From Ancient Texts to Digital Imagery: A Brief History on the Evolution of Anatomic Illustrations.

In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.

The science of art: Leonardo Da Vinci and facial plastic surgery.

PURPOSE OF REVIEW: Leonardo Da Vinci possessed one of humanity's greatest minds, known for exploring the boundaries of art and science. The discipline of facial plastic surgery also relies on art and science for its advancement. This review focuses on key elements of Leonardo Da Vinci's work, and how they relate to concepts within facial plastic surgery. RECENT FINDINGS: Leonardo Da Vinci was a self-taught creative genius. Common themes that permeated his art were those of proportion, perspective, light and shadow, anatomy, and science. These principles are reflected in key aspects of facial plastic surgery, such as facial analysis, human gaze, facial subunits, surgery of the craniofacial skeleton, and evidence-based medicine. SUMMARY: Leonardo Da Vinci's approach to scientific inquiry and artistic beauty strikes a balance from which facial plastic surgeons have much to learn. In depth study of how Leonardo Da Vinci viewed the world furthers the analytical and creative sides of a facial plastic surgeon as well as informs their personal development.

Anatomy theaters in the history and teaching of surgery.

The study of anatomy has played a large part in the progress of scientific observation throughout the centuries and was pivotal in elevating anatomy from the magical thinking of the Hippocrates era and freeing it from subservience to medicine which was all-powerful in the past. Anatomy theaters appeared in Northern Italy in the 14th century and developed in Western Europe from the early 16th century to the beginning of the 19th century. Anatomy theaters lived their golden age in France during the 18th century when the Royal Academy of Surgery (Académieroyaledechirurgie) was created in 1743. These theaters were open to the public, and therefore offered the double vocation of teaching and public entertainment: they were used to teach anatomy and surgery to students and surgeons and offered distraction for the well-informed public that was fascinated by death, ever-present and familiar to all. Anatomical dissection accomplished a double ritual: the "profane" ritual of valorization of scientific knowledge and the "sacred" ritual, where mankind, obsessed with death, respected the human body considered as a divine image. Anatomy theaters declined as they became overshadowed by progress in anatomical teaching using well-illustrated works in well-equipped medical schools while exhibition of anatomic oddities for public amusement was relegated to fairs and circus sideshows. Nonetheless they opened the way to modern anatomo-clinical methods and surgery.

Medical Illustration in the Era of Cardiac Surgery.

This article reviews the collaboration between clinician and illustrator throughout the ages while highlighting the era of cardiac surgery. Historical notes are based on Professor Sanjib Kumar Ghosh's extensive review, literature searches, and the archives of the Johns Hopkins University Department of Art as related to Medicine in Baltimore. Personal communications were explored with medical illustrators and medical practitioners, many of whom are colleagues and trainees, to further chronicle the history of medical illustration and education in the era of cardiac surgery. Medical illustrators use their talents and expressive ideas to demonstrate procedures and give them life. These methods are (1) hovering technique; (2) hidden anatomy, ghosted views, or transparency; (3) centrally focused perspective; (4) action techniques to give life to the procedure; (5) use of insets to highlight one part of the drawing; (6) human proportionality using hands or known objects to show size; and (7) step-by-step educational process to depict the stages of a procedure. Vivid examples showing these techniques are demonstrated. The result of this observational analysis underscores the importance of the collaboration between clinician and illustrator to accurately describe intricate pathoanatomy, three-dimensional interrelated anatomic detail, and complex operations. While there are few data to measure the impact of the atlas on medical education, it is an undeniable assertion that anatomical and surgical illustrations have helped to educate and train the modern-day surgeon, cardiologist, and related health-care professionals.

Pernkopf's atlas: Should unethically obtained life-saving data be discarded?

Dr Pernkopf's Topographische anatomie des menschen (Topographical anatomy of man), in four volumes, was originally published in German. It had taken the author and his colleagues over twenty years to produce it, the first volume being published in 1937. It was translated into English in 1964. The atlas was received with uniform acclaim in Europe and America and praised for its accuracy and the quality of its illustrations. A recent study compared its utility with that of Dr Frank Netter's Atlas of human anatomy, first published in 1989, with its 7th edition out in 2018. "The respondents (nerve surgeons) found Pernkopf 's atlas having both greater anatomical detail (range 79%-91%) and greater utility for surgery (range 66%- 82%) when compared with Netter's (P < .001) in all plate comparisons." (1) Internationally renowned and respected neurosurgeon, Dr M Gazi Yasargil - not given to handing out praise lightly - said in 2004 of this atlas, "Pernkopf's work, in particular … Vol. 4 (800 pages, 218 figures) is of fantastic quality and is appreciated worldwide." (2) Surgeons continue to use Dr. Pernkopf's atlas to plan their operations (3). A recent example is its use in the treatment of a 13-year-old Israeli schoolboy (4). This essay discusses whether it is rational to refuse to use data and publications that are accurate and likely to help in treating patients. Since such information can save lives, should we spurn it because it was based on information obtained unethically?

