History of anatomy
Encyclopedia
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
as a science
Science
Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe...
extends from the earliest examinations of sacrificial
Sacrifice
Sacrifice is the offering of food, objects or the lives of animals or people to God or the gods as an act of propitiation or worship.While sacrifice often implies ritual killing, the term offering can be used for bloodless sacrifices of cereal food or artifacts...
victims to the sophisticated analyses of the body performed by modern scientists. It has been characterized, over time, by a continually developing understanding of the functions of organ
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...
s and structures in the body. The field of Human Anatomy has a prestigious history, and is considered to be the most prominent of the biological sciences of the 19th and early 20th centuries. Methods have also improved dramatically, advancing from examination of animal
Animal
Animals are a major group of multicellular, eukaryotic organisms of the kingdom Animalia or Metazoa. Their body plan eventually becomes fixed as they develop, although some undergo a process of metamorphosis later on in their life. Most animals are motile, meaning they can move spontaneously and...
s through dissection of cadaver
Cadaver
A cadaver is a dead human body.Cadaver may also refer to:* Cadaver tomb, tomb featuring an effigy in the form of a decomposing body* Cadaver , a video game* cadaver A command-line WebDAV client for Unix....
s to technologically complex techniques developed in the 20th century.
Anatomy is one of the cornerstones of a doctor’s medical education. Despite being a persistent portion of teaching from at least the renaissance, the format and the amount of information being taught has evolved and changed along with the demands of the profession. What is being taught today may differ in content significantly from the past but the methods used to teach this have not really changed that much. For example all the famous public dissections of the Middle Ages and early renaissance were in fact prosection
Prosection
A prosection is the dissection of a cadaver or part of a cadaver by an experienced anatomist in order to demonstrate for students anatomic structure...
s. Prosection is the direction in which many current medical schools are heading in order to aid the teaching of anatomy and some argue that dissection is better. However looking at results of post graduate exams, medical schools (specifically Birmingham) that use prosection as opposed to dissection do very well in these examinations. This would suggest that prosection can fit very well into the structure of modern medical training.
Egypt
The study of anatomy begins at least as early as 1600 BCE, the date of the Edwin Smith Surgical Papyrus. This treatise shows that the heartHeart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
, its vessels, liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
, kidneys, hypothalamus
Hypothalamus
The Hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions...
, uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
were recognized, and that the blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s were known to emanate from the heart. Other vessels are described, some carrying air, some mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
, and two to the right ear
Ear
The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
are said to carry the "breath of life
Life
Life is a characteristic that distinguishes objects that have signaling and self-sustaining processes from those that do not, either because such functions have ceased , or else because they lack such functions and are classified as inanimate...
", while two to the left ear the "breath of death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
". The Ebers papyrus
Ebers papyrus
The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt, it was purchased at Luxor, in the winter of 1873–74 by Georg Ebers...
(c. 1550 BCE) features a treatise on the heart. It notes that the heart is the center of the blood supply, with vessels attached for every member of the body. The Egyptians seem to have known little about the function of the kidneys and made the heart the meeting point of a number of vessels which carried all the fluids of the body – blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, tear
Tear
Tear may refer to:*Tears, a type of eye secretion*Tearing, the ripping apart of something by force*Robert Tear, a Welsh singer-Elements in fiction:*Tear, a character Tear Grants in video game Tales of the Abyss...
s, urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
and sperm
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
.
Greece
The earliest medical scientist of whose works any great part survives today is HippocratesHippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
, a Greek
Ancient Greece
Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...
physician active in the late 5th and early 4th centuries BCE (460 - 377 BCE). His work demonstrates a basic understanding of musculoskeletal structure, and the beginnings of understanding of the function of certain organs, such as the kidneys. Much of his work, however, and much of that of his students and followers later, relies on speculation rather than empirical observation of the body. One of the greatest achievements of Hippocrates was that he was the first to discover the tricuspid valve
Tricuspid valve
The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, between the right atrium and the right ventricle. The normal tricuspid valve usually has three leaflets and three papillary muscles. They are connected to the papillary muscles by the chordae...
of the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
and its function which he documented in the treatise On the Heart in the Hippocratic Corpus
Hippocratic Corpus
The Hippocratic Corpus , or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings...
