Bygone theatres of events: A history of human anatomy and dissection.

Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.

The evolution of epistemological methodologies in anatomy: From antiquity to modern times.

Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.

[On the dawn of human dissections in early modern Japan].

The commencement of human dissections in Japan during the Edo period is often depicted as the individual achievement of Yamawaki Toyo. In 1754, this renowned scholar of the "School of Ancient Prescriptions, " feeling unable to resolve discrepancies in the Chinese classical literature, succeeded in obtaining permission for a dissection and was allocated a corpse at the execution place in Kyoto. However, a closer look at this issue reveals that the paradigm change to gaining knowledge through anatomical studies did not occur suddenly after centuries of stagnation. Beginning with the arrival of western medicine in the mid-17th century, this paper demonstrates how foreign and indigenous medical, social, political and religious stimuli gradually led to a new attitude toward human dissections and a rising awareness of the merits of anatomical observations. Decades before Yamawaki counted the number of human viscera, an ophthalmologist had discovered the faculty of the eye as a means for new insights and bone-setters had begun to revise textual knowledge by observing and manipulating the skeletons of rotting corpses. Yamawaki's accomplishment does not lie in the nature of his dissection or the (quickly outdated) results, but in the sheer fact that he carried out the dissection with the permission of the shogunal authorities and managed to publish his findings. Furthermore, among those physicians who quickly followed his example, we find Kawaguchi Shinnin, whose intellectual and mental breakthrough has not been recognized sufficiently yet. In Kawaguchi's case, there was no searching through the classical literature, no detached reflection and no awe resulting from the knife and the body fluids. The dissection that he conducted in 1770 was an unemotional "clinical" search for new insights by measuring sizes, determining positions, colors and consistencies, and by manipulating and investigating. The paper finishes with a comparison of the basic traits of anatomical illustrations in Japan and Europe.

The evolution of pelvic dissection for rectal cancer from blunt dissection to total mesorectal excision.

"Modern" rectal cancer treatment began in the 18th century. However, initial results of the pioneer surgeons were very poor. During the next several decades, significant progress was made towards the cure of rectal cancer. Improvements have included lowering mortality, reducing recurrence, and optimizing functional outcomes. This article reviews the individuals and their advancements in rectal cancer treatment. It describes the changes in the surgical approach for tumor resection, the study of the lymphatic spread of rectal cancer and the advances in sphincter preservation procedures from the era of blunt dissection until the paradigm changing revolution of total mesorectal excision.

Pathfinders in oncology from ancient times to the end of the Middle Ages.

This commentary highlights the onset and progression of the diagnosis and treatment of cancer from ancient times to the 15th century. During the preparation of this synoptic review of the lives and contributions to oncology of 7 ancient physicians, it became clear that despite separation by centuries, ethnicity, and religion, they had many things in common. For example, with the exception of Chauliac, all were born into wealthy families, had an excellent education in the liberal arts and sciences, and were mentored by outstanding teachers. After they became physicians, they traveled extensively, were polyglots, were sponsored by influential individuals, had inquisitive minds, searched for the true nature of diseases, and were proud to share the results of their observations with others. Except for Galen, all of them were kind and well-mannered individuals. They cared with sincere dedication for the poor and those who had untreatable disease, including cancer. Although their understanding of cancer was limited, they were deeply concerned about the neglect and hopelessness of cancer patients. They were aware of their shortcomings in offering effective treatment beyond the surgical excision of early cancers. For advanced cancers, they had nothing to give beyond palliative care with herbals and minerals. All physicians who care for cancer patients owe these pioneer physicians, whatever their shortcomings, an inexpressible debt for their attempts to cure cancer. Cancer 2016;122:1638-46. © 2016 American Cancer Society.

Medical missionaries to China and the reformation of anatomy.

The earliest record of human anatomy in chapters of the Yellow Emperor's Inner Classic is likely to be based upon proper dissections. The first incident of human dissection for medical purpose documented in the History of Han Dynasty occurred in AD 13. During the Sung dynasty, a physician prepared illustrations of internal organs of executed criminals, published in 1113 as the Images of Truth Successive Chinese medical treatises have plagiarized but preserved the anatomical diagrams without improvements or modifications. China had to wait till the mid-19th century for Anglo-American Protestant medical missionaries to bring about a complete and permanent reformation of anatomical science.