Sandro Botticelli's Madonna of the Pomegranate: the hidden cardiac anatomy.

Sandro Botticelli was one of the most renowned artists of the 15th century. He was based in Florence during the flourishing of the Renaissance, a time when anatomical knowledge of ancient times was reclaimed through cadaveric dissection. This report proposes that such knowledge enabled Botticelli to enhance the iconography of his masterpieces, Madonna of the Pomegranate, by incorporating a concealed image of the heart and cardiac anatomy within it.

Ophthalmologic wax models as an educational tool for 18th-century vision scientists.

The Medical Faculties of the University of Padua (Italy) and the University of Vienna (Austria) preserved two series of wax models, made by the Austrian Johann Nepomuk Hoffmayr at the beginning of the 19th century. These models were created in a period of evolution of both medical specialties and organ pathology, which brought morbid organs at the centre of medical investigation. Ceroplastic was considered a useful tool for didactic and research, as it provided a three-dimensional realistically coloured reproduction of organic lesions. The models represent the typical eye diseases of the period, in particular those affecting external parts, which could be investigated without the need for specific instruments devised for the observation of the inner and posterior anatomy of the eye, at that time not yet available. Even if the nosological categories then employed by Hoffmayr were different from those currently used, it has been possible to find a correspondence thanks to the ophthalmological literature of his period. Ceroplastic started to decline at the end of 19th century, substituted by the much less expensive method of preservation of morbid organs in formalin and by new techniques of investigation of the inner body, such as X-ray.

Charles Estienne (1504-1564): His Life, Work, and Contribution to Anatomy and the First Description of the Canal in the Spinal Cord.

The purpose of this historic review is to summarize the life, work, and contribution to anatomy of Charles Estienne (also known by the Latin name Carolus Stephanus). Charles Estienne was an early exponent of the science of anatomy in France. Although he remained under the influence of the Galenic tradition of medicine, anatomy, and surgery throughout his distinguished career, he had a significant influence on the scientific revolution and anatomy reformation of the 16th century. Nevertheless, he cannot be placed at the same level of contribution as Vesalius, because of his lack of discipline in his work, hesitation to diverge totally from traditional beliefs, and his hesitation for a total criticism of the Galenic tradition.

[Modelling science. The ceroplastics of Ignacio Lacaba in the Colegio de Cirugía de San Carlos, Madrid]. / Modelando ciencia. La ceroplástica de Ignacio Lacaba en el Colegio de Cirugía de San Carlos de Madrid.

Models made of wax had enormous diffusion in the anatomical teaching of the 18th century. It transcended the borders of a science that impregnated with scientific knowledge the artistic expression of beauty. Based on this premise, the San Carlos Royal College of Surgery created in Madrid a large collection of anatomical models, which is currently maintained by the Javier Puerta Anatomy Museum in the School of Medicine at Madrid Complutense University. The collection began in 1786 with Ignacio Lacaba, the first dissector of the Surgery College of Madrid, whose artistic sensibility and deep knowledge of anatomy contributed and facilitated harmonization between the work of the wax sculptors and language and anatomical expression.

Andreas Vesalius' 500th Anniversary: First Description of the Mammary Suspensory Ligaments.

Sir Astley Paston Cooper has, to date, been acknowledged to be the first to describe the suspensory ligaments of the breast, or Cooper's ligaments, in 1840. We found these ligaments to be recorded in the first edition of 'De Humani Corporis Fabrica Libri Septem' by Andreas Vesalius, published in 1543. To commemorate Vesalius' 500th birthday, we quote and discuss this earlier record. Vesalius' record of the nature and function of the fleshy membrane between mammary gland and pectoral muscle, the hard fat intervening the mammary glands, and the fibers running from the fleshy membrane to the skin are a clear representation of posterior layer of the superficial fascial system, the fibro-adipose stroma surrounding and linking the mammary glandular elements, and the suspensory ligaments as we know them. Vesalius recorded the anatomy and function of the latter structures nearly 300 years before Sir Astley Paston Cooper did.