. Later anatomists knew the function of the tricuspid valve after reading the Hippocratic Corpus.
In the 4th century BCE, Aristotle
Aristotle
Aristotle was a Greek philosopher and polymath, a student of Plato and teacher of Alexander the Great. His writings cover many subjects, including physics, metaphysics, poetry, theater, music, logic, rhetoric, linguistics, politics, government, ethics, biology, and zoology...
and several contemporaries produced a more empirically founded system, based animal dissection
Dissection
Dissection is usually the process of disassembling and observing something to determine its internal structure and as an aid to discerning the functions and relationships of its components....
. Around this time, Praxagoras
Praxagoras
Praxagoras was an influential figure of medicine in ancient Greece. He was born on the Greek island of Kos in about 340 BC. Both his father, Nicarchus, and his grandfather were physicians...
is credited as the first to identify the difference between arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
and vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
s, and the relations between organs are described more accurately than in previous works.
The first use of human cadaver
Cadaver
A cadaver is a dead human body.Cadaver may also refer to:* Cadaver tomb, tomb featuring an effigy in the form of a decomposing body* Cadaver , a video game* cadaver A command-line WebDAV client for Unix....
s for anatomical research occurred later in the 4th century BCE when Herophilos
Herophilos
Herophilos , sometimes Latinized Herophilus , was a Greek physician. Born in Chalcedon, he spent the majority of his life in Alexandria. He was the first scientist to systematically perform scientific dissections of human cadavers and is deemed to be the first anatomist. Herophilos recorded his...
and Erasistratus
Erasistratus
Erasistratus was a Greek anatomist and royal physician under Seleucus I Nicator of Syria. Along with fellow physician Herophilus, he founded a school of anatomy in Alexandria, where they carried out anatomical research...
gained permission to perform live dissections, or vivisection, on criminals in Alexandria
Alexandria
Alexandria is the second-largest city of Egypt, with a population of 4.1 million, extending about along the coast of the Mediterranean Sea in the north central part of the country; it is also the largest city lying directly on the Mediterranean coast. It is Egypt's largest seaport, serving...
under the auspices of the Ptolemaic dynasty
Ptolemaic dynasty
The Ptolemaic dynasty, was a Macedonian Greek royal family which ruled the Ptolemaic Empire in Egypt during the Hellenistic period. Their rule lasted for 275 years, from 305 BC to 30 BC...
. Herophilos in particular developed a body of anatomical knowledge much more informed by the actual structure of the human body than previous works had been.
Galen
The final major anatomist of ancient times was GalenGalen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
, active in the 2nd century. He compiled much of the knowledge obtained by previous writers, and furthered the inquiry into the function of organs by performing vivisection
Vivisection
Vivisection is defined as surgery conducted for experimental purposes on a living organism, typically animals with a central nervous system, to view living internal structure...
on animals. Due to a lack of readily available human specimens, discoveries through animal dissection were broadly applied to human anatomy as well. His collection of drawings, based mostly on dog anatomy, became the anatomy textbook for 1500 years. The original text is long gone, and his work was only known to the Renaissance
Renaissance
The Renaissance was a cultural movement that spanned roughly the 14th to the 17th century, beginning in Italy in the Late Middle Ages and later spreading to the rest of Europe. The term is also used more loosely to refer to the historical era, but since the changes of the Renaissance were not...
doctors through the careful custody of Arabic
Islamic Golden Age
During the Islamic Golden Age philosophers, scientists and engineers of the Islamic world contributed enormously to technology and culture, both by preserving earlier traditions and by adding their own inventions and innovations...
medicine.
Early modern anatomy
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
and Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...