Man-midwifery history: 1730-1930.

This paper seeks to determine whether the man-midwives William Smellie and William Hunter deserve continuing approbation as 'Founding Fathers' of the obstetrics profession. Scrutiny of their careers reveals their involvement in murders for dissection. In addition, the man-midwifery initiative of delivery in lying-in hospitals resulted in around 1 million more deaths in Britain and Ireland between 1730 and 1930, than would have occurred had home-births remained as the norm. While some may still credit Smellie and Hunter with obstetric discoveries, their knowledge was obtained by murder-for-dissection. That indictment, together with the lying-in hospital legacy, far outweighs their discoveries. The paper invites further constructive discussion and debate, but concludes the accolade of Founding Fathers is undeserved. Any continuing endorsement of Smellie and Hunter effectively demeans the high ethical standards and reputation of current obstetric professionals.

Ibn Bajja on medicine and medical experience.

This article lists the medical works written by Ibn Bajja, overviews those that have come down to us and studies the super-commentary of Galen's commentary to Hippocrates' "Aphorisms (Sharh fi al-Fusul)". This text shows a deep influence of al-Farabi, namely in a conception of medical experience which stems from the latter's construal of experience (tajriba) as the inductive process described by Aristotle in "Posterior Analytics" which brings the premises of demonstration. On this basis, Ibn Bajja advocated for a less scholastic, more empiric medicine, and his claim was echoed by Ibn Rushd. There are some similarities between Ibn Bajja's text and Ibn Rushd's "K. al-Kulliyyat fi al-tibb" which suggests that the latter had read "Sharh fi al-Fusul". This work gives moreover some evidence that human dissection could have been performed during Ibn Bajja's time.

Students as resurrectionists--A multimodal humanities project in anatomy putting ethics and professionalism in historical context.

Because medical students have many different learning styles, the authors, medical students at Mayo Clinic, College of Medicine researched the history of anatomical specimen procurement, reviewing topic-related film, academic literature, and novels, to write, direct, and perform a dramatization based on Robert Louis Stevenson's The Body-Snatcher. Into this performance, they incorporated dance, painting, instrumental and vocal performance, and creative writing. In preparation for the performance, each actor researched an aspect of the history of anatomy. These micro-research projects were presented in a lecture before the play. Not intended to be a research study, this descriptive article discusses how student research and ethics discussions became a theatrical production. This addition to classroom and laboratory learning addresses the deep emotional response experienced by some students and provides an avenue to understand and express these feelings. This enhanced multimodal approach to"holistic learning" could be applied to any topic in the medical school curriculum, thoroughly adding to the didactics with history, humanities, and team dynamics.

The birth and evolution of neuroscience through cadaveric dissection.

Although interest in the art of dissection and vivisection has waxed and waned throughout the ages, the past century has seen it accepted as commonplace in medical schools across the country. No other practice in medicine has contributed more to the understanding of neuroanatomy and the neurosciences as dissection of the human cadaver, the origins of which are widely documented to have been in Alexandrian Greece. This article chronicles the fascinating and often controversial use of dissection and vivisection in these fields through the ages, beginning with Herophilus of Alexandria, among the first systematic dissectors in the history of Western medicine. The authors comment on its role in the development of modern neurosurgery and conclude with remarks about use of this educational tool today in the United States.

Anatomy, technology, art, and culture: toward a realistic perspective of the brain.

In the 15th century, brain illustration began to change from a schematic system that involved scant objective rendering of the brain, to accurate depictions based on anatomical dissections that demanded significant artistic talent. Notable examples of this innovation are the drawings of Leonardo da Vinci (1498-1504), Andreas Vesalius' association with the bottega of Titian to produce the drawings of Vesalius' De humani corporis fabrica (1543), and Christopher Wren's illustrations for Thomas Willis' Cerebri Anatome (1664). These works appeared during the Renaissance and Age of Enlightenment, when advances in brain imaging, or really brain rendering, reflected not only the abilities and dedications of the artists, but also the influences of important cultural and scientific factors. Anatomy and human dissection became popular social phenomena as well as scholarly pursuits, linked with the world of the fine arts. The working philosophy of these artists involved active participation in both anatomical study and illustration, and the belief that their discoveries of the natural world could best be communicated by rendering them in objective form (that is, with realistic perspective). From their studies emerged the beginning of contemporary brain imaging. In this article, the authors examine how the brain began to be imaged in realism within a cultural and scientific milieu that witnessed the emergence of anatomical dissection, the geometry of linear perspective, and the closer confluence of art and science.