Andreas Vesalius' 500th Anniversary: Initiation of the Superficial Facial System and Superficial Musculoaponeurotic System Concepts.

Because of their relevance for liposuction and rhytidectomies, respectively, the superficial fascial system (SFS) and superficial musculoaponeurotic system (SMAS) have been thoroughly studied over the past decennia. Although it is well known that the SMAS concept was introduced by Tessier in 1974, it remains unknown who first properly described the stratum membranosum of the SFS. In light of the 500th birthday of Andreas Vesalius (1515-1564), we searched his 1543 masterwork De Humani Corporis Fabrica Libri Septem and related work for references to these structures. We found ample reference to both structures as the membrana carnosa (or fleshy membrane) in his works and concluded that Vesalius recognized the extension, nature, and functions of the stratum membranosum of the SFS, as well as its more musculous differentiation as the SMAS in the head and neck area, and the dartos in the perineogenital area. In doing so, Vesalius recorded most details of the SFS and SMAS concepts avant la lettre.

The Rise of Pathological Illustrations: Baillie, Bleuland, and Their Collections.

This essay examines the illustrated pathological works by Matthew Baillie (London, 1799-1803) and Jan Bleuland (Utrecht, 1826-28). Both works relied on extensive collections of specimens preserved in London and Utrecht, respectively. The essay discusses changing notions of disease, the erosion of the boundaries between surgeons and physicians, the role and significance of pathological collections, and the relations between preserved specimens and their representations.

El cuerpo humano en el "Moisés" de Miguel Ángel / The human body in Michelangelo's Moses

What grips us so powerfully to a work of art is the artist's intention, if he succeeds to express it in his work and we are able to understand it. Michelangelo's Moses established the essential structures of an animate organism and the embodiment of consciousness in the world. Since the body is an expressive unit, it is possible to reconstruct a highly feasible sequence of movements that might have preceded the moment caught in the statue. It is an expression of the highest ideal of mental and spiritual achievement through the controlled tension between action and restraint. The phenomenon of embodiment and feeling the body as own is the basis of concrete human existence.

John Bell (1763-1820): brother artist and anatomist.

John Bell, brother-surgeon of Charles Bell, was, like Charles, an outstanding surgeon and a good artist. John was one of the few who illustrated his work with their own drawings in the days before audiovisual aids were available and without the benefit of reliable drawing aids, photography and computer-aided design. Charles, on the other hand, was the better artist and illustrated much of the normal anatomy of the nervous system. Each brother undertook extensive surgery of men who had been wounded in war; John Bell left us his engravings from the textbooks, more numerous perhaps than Charles, but Charles left us a series of oil paintings and watercolours in addition to the illustrations in his textbooks.

Bidloo's and De Lairesse's early illustrations of the anatomy of the arm (1690): a successful collaboration between a prominent physician and a talented artist.

Govard Bidloo (1649-1713) was trained as a surgeon at the Amsterdam Guild of Surgeons, and later in his career, he became a professor of anatomy in The Hague and Leiden. At the end of the 17th century, he performed dissections on the corpses of executed criminals to teach and study anatomy. Based on his findings, he published a magnificent anatomical atlas in 1690, entitled Ontleding des Menschelijken Lichaams (Dissection of the Human Body). The talented painter Gerard De Lairesse, a pupil of Rembrandt, made the drawings of the anatomical dissections for the atlas in close collaboration with the dissector. The drawings of Bidloo and De Lairesse represent, in a unique and artistic way, an early series of anatomical preparations of the arm and hand from more than 300 years ago.

Museo Anatómico Pedro Ara. Facultad de Ciencias Médicas, Universidad Nacional de Córdoba / Pedro Ara Anatomy Museum. School of Medical Sciences, National University of Cordoba

Los autores reseñan las características del material que encierra el museo Ara, creado en 1878, que lleva el nombre de uno de los más destacados taxidermistas, el Dr. Pedro Ara, autor de las tareas de conservación del cadáver de Eva Perón. El museo Ara posee una de las colecciones más importantes del mundo en diafanizaciones y recibe las visitas de expertos de todas partes que desean consultar sobre su valioso patrimonio.