, especially The Canon of Medicine
The Canon of Medicine
The Canon of Medicine is an encyclopedia of Galenic medicine in five books compiled by Ibn Sīnā and completed in 1025. It presents a clear and organized summary of all the medical knowledge of the time...
which incorporated the teachings of both, were translated into Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
, and the Canon remained the most authoritative text on anatomy in European medical education until the 16th century. The first major development in anatomy in Christian Europe, since the fall of Rome, occurred at Bologna
Bologna
Bologna is the capital city of Emilia-Romagna, in the Po Valley of Northern Italy. The city lies between the Po River and the Apennine Mountains, more specifically, between the Reno River and the Savena River. Bologna is a lively and cosmopolitan Italian college city, with spectacular history,...
in the 14th to 16th centuries, where a series of authors dissected cadavers and contributed to the accurate description of organs and the identification of their functions. Prominent among these anatomists were Mondino de Liuzzi
Mondino de Liuzzi
Mondino de Luzzi, or de Liuzzi or de Lucci, , also known as Mundinus, was an Italian physician, anatomist, and professor of surgery who lived and worked in Bologna...
and Alessandro Achillini
Alessandro Achillini
Alessandro Achillini was an Italian philosopher and physician.-Biography:He was born and died in Bologna, and is buried in the Church of Saint Martin there...
.
The first challenges to the Galenic doctrine in Europe occurred in the 16th century. Thanks to the printing press
Printing press
A printing press is a device for applying pressure to an inked surface resting upon a print medium , thereby transferring the ink...
, all over Europe a collective effort proceeded to circulate the works of Galen and Avicenna, and later publish criticisms on their works. Vesalius
Vesalius
Andreas Vesalius was a Flemish anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica . Vesalius is often referred to as the founder of modern human anatomy. Vesalius is the Latinized form of Andries van Wesel...
was the first to publish a treatise, De humani corporis fabrica, that challenged Galen "drawing for drawing" travelling all the way from Leuven
Leuven
Leuven is the capital of the province of Flemish Brabant in the Flemish Region, Belgium...
to Padua
Padua
Padua is a city and comune in the Veneto, northern Italy. It is the capital of the province of Padua and the economic and communications hub of the area. Padua's population is 212,500 . The city is sometimes included, with Venice and Treviso, in the Padua-Treviso-Venice Metropolitan Area, having...
for permission to dissect victims from the gallows
Gallows
A gallows is a frame, typically wooden, used for execution by hanging, or by means to torture before execution, as was used when being hanged, drawn and quartered...
without fear of persecution. His drawings are triumphant descriptions of the, sometimes major, discrepancies between dogs and humans, showing superb drawing ability. Many later anatomists challenged Galen in their texts, though Galen reigned supreme for another century.
A succession of researchers proceeded to refine the body of anatomical knowledge, giving their names to a number of anatomical structures along the way. The 16th and 17th centuries also witnessed significant advances in the understanding of the circulatory system
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
, as the purpose of valve
Valve
A valve is a device that regulates, directs or controls the flow of a fluid by opening, closing, or partially obstructing various passageways. Valves are technically pipe fittings, but are usually discussed as a separate category...
s in veins was identified, the left-to-right ventricle flow of blood through the circulatory system was described, and the hepatic vein
Hepatic vein
In human anatomy, the hepatic veins are the blood vessels that drain de-oxygenated blood from the liver and blood cleaned by the liver into the inferior vena cava....
s were identified as a separate portion of the circulatory system. The lymphatic system
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
was also identified as a separate system at this time.
17th and 18th centuries
Michelangelo
Michelangelo di Lodovico Buonarroti Simoni , commonly known as Michelangelo, was an Italian Renaissance painter, sculptor, architect, poet, and engineer who exerted an unparalleled influence on the development of Western art...
to Rembrandt. For the first time, prominent universities could teach something about anatomy through drawings, rather than relying on knowledge of Latin. Contrary to popular belief, the Church neither objected to nor obstructed anatomical research. The increase in demand for cadavers, though, led to rumors about anatomy murder
Anatomy murder
An anatomy murder is a murder committed in order to use all or part of the cadaver for medical research or teaching. It is not a medicine murder because the body parts are not believed to have any medicinal use in themselves. The motive for the murder is created by the demand for cadavers for ...
.
Only certified anatomists were allowed to perform dissections, and sometimes then only yearly. These dissections were sponsored by the city councilors and often charged an admission fee, rather like a circus act for scholars. Many European cities, such as Amsterdam, London, Copenhagen, Padua, and Paris, all had Royal anatomists (or some such office) tied to local government. Indeed, Nicolaes Tulp
Nicolaes Tulp
Nicolaes Tulp was a Dutch surgeon and mayor of Amsterdam. Tulp was well known for his upstanding moral character.-Life:...
was Mayor of Amsterdam for three terms. Though it was a risky business to perform dissections, and unpredictable depending on the availability of fresh bodies, attending dissections was perfectly legal. Many anatomy students traveled around Europe from dissection to dissection during the course of their study - they had to go where a fresh body was available (e.g. after a hanging) because before refrigeration, a body would decay rapidly and become unsuitable for examination.