De Humani Corporis Fabrica surgical revolution.

De Humani Corporis Fabrica (1543), by the Belgian anatomy master Andreas Vesalius (1514-1564), represents one of the most advanced surgical revolutions in history. The creation of an anatomy book that carefully and systematically introduced the structure of the human body in a way that was truthful to the findings of human dissection had never been accomplished before. No one challenged Galen's teachings as Vesalius did. De Humani Corporis Fabrica offered to the surgeon's world new knowledge and a systematic approach to human anatomy. The novel concepts and perspectives introduced by Vesalius constituted a real surgical revolution worthy of study in the annals of surgery.

Neuroanatomy and cadaver dissection in Italy: History, medicolegal issues, and neurosurgical perspectives.

Despite the significant Italian tradition of important anatomical studies, an outdated law historically influenced by the Catholic church restricts the use of cadavers for teaching and scientific purposes. The object of the present paper was to trace the historical evolution of the Italian anatomical tradition, particularly neuroanatomical studies, in relation to the juridical regulations on the use of cadavers today. Special attention was paid to the opportunities offered to neurosurgery by using cadavers and to the scientific and social issues in neurosurgical training in the twenty-first century. Considering the new Common European Constitution, the authors advocate a political solution from the European community to improve the quality of training in the disciplines with a social impact such as neurosurgery.

Tactility and the body in early Chinese medicine.

If visual inspection of corpses was central to the development of anatomy in modern Europe, one may ask which of the senses was important for the emergence of the predominant currents of scholarly medical knowledge and practice in third- and second-century B.C.E. China? This article argues that it was tactile perception prompted by a tactile exploration of living bodies. The evidence, derived from a close reading of the Mawangdui medical manuscripts, the 105th chapter of the Records of the Historian, and selected passages from the Huang Di's Inner Canon, points to three important trends: first, the tactile exploration of the extremities led to a rich vocabulary of compound words for pain as localized in specific body parts; second, the tactile exploration of the mai gave rise to an even richer vocabulary on qualities of touch in pulse diagnostics; and third, the tactile exploration of the abdomen led to the assessment of the quality of the internal viscera with words that generally were used for describing the tactile quality of skin and flesh. This finding may appear surprising in the light of later developments during the dynastic history of Chinese medicine where tactile exploration of abdomen and extremities would appear unseemly. The author suggests that extensive tactile explorations of the body were possible before Confucius' teachings became a predominant aspect of state ideology.

Galen and his anatomic eponym: vein of Galen.

Galen or Galenus was born at Pergamum (now Bergama in Turkey) in 129 A.D., and died in the year 200 A.D. He was a 2nd century Greek philosopher-physician who switched to the medical profession after his father dreamt of this calling for his son. Galen's training and experiences brought him to Alexandria and Rome and he rose quickly to fame with public demonstrations of anatomical and surgical skills. He became physician to emperor Marcus Aurelius and the emperor's ambitious son, Commodus. He wrote prodigiously and was able to preserve his medical research in 22 volumes of printed text, representing half of all Greek medical literature that is available to us today. The structures, the great cerebral vein and the communicating branch of the internal laryngeal nerve, bear his eponym.

Chemical dissection and the ethics of preclinical science.

It is my contention in this paper that the bioethical landscape is closely linked to the model of health and disease with which we work, as scientists or as medical practitioners. The Human Genome Project is the logical extension of the dissection process, which has constituted the history of medical science. It is already revealing an ethical minefield which may result in harming the very people we need to serve. Adoption of more holistic models of health and disease would counter the reductionist drift into eugenics, and would place the practice of medical science more humbly within a wider context, as the servant of the patient, rather than as the sole arbiter of health and social aceptability.