Medicina Historica 2019; Vol. 3, N. 2: 69-77 © Mattioli 1885 Original article: history of medicine The teaching of anatomy throughout the centuries: from Herophilus to plastination and beyond Veronica Papa1, 2, Elena Varotto2, 3, Mauro Vaccarezza4, Roberta Ballestriero5, 6, Domenico Tafuri1, Francesco M. Galassi2, 7 1 Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Napoli, Italy; 2 FAPAB Research Center, Avola (SR), Italy; 3 Department of Humanities (DISUM), University of Catania, Catania, Italy; 4 School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA, Australia; 5 University of the Arts, Central Saint Martins, London, UK; 6 The Gordon Museum of Pathology, Kings College London, London, UK;7 Archaeology, College of Hu- manities, Arts and Social Sciences, Flinders University, Adelaide, Australia Abstract. Cultural changes, scientific progress, and new trends in medical education have modified the role of dissection in the teaching of anatomy in today’s medical schools. Dissection is indispensable for a correct and complete knowledge of human anatomy, which can ensure safe as well as efficient clinical practice and the hu- man dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians. In this manuscript, we discuss the role of dissection itself, the value of which has been under debate for the last 30 years; furthermore, we attempt to focus on the way in which anatomy knowledge was delivered throughout the centuries, from the ancient times, through the Middles Ages to the present. Finally, we document the rise of plastination as a new trend in anatomy education both in medical and non-medical practice. Key words: anatomy, dissection, medical education, wax modelling, body donation, plastination 1. Introduction plete a medical examination, to make a diagnosis and also to properly communicate with colleagues. To date Dissection is indispensable for a correct and com- worldwide curricula reforms, which have resulted in a prehensive knowledge of human anatomy which can reduction both in the gross anatomy teaching hours ensure both safe and efficient clinical practice and the and its context, lead to a serious re-examination of the human dissection lab could possibly be the ideal place way in which anatomy is taught (3, 4). to cultivate humanistic qualities among future physi- cians in the 21st century (1, 2). Nevertheless, cultural 1.1 Human dissection from the Ancient times to the changes, scientific progress, and new trends in medi- Middle Ages cal education have modified the role of dissection in teaching anatomy in today’s medical schools. Towards Human cadaveric dissection has been the primary the end of 20th century dissection was the core basis way of teaching gross anatomy to medical students for in medical education. Even today defining the exact centuries. Before any “scientific” autopsies and formal anatomical site of a lesion is crucial for a physician to teaching in ancient times were established, an early at- resolve a problem effectively and safely. Therefore, ad- tempt to explore the inner structure of the human body equate anatomical knowledge is essential for surgeons was made by pre-historic people. This often coincided and anyone performing an invasive procedure on a pa- with invasive interventions such as the cranial trepana- tient. Anatomical knowledge is also pivotal to com- tions still visible on skulls from the Palaeolithic. Those 70 V. Papa, E. Varotto, M. Vaccarezza, et al. traces have sometimes been interpreted as surgical tool for teaching anatomy at the University of Bologna operations, following traumatic or pathological events (16,17). as would be suggested by the evidence of new bone Recently, the idea that the Middle Ages were a formation at the margins of the excised area, although time of obscurantism and decadence has been revised: purely religious or medico-magical rituals have also the middle-to-late Middle Ages indeed were marked been proposed as a valuable explanation (5, 6). by many scientific accomplishments. Moreover, the According to Porter (7), the ancient Egyptians late 11th and 12th centuries saw the establishment of a were the first people to recognize medicine as a craft; number of universities across Europe, for example in moreover, dissection was more a ritual needed to evis- Bologna (1088), Paris (1150), Oxford (1167), Mont- cerate the bodies in the final step of the embalming pellier (1181) and Padua (1222) (15, 18); from the 12th process, than a scientific procedure being required as a century onwards, the Church did not forbid human rite of passage to the kingdom of the dead (1, 8): the dissection in general even if certain restrictions re- mummification practices, which required the removal mained: in 1163 a bull by Pope Alexander III (c. 1105- of internal organs, most notably lungs, livers, intestines 1181) stated the prohibition of clerics being involved and stomach, destined to canopic jars (9, 10), failed to in the studies of physical nature; in 1231, Frederick II provide the ancient Egyptians with an exact anatomi- (1194-1250), Emperor of the Holy Roman Empire, cal knowledge. As a matter of fact, the embalming pro- decreed that medical schools were allowed to dissect at cess only required a small incision (e.g. a left oblique least one human body each five years (19) for anatomi- inguinal one) to remove the viscera and the priests who cal studies and attendance was made mandatory for carried out the process were not primarily interested in everyone who practiced medicine or surgery (20-22). studying the extracted organs (5). Only in 1292 did a bull by Pope Nicolas II permitted The introduction of systematic human cadaveric all doctors having graduated from Bologna to teach at dissection represented a milestone in the history of any University in the world (23). medicine: in the 5th century BC, the development of One step forward and one step back, when Pope Greek medicine culminated with Hippocrates (c. 460- Boniface VIII (c. 1235-1303) issued a Papal bull en- c. 375), who founded a medical school in Kos (Do- titled “De sepolturis” declaring that anybody “cutting decanese); Herophilus (c. 335-c.280 BC), a disciple up bodies of the dead and boiling them in order to of Praxagoras of Kos (born 340 BC), later became a separate the bones” would be excommunicated (15), well-respected anatomist of the so-called Alexandria therefore the post-mortem manipulation of corpses School during the 3rd century BC (11-13) and together and their reduction to bones might have been partly with his colleague Erasistratus of Ceos (fl. c. 250 BC), limited. The bull has often been misinterpreted: it was became the first Greek physicians to perform system- indeed intended to stop the dismemberment of the atic dissections of human cadavers in the first half of cadavers and prohibit the bones trading from soldiers 3rd century BC (11), elevating cadaveric dissection to a killed during the Crusades. It was not meant to pre- fundamental tool for learning anatomy. However, after vent human dissection and in the end the bull did not the deaths of Herophilus and Erasistratus, human dis- have any significant impact on the anatomical activi- section first decayed in Alexandria and subsequently ties in Italy (24). across the Hellenistic world (13). The first public dissection was made in 1315 by After the glorious Alexandrian season, the fall of Mondino de’ Liuzzi (1275-1326) the ‘‘Restorer of Anat- the Western Roman Empire and the beginning of the omy’’ (17), who is considered the first to have followed Middle Ages, limited advances were made in the study in the foosteps of after Herophilus and Erasistratus. of human anatomy (14); physicians could therefore The dissected cadaver belonged to an executed only follow the works of the eminent figures from past criminal, most likely a woman and was observed by such as Aristotle or Galen, without seriously question- medical students and the public with the purpose of ing their scientific validity (15). It was only in the early showing the exact position of the anatomical elements 14th century that human dissection was revitalized as a described by Galen. According to the custom of the The teaching of anatomy throughout the centuries 71 time, Mondino did not perform the dissection him- and death. These theatres were everything—a place self: a professor, because of his distinguished status, he to understand human anatomy, a place to witness the would sit on a large, elevated chair, above the dissec- celebration of life through the analysis of death, and a tion table, and would read aloud from Galen’s works place to be captivated by science. commenting on it to the audience, while a demonstra- Anatomists began to dissect bodies in order to tor attempted to isolate or point the body parts accord- investigate their inner structure and produced texts ing to the professor’s instructions (2, 15, 25). illustrated with images based on their own “autoptic” When a cadaver was made available, time became dissections (1, 33, 34). a capital issue, since there were no means to preserve it. In the 16th century, Andreas Vesalius (1514-1564), This is why the abdominal cavity, which contained or- a student from Brussels who frequently attended hu- gans that putrefied most easily, was dissected first, fol- man dissections, decided to investigate the accuracy of lowed by thorax, head, and extremities. To prevent pu- the Galenic concepts and made records of his findings trefaction dissections were scheduled in winter when (35). In 1537 a day after obtaining his doctoral degree, the weather conditions were more suitable to preserve he became professor of anatomy and surgery and six the organs at best (26-30). years later, at the age of 27 years, he finished his mas- Mondino’s book Anothomia was completed around terpiece, De Humani corporis Fabrica (36).