Many Europeans interested in the study of anatomy traveled to Italy, then the center of anatomy. Only in Italy could certain important research methods be used, such as dissections on women. M. R. Columbus
Realdo Colombo
Realdo Colombo was an Italian professor of anatomy and a surgeon at the University of Padua between 1544 and 1559.- Early life and education :Matteo Realdo Colombo or Renaldus Columbus, was born in Cremona, Lombardy to an apothecary named Antonio Colombo...
and Gabriele Falloppio
Gabriele Falloppio
Gabriele Falloppio , often known by his Latin name Fallopius, was one of the most important anatomists and physicians of the sixteenth century....
were pupils of Vesalius, the 16th century anatomist. Columbus, as his immediate successor in Padua, and afterwards professor at Rome, distinguished himself by rectifying and improving the anatomy of the bones, by giving correct accounts of the shape and cavities of the heart, of the pulmonary artery and aorta and their valves, and tracing the course of the blood from the right to the left side of the heart, by a good description of the brain and its vessels, and by correct understanding of the internal ear, and the first good account of the ventricles of the larynx. Osteology at nearly the same time found an assiduous cultivator in Giovanni Filippo Ingrassias
Giovanni Filippo Ingrassias
Giovanni Filippo Ingrassia was a major figure in the history of the science of human anatomy.Ingrassia was a learned Sicilian physician, who, in a skilful commentary on the osteology of Galen, corrected numerous mistakes. He was university professor at the University of Naples...
.
19th century anatomy
Human anatomy
Human anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...
of the previous century. The discipline also progressed to establish growing sources of knowledge in histology
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
and developmental biology
Developmental biology
Developmental biology is the study of the process by which organisms grow and develop. Modern developmental biology studies the genetic control of cell growth, differentiation and "morphogenesis", which is the process that gives rise to tissues, organs and anatomy.- Related fields of study...
, not only of humans but also of animal
Animal
Animals are a major group of multicellular, eukaryotic organisms of the kingdom Animalia or Metazoa. Their body plan eventually becomes fixed as they develop, although some undergo a process of metamorphosis later on in their life. Most animals are motile, meaning they can move spontaneously and...
s. Extensive research was conducted in more areas of anatomy. Great Britain was particularly important in this research. Demand for cadavers grew so great there that body-snatching
Body-snatching
Body snatching is the secret disinterment of corpses from graveyards. A common purpose of body snatching is to sell the corpses for dissection or anatomy lectures in medical schools...
and even anatomy murder
Anatomy murder
An anatomy murder is a murder committed in order to use all or part of the cadaver for medical research or teaching. It is not a medicine murder because the body parts are not believed to have any medicinal use in themselves. The motive for the murder is created by the demand for cadavers for ...
came into use as a means of obtaining them. In response, the English Parliament passed the Anatomy Act 1832
Anatomy Act 1832
The Anatomy Act 1832 was a United Kingdom Act of Parliament that gave freer license to doctors, teachers of anatomy, and bona fide medical students to dissect donated bodies...
, which finally provided for an adequate and legitimate supply of corpses by allowing dissection of destitutes. The relaxed restrictions on dissection provided a suitable environment for Gray's Anatomy
Gray's Anatomy
Gray's Anatomy is an English-language human anatomy textbook originally written by Henry Gray. The book is widely regarded as an extremely influential work on the subject, and has continued to be revised and republished from its initial publication in 1858 to the present day...
, a text that was a collective effort and became widely popular. Now seen as unwieldy, Gray's Anatomy was born out of a need to create a single volume on anatomy for the traveling doctor.
