middle Ages, medicine had developed through interpretation of Galen’s work, but it was mainly taught in monasteries where dissection, as in Rome, was prohibited and viewed as blasphemous. The way to learn at that time, was by listening to professors reciting established texts – something that would not stand with students today! (4).

Enter Versalius

When the Renaissance arrived, there was renewed interest in demystifying the human body. Galen’s errors were exposed as Andreas Versalius published de humani corporis fabrica(2) . Versalius’ influence on anatomical understanding and teaching is incalculable. At a time when images were viewed as unnecessary in academia, he produced and distributed pictorial charts for his students. When dissection was left to lowly barber-surgeons under instruction from professors, Versalius encouraged students to adopt a more hands-on approach. He gave impetus to the movement from dogmatic teaching to learning through observation which is central to the scientific method that we employ today (2). A period in which students had to study anatomy without Gray’s Anatomy or Netter’s Flash Cards may well be inconceivable to us now, but this is further testament to Versalius’ efforts.

Figure 2: A portrait of Versalius from De humani corporis fabrica

Figure 2: A portrait of Versalius from De humani corporis fabrica

The Grave Robbing Era

By the beginning of the 19th century, there was a surge in the number of medical schools and demand for cadavers far outstripped supply. Grave robbing and other morally unacceptable means for acquiring cadavers emerged. In Edinburgh, the infamous Burke and Hare committed to the murder and selling of bodies to organisations for dissection (5,6). The bodies of criminals were also used – a form of punishment that denied them the right to a proper burial. Legislation was eventually passed such that the only bodies that could be used for dissection were those that were unclaimed. Following on from this,  numerous addenda made the processes of body donation clear (6).

The story of how we went from acquiring cadavers to receiving donations shows the shift in how anatomy teaching was perceived. From desecration to being a gift to future physicians. It highlights that there is more to the human body, when viewed through an anatomical lens, than just form.

Anatomy in the Present Day

The 20th and 21st centuries have seen many developments, from updated anatomical diagrams, medical imaging to visualise structures and apps or computer programs to enhance learning. We now have cheaper and more practical means to teach students about the structure and function of the human body (2). Phone and tablet apps are portable and interactive and require none of the special preparations needed for anatomy demonstrations. One hour of focussed learning using an app dedicated to anatomy may well yield more facts than an hour in an anatomy demonstration.

Medical educators argue that anatomy demonstrations have additional benefits than just delivery of information. Interactive demonstrations in an anatomy laboratory allow the development of practical skill acquisition and enhance understanding of anatomical variability. These elements are directly examinable, but the benefits go further. Interactive study allows a unique tactile appreciation for the tissues making up the human body and nurtures respectful attitudes towards the body that a computer program cannot simulate. Furthermore, many of us will be able to remember the friendships that can only be formed in a dissection demonstration! Beyond the anatomy laboratory, demonstrations of key anatomical landmarks is best done on an actual human form – a textbook or app cannot teach a student how best to feel for the sternal notch, or how to differentiate between key bony landmarks. When learning human anatomy, hours of study are assumed, therefore we should look for a learning experience that is the most enriching, not just in terms of medical facts.

Technology may make it far too easy to learn interactively, though not inter-personally – itself a bigger debate for another time. As far as educating on anatomy is concerned, integration of dissection/demonstration, medical imaging, clinical data and case histories will surely yield the best results.

The study of anatomy encourages the focus on both normality and abnormality – making the human body more than just an object in which pathology is observed.  The approaches to anatomy have shifted in line with cultural, social and professional attitudes. This has as much influenced our understanding of anatomy, as it has the way it is taught. These methods have changed from being dictated classical anatomy texts in Galen’s era, to the diagram based learning that Versalius advocated. Similarly, the study of anatomy has shifted seismically from being a textual pursuit to one based upon observation. Modern medical students now have enough resources to learn in any way they chose – integrating cadaver demonstrations, numerous styles of diagram and interactive digital resources.

This a fascinating story that underpins a significant part of Medicine. If there is anything at all to take away, aside from the rich, inspiring and occasionally gruesome history, is that the study of practical anatomy is just one of the many privileges afforded to aspiring doctors, and one that is central to our subject. This is grounded as much in gaining an understanding of structure and function, as it is respecting the human body and mortality.

 

Note from Author:

Thank you for reading this article. I hope that you found it interesting or informative! I have done my best to cover the main points, though do let me know if you feel that I have omitted something important! If you’d like to comment on the article, please don’t hesitate to do so using the form below, or by contacting me directly.

 

  1. Moxham BJ, Plaisant O. The history of the teaching of gross anatomy how we got to where we are! Eur J Anat. 2014;18(3):219–44.
  2. Elizondo-Omaña RE, Guzmán-López S, De Los Angeles García-Rodríguez M. Dissection as a teaching tool: Past, present, and future. Anat Rec – Part B New Anat. 2005;285(1):11–5.
  3. Gregory SR, Cole TR. The Changing Role of Dissection in Medical Education. Med Student JAMA. 2002;287(9):1180–1.
  4. Dyer GS, Thorndike ME. Quidne mortui vivos docent? The evolving purpose of human dissection in medical education. J Assoc Am Med Coll [Internet]. 2002;75(10):969–79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11031139
  5. AD T, HA P. From grave robbing to gifting: Cadaver supply in the united states. JAMA [Internet]. 2002 Mar 6;287(9):1183. Available from: http://dx.doi.org/10.1001/jama.287.9.1183-JMS0306-6-1
  6. Mitchell PD, Boston C, Chamberlain AT, Chaplin S, Chauhan V, Evans J, et al. The study of anatomy in England from 1700 to the early 20th century. J Anat. 2011;219(2):91–9.

 

Figure 1: Egyptian Mummification, from “Introduction to Egyptian Mummification, accessed 16 August 2017, http://historylink101.com/n/egypt_1/religion_mumification.htm

Figure 2: A portrait of Versalius from De humani corporis fabrica


 

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