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Dissection As a Teaching Tool: Past, Present, and Future

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Dissection As a Teaching Tool: Past, Present, and Future THE ANATOMICAL RECORD (PART B: NEW ANAT.) 285B:11–15, 2005 EDUCATION NOTE Dissection as a Teaching Tool: Past, Present, and Future RODRIGO E. ELIZONDO-OMAN˜ A,* SANTOS GUZMA´ N-LO´ PEZ, AND MARI´A DE LOS ANGELES GARCI´A-RODRI´GUEZ Cultural changes, scientific progress, and new trends in medical education have modified the role of dissection in teaching anatomy in today’s medical schools. We discuss in this article the role of dissection itself, the value of which has been under debate for the last 30 years. The importance of dissection is considered from different points of view: educational, bioethical, and human values. Included are different opinions from professors and students. Finally, the current practice of dissection is described for some universities in the United States and Europe, showing its use as a learning tool. Anat Rec (Part B: New Anat) 285B:11–15, 2005. © 2005 Wiley-Liss, Inc. KEY WORDS: dissection; anatomy education; cadaver INTRODUCTION nally, the discussion considers the re- bloomed in Alexandria and was later lationship of dissection to other teach- introduced to Rome. The Greek phy- Cultural changes, scientific progress, ing resources that could determine an sician Galen traveled to Rome, where and new directions in medical educa- important change in the history of he had been summoned by emperor tion have modified the role of dissec- anatomy teaching. tion in teaching anatomy in today’s Marcus Aurelius, and became the medical schools. In order to under- most prestigious and successful phy- sician in the city. Galen practiced dis- stand the present situation, it is nec- THE PAST AS A WAY TO section on animals (principally Barbe- essary to mention some important UNDERSTAND THE PRESENT facts that have changed the way in ria monkeys) and wrote Treaty of which anatomy is taught and also to In ancient Greece, logic emerged as a Anatomy. Despite multiple mistakes analyze the role of the dissection in deductive method in the study of sci- in its descriptions, especially those re- this process. The main purpose of this ence in general. For many centuries, ferring to the anatomy of organs, his article is to show a general view of physicians of ancient Greece gained work was transmitted and taught for dissection as a teaching aid through- much information about the human more than 14 centuries until the Mid- out history, from its beginning until body and health. In the 5th century BC, dle Ages. now and highlighting some works that the development of Greek medicine In Europe during the Middle Ages, have been decisive in its evolution. Fi- culminated with Hippocrates, who the study of medicine developed founded a medical school on the is- around the transmission and interpre- land of Cos. Praxagoras, another fa- tation of the work of Galen and it was Dr. Elizondo-Oman˜ a is the coordinator mous physician from Cos, had taught mainly in monasteries. During of scholarship recipients for the Depart- ment of Human Anatomy, School of Herophilus as a disciple, who later be- this period, all that related to “mate- Medicine, Universidad Autonoma de came a well-respected anatomist in rial” things was considered to be of Nuevo Leo´ n, Monterrey, Mexico. E-mail: the school of Alexandria. Herophilus little importance. Because material [email protected] Dr. Guzma´ n-Lo´ pez is the head of the is known as the father of scientific things are temporary, the human Department of Human Anatomy at the anatomy. In the school of Alexandria, body was not studied. Anatomical dis- same university. the practice of anatomic dissection section was considered to be blasphe- Ms. Garcı´a-Rodrı´guez is a scholarship recipient of the department. was the dominant means of learning mous and so was prohibited (Gregory *Correspondence to: Dr. Rodrigo E. anatomy and it was considered the and Cole, 2002). At that time, anat- Elizondo-Oman˜ a, Ave. Francisco I. Madero y Dr. Aguirre Pequen˜ o. Col. first place where dissection was done omy was taught by professors who re- Mitras Centro, Monterrey, Nuevo Leo´n, in a regular and systematic way. At cited Galen’s texts (Dyer and Mexico. Fax: (81) 83477790; E-mail: that time, some empiricist physicians Thorndike, 2000); however, during [email protected] like Filinos from Cos (Herophilus’ dis- the 14th and 15th centuries AD, some DOI 10.1002/ar.b.20070 ciple) considered that dissection had professors in French and Italian uni- Published online in Wiley InterScience (www.interscience.wiley.com). no practical utility. versities began to use cadavers as Greek medicine after Hippocrates teaching tools in their classes (Greg- © 2005 Wiley-Liss, Inc. 12 THE ANATOMICAL RECORD (PART B: NEW ANAT.) EDUCATION NOTE ory and Cole, 2002). One of them was innovation as far as medical educa- was passed in New York in 1789 