The shift from the largely public displays of dissection in anatomy theatres to dissections carried out in classrooms meant that there was a drastic change in who could observe a dissection. Females for example, who at this time were not allowed to attend medical school, could broaden their knowledge by attending the anatomy theatres. So the shift from prosection to dissection meant a reduction in the number of people that could benefit from a single cadaver. At this point as well tighter regulation of the medical profession and donations of bodies resulted in various implications for carrying out dissections. Private medical schools which offered summer schools and various other courses involving cadaveric dissection allowed one route into gaining membership to the Royal College of Surgeons. However from 1822 the Royal College of surgeons would no longer accept these qualifications, this as result would see these largely unregulated schools begin to close. Not only as a result of this, but the Anatomy Act 1832 made it much harder (more bureaucracy) to obtain bodies for dissection. The act resulted in only the large teaching hospitals feasibly being able to continue teaching anatomy courses due to agreements with patients that if they donated their body they would receive free treatment. So towards the end of 19th century anatomy courses had been largely professionalised at established medical schools and public dissection was no longer common place.
Another source of anatomy teaching began with the foundation of many medical schools (particularly within the provincial medical schools) and the medical museums found within them. A large portion of training occurred within these up until and for some time after the Second World War. The medical museum was very important and a lot of effort was put into creating something impressive. This was particularly so in provincial medical schools which were just being established that needed credibility not only from other medical schools (namely Oxford and the London teaching hospitals) but also from the public. The museums were not only for students but also members of the public paid to see the exhibits within the museum. This brought not only much needed income but prestige as well. The more exhibits within the museum the more established the medical school appeared to be (at least to the public). Significant amounts of teaching occurred in the museum as well with students claiming they learnt far more in the museum than they ever did in the lecture theatre. The decline of the museums within medical schools was largely due to the demand in floor space for teaching and new disciplines and less importantly the great improvements in photography and colour texts. For example the museum at Birmingham Medical School is now a computer cluster and teaching rooms, the only remains of the museum are the preserved specimens decorating the walls around the computer cluster.
Modern anatomy
Anatomical research in the past hundred years has taken advantage of technological developments and growing understanding of sciences such as evolutionary and molecular biologyMolecular biology
Molecular biology is the branch of biology that deals with the molecular basis of biological activity. This field overlaps with other areas of biology and chemistry, particularly genetics and biochemistry...
to create a thorough understanding of the body's organs and structures. Disciplines such as endocrinology
Endocrinology
Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions called hormones, the integration of developmental events such as proliferation, growth, and differentiation and the coordination of...
have explained the purpose of glands that anatomists previously could not explain; medical devices such as MRI machines and CAT scanners have enabled researchers to study the organs of living people or of dead ones. Progress today in anatomy is centered in the development, evolution, and function of anatomical features, as the macroscopic aspects of human anatomy have been largely catalogued. The subfield of non-human anatomy is particularly active as modern anatomists seek to understand basic organizing principles of anatomy through the use of advanced techniques ranging from finite element analysis to molecular biology.
With increasing demands on the healthcare system and what could be deemed chronic under-training of doctors (numbers of doctors per capita compared to other industrialised countries) during the latter half of the 20th century, medical schools are now facing massive pressure to train as many doctors as possible. This has meant in recent years cohort sizes have doubled and more in size, in order to try and meet the demand. This has resulted in increased pressure of the facilities at all medical schools in the country. Anatomy is one department in particular that has had to evolve to accommodate the number of students. At Birmingham dissection was once essential to the teaching of anatomy but since the end of the 1980s the medical school has adopted prosection over dissection. At the time new directives from the General Medical Council (GMC) on the direction medical education was the major factor according the current head of anatomy. There are also many other reasons why prosection maybe favoured (discussed below). It has probably now become near impossible to restart dissection at Birmingham even if one wanted to. This is due to the fact that current prosection uses a very similar number of cadavers as dissection previously did. If dissection was to be brought back the number of cadavers would be very large due the current cohort size. To increase provision of prosection the medical school is currently investing in the region of £800,000-900,000 on a new prosectorium. This will allow up to about 40 students to observe prosected material in any one session. The vast amount of money required just to increase the amount of prosection demonstrates that it is no longer possible to carry out dissection at Birmingham (and is the case for many other universities). Prosection makes more efficient use of a cadaver when compared to dissection. A single cadaver when dissecting would be used by up to 5 students whereas prosection allows if necessary and entire cohort to observe the prosected cadaver. Prosection also allows students to observe more than one cadaver whereas in dissection you would tend to just use a single one. Logistically prosection allows more flexibility than dissection as there is no commitment to provide a cadaver per a certain number of students, this in fact create opportunities for cadavers to be used, for example at Birmingham, for Special Study Modules (SSMs) and postgraduate teaching.
