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ScienceWeek
2004 11 June B6 HISTORY OF MEDICINE: ON THE PUBLIC CADAVER
The following points are made by H-W. Korf and H. Wicht (Nature 2004 428:805):
1) Knowledge of anatomy underpins contemporary medicine, and is indispensable for understanding the structural and biological nature of humans. Dissection is used to analyse the body, and provide insights into its structure, function, and dysfunction. Anatomists have to communicate their results to medical doctors and students -- and to all those who are interested in their own body.
2) Anatomists have always had to walk the thin line between scientific objectivity and public spectacle. The first recorded dissections of human bodies, performed by Herophilus around 300 BC, were public, as were the few dissections carried out during the Middle Ages. In the seventeenth and eighteenth centuries, anatomical theaters were founded in many European cities. The dissections held in these theaters served partly to educate medical practitioners and students, but were also public spectacles of little educational value. In the nineteenth century, the rising numbers of students, the increasing amount of data, the intricacy and delicacy of the preparations, and finally, the use of microscopy requiring sophisticated histological equipment, forced anatomy to retreat into the well-equipped laboratories, dissection halls, and lecture theaters of universities.
3) Modern anatomy consists not only of macroscopic examination of the body, but also views cells and molecules as essential players in any physiological or pathological process. It is no longer restricted to the static and descriptive levels, but has evolved into "living anatomy". Our anatomical knowledge has expanded tremendously, and today covers not only the spatial dimension of a dead body or cell, but also the temporal and dynamic dimensions underlying all living processes. For example, anatomical investigations of the circadian, rhythm-generating systems have located the internal clock in the hypothalamic suprachiasmatic nuclei, identified the neuronal pathway that serves the entrainment of the endogenous rhythm with the day-night rhythm, discovered photoreceptors in the retina responsible for this entrainment, and reached down to the level of the rhythmically expressed genes that make the clock tick. As a welcome side effect, anatomy remains one of the few medical disciplines that deals with the humans holistically.
4) Anatomy has come a long way from the "show and tell" anatomy that could be taught to a paying audience in an anatomical theater within a few hours. Today, anatomy still requires the dissection of a human body and the display and naming of all its visible parts. But this macroscopic view is only the first part of the anatomical curriculum which embraces a "vertical" holistic approach -- from the macroscopical level (including self-examinations and demonstrations on living subjects) to the molecular (laboratory courses in molecular biology), from the spatial dimension (topographic anatomy) to the temporal (embryology, gerontology and evolutionary anatomy). This conceptual integration is central to the understanding and teaching of modern anatomy.
References:
1. Haeser, H. Lehrbuch der Geschichte der Medizin Vol. 1. (Friedrich Mauke, Jena, 1853)
2. Korf, H.-W. & Stehle, J. H. (eds.) Cell Tissue Res. 309, 1-199 (2002)
3. Stukenbrock, K. "Der zerstckte Crper". Zur Sozialgeschichte der anatomischen Sektionen in der frhen Neuzeit (1650-1800) (Steiner, Stuttgart, 2001)
4. Yamaguchi, S. et al. Nature 409, 684 (2001)
Nature http://www.nature.com/nature
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HISTORY OF MEDICINE: CADAVERS AND MEDICAL EDUCATION
The following points are made by Neela Dasgupta (J. Am. Med. Assoc. 2004 291:122):
1) Although no studies have conclusively demonstrated that anatomical dissection is necessary to future clinical abilities, use of cadavers to teach anatomy has long been deemed essential to medical education. In an 1824 Lancet editorial described by Shultz,(1) Thomas Wakely wrote, "If dead bodies can not be procured, it will be impossible for the pupils to learn anatomy, and without anatomy, neither surgeons nor physicians can practice with the least prospect of benefiting their patients."
2) Procuring cadavers from willing donors has never been easy, however; accounts of early medical instruction dwell on the prisons, grave robberies, and pauper murders that often supplied early American anatomy labs. Two hundred years later, with regulations forbidding the sale of human bodies and programs encouraging people to donate their bodies to medical science, anatomy departments receive little criticism. However, unclaimed bodies are still the source of cadavers in anatomy laboratories at about 20% of US and Canadian medical schools.(2)
3) Historically, the desire for dissection-based learning was so strong that medical institutions often supported acts of grave robbery, and some physicians passively condoned murder for medicine. In 1829, two Irishmen, William Burke and William Hare, committed 16 murders and delivered the victims' corpses to Dr Robert Knox for payment.(3) Similarly disturbing stories of grave robbing and murder in the name of anatomy were reported in US cities, including Baltimore, Cincinnati, and Philadelphia. Even today, medical schools in some countries benefit from questionable methods of cadaver acquisition. In Barranquilla, Columbia, in 1992, janitor Oscar Rafael Hernandez survived an attempt by local guards to murder him in order to sell his body to the local medical school's anatomy laboratory.(4) As stories of grave robbing circulated in the 1800s, US states responded with specific anatomy acts to prohibit the use of bodies thus acquired.(1) However, medical schools soon faced cadaver shortages, leading some states to introduce new acts specifically permitting the use of unclaimed bodies for medical school dissection.(1)
4) With the passage of Uniform Anatomical Gift Acts in the 20th century, voluntary donations became a substantial resource for anatomy departments.(5) These acts permit individuals to bequeath their bodies to the state for the purpose of medical education and research. Some programs moved to entirely donor-based body acquisition while others continued to supply anatomy labs with unclaimed bodies. Geographic, demographic, and socioeconomic factors contributed to each state's decision regarding the use of unclaimed bodies.(5) States relying entirely on voluntary donors have faced cadaver shortages in the past several years.
References (abridged):
1. Shultz S. Body Snatching: The Robbing of Graves for the Education of Physicians. Jefferson, NC: McFarland & Co Inc; 1992:78-82
2. Liles KL, Ross LM. Donor program survey. Paper presented at: American Association of Clinical Anatomists Conference; June 10, 1998; Lexington, Ky
3. Guttmatcher A. Bootlegging Bodies: A History of Body-Snatching. Fort Wayne, Ind: Public Library of Fort Wayne and Allen County; 1955
4. Roach M. Stiff: The Curious Lives of Human Cadavers. New York, NY: WW Norton & Co; 2003:50
5. Coelho D, Caplan A. The unclaimed cadaver. Acad Med. 1997;72:741-743
J. Am. Med. Assoc. http://www.jama.com
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