that Mondino dei Luzzi (1275–1326), who tion was concerned. Anatomy was prohibited the robbing of tombs and reintroduced the practice of the Alex- taught inadequately and the majority established that only the cadavers of andrian School, emphasizing the im- of professors faithfully followed clas- criminals could be dissected. portance of dissection by performing sical methods. In the 18th century, al- Simultaneously, in the city of Edin- a series of public dissections in the though it was felt that the tyranny of burgh, Scotland, occurred the case of early part of the 14th century. He sys- medieval dogmatism had been over- William Burke and William Hare. The temized dissection and in 1315 pub- come, the conservative nature of phy- latter was the owner of a boarding lished a manual called Anathomia (De sicians impeded medicine from evolv- house where a customer died, leaving anatome), which, due to the clarity of ing at the same speed as other a debt of 4 pounds. A local laboratory its text, became the textbook of choice scientific areas. During this period, offered 7 pounds for the body of the in nearly all European medical ancient medical schools in northern subject, and Burke and Hare accepted schools for the next 3 centuries. Italy lost their hegemony, and others the offer. After this, these men con- During the Renaissance, Galen’s er- located in Vienna and Edinburg grew spired to intoxicate guests with alco- rors were exposed. This occurred in importance. The study of anatomy hol, murder them by asphyxiation, when Andreas Vesalius, a professor at progressed in an orderly fashion dur- and then sell the bodies. Burke and the University of Padua, published his ing this period, and there was greater Hare were found guilty in 1829 of the masterpiece De humani corporis fab- interest in new subject areas such as murder of 16 persons. Burke was rica (1543). The impact of this publi- comparative anatomy and embryol- hung, dissected, and exhibited (Tward cation was that it produced one of the ogy (Lyons and Petrucelli, 2001). and Patterson, 2002). most important changes in science in The fundamental characteristic of In 1825, in order to end the robbery general: dogmatic teaching from an- medicine in the 19th century was the of tombs, Harvard University and the cient books was transformed into attempt to correlate discoveries in the Medical Society of Massachusetts be- learning by direct observation, setting laboratory and the autopsy room with gan a movement to legalize dissection the foundation for the present scien- observations made at the patient’s in medical schools and in 1831 the tific method (Aziz et al., 2002). In that bedside. The first medical school in Massachusetts Anatomical Act was context, cadavers were considered to America was founded in 1765 at the passed, which established that un- be like “books” from which students College of Philadelphia. In 1767 and claimed bodies could be used for an- learned by observation. By the end of 1782, other schools of medicine were atomical dissection (Dyer and the 15th century, renewed interest in founded in New York and Boston, re- Thorndike, 2000). A similar law was dissection led to closer inspection of spectively. The curriculum of the Col- established in the United Kingdom in skeletons. Jacobo Berengario da Carpi lege of Philadelphia included a vigor- 1832. Thus, most of the cadavers used proposed possible names for skeletal ous anatomy course with dissection for dissection at the beginning of the parts. He also seemed to have been the laboratory. During this period, the in- 20th century were exclusively those of first anatomist to approach systemat- troduction of anesthesia, sterile tech- unclaimed bodies. This was the most ically the tissues of which the body is niques, and the development of sur- common way of obtaining cadavers in composed by describing the proper- gery all contributed notably to the the United States until 1968, when a ties of fat, membrane, nerve, liga- change from descriptive anatomy to Uniform Anatomy Gift Act was ment, tendon, and muscle. Another practical anatomy. adopted, in which the right of dona- important anatomist was Alessandro At the beginning of the 19th cen- tion was recognized based on free Achillini, who wrote Carports humani tury, there was an increase in the de- choice and volunteerism. The act was anatomia and Anatomicae annotatio- mand for cadavers in the United modified in 1987, making the process nes, in which he was the first to de- States but not enough bodies to meet of donation clear, and the donor’s in- scribe the malleus and to demonstrate the demand. This was largely because tent was recognized as irrevocable that there are seven tarsal bones. in some states, the only cadavers that (Jones, 1994). At present, the great Later, as the Renaissance evolved, em- were legally available were those of majority of cadavers are obtained by phasis was once more placed on the executed criminals.
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