Also there are many more aids to teaching anatomy then merely the prosectorium; improvements over the last century in colour images and photographs means that an anatomy text is no longer an aid to dissection but rather a central material to learn from. Plastic models are also regularly used in anatomy teaching sessions and they offer a good substitute to the real thing. One argument against plastic models is that they may provide a false sense of conformity in the human body; there is no doubt quite a difference between a plastic model and a prosected cadaver. Use of living models for anatomy demonstration is once again becoming popular within teaching of anatomy. Anatomy is dynamic, for example the anatomy of the musculoskeletal system is by definition the anatomy of movement. So to provide an example of this to the audience (students) and be able to demonstrate the possible movements is beneficial. Surface landmarks that can be palpated on another individual also provide practice for future clinical situations. It is possible to do this on oneself and a good example of this being implemented is Integrated Biology at the University of Berkeley; students are encouraged to “introspect” on themselves and link what they are being taught to their own body. This may seem like a relatively obvious idea but to formally link it into teaching of anatomy should aid memory recall.
Donations of bodies have also declined in recent years with a marked decline of public confidence in the medical profession. With scandals such as Alder hay and Bristol, people are less confident that their wishes on what will happen to their body will be carried out, so instead have not donated to medical science when in the past they may have. The resultant legislation from these scandals (namely the Human Tissue Act 2004
Human Tissue Act 2004
The Human Tissue Act 2004 is an Act of the Parliament of the United Kingdom which consolidated previous legislation and created the Human Tissue Authority to "regulate the removal, storage, use and disposal of human bodies, organs and tissue."...
) has tightened up the availability of resources to anatomy departments. Another factor facing body donations is the problems arising from the outbreaks of Bovine Spongiform Encephalitis (BSE) in the late 80s and early 90s and the restrictions of handling of brain tissue that resulted from this. The exact pathology of the human form, variant Creutzfeldt–Jakob disease (vCJD) has meant that patients donating their body who suffered from Alzheimer’s or dementia and of course vCJD means their brains cannot be handled. As the method of transmission of these diseases and the link between them (i.e. is Alzheimer’s vCJD and vice versa) is not fully understood these precautions have to be taken. Very symptomatic patients are also not normally accepted for cadavers. However this means that students are more limited on what they can dissect within the head, this is particularly a problem in medical schools where dissection is still carried out. It is less of a problem where prosection is carried out as the specimen will have already been dissected.
Conclusion
Anatomy teaching has changed considerably over the last 1000 years though it is still very much at the heart of the philosophy of western medicine. Western medicine seeks to find a cause to all disease and attempt to cure it; very much cause and effect. Without a good understanding of the arrangement of the human body then this becomes somewhat challenging. Western medicine is in fact taking a more holistic approach today, with the psychosocial biomedical model of disease. However, most practicing doctors would readily adapt their thoughts and treatments if it was proven that there was a biological cause to disease previously thought to be idiopathic. Anatomy is often regarded as being a complete science, in that we know what and where most of the body is and does with little left to discover. The recent controversies with Gunther von HagensGunther von Hagens
Gunther von Hagens is a controversial German anatomist who invented the technique for preserving biological tissue specimens called plastination.-Early life:...
and public displays of dissection may divide opinions on what is ethical (even the legality of a public dissection) The future of dissection may be uncertain and indeed, if pressure to obtain cadavers continues, even the few medical schools that continue to do dissection may have to halt. This hopefully however will not reduce the number of people able to benefit from a single cadaver if current prosection methods become the prevalent method of demonstrating gross anatomy.
External links
- Historical Anatomies on the Web. National Library of Medicine. Selected images from notable anatomical atlases.
- Anatomia 1522-1867: Anatomical Plates from the Thomas Fisher Rare Book Library
- Human Anatomy & Physiology Society A society to promote communication among teachers of human anatomy and physiology in colleges, universities, and related institutions.