The Teaching of the Anatomical Sciences Eur. J. Anat. 18 (3): 219-244 (2014) REVIEW The History of the Teaching of Gross Anatomy - How we got to where we are! Bernard J. Moxham* ,1 and Odile Plaisant 2 1Cardiff School of Biosciences, Cardiff University, Museum Avenue, Cardiff, Wales, U.K. and St George’s University, Grenada, West Indies 2Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médicine, URDIA EA4465, Paris, France SUMMARY model and not towards the functionality (health) - based model. Overall, we conclude that the main Evidence primarily from historical considera- focus of attention historically has been the rôle of tions is gathered to compare a variety of approach- dissection. Where in the past religious authorities es to the teaching and learning of gross were foremost in condemning dissection now it is (topographical) human anatomy. The historical academic and postmodernist strictures that deni- approach adopted is not just a chronological ap- grate historical perspectives. proach to the development of pedagogy but is con- ceptually based to underline the changing culture CONTENTS of medicine and the ways in which normal and ab- normal structure and function have been consid- INTRODUCTION ered. Although there is often claimed to be an un- breachable divide between ‘traditionalists’ and ANATOMICAL EDUCATION PRE-RENAISSANCE ‘modernists’ amongst teachers of gross anatomy, (UNTIL c. 1450) and although the method of teaching gross anato- The earliest anatomists my by means of dissection by the students is fre- The eras of Galen and Avicenna quently referred to as the ‘traditional’ method, his- The European Era before the Renaissance torically this method only came into its heyday rel- ANATOMICAL EDUCATION POST- atively recently when legislation permitted a suffi- RENAISSANCE ciency of bodies to dissect and with the advent of The era of Vesalius experiential learning and the development of the The era of William Harvey idea of students achieving competency skills. Par- The development of the medical school adoxically, the so-called ‘modern’ way (e.g. prob- Anatomical museums lem-based learning, computer-based learning) that Anatomical terminologies Art and anatomy and anatomical texts relies more on library/book work and computer simulations harks back to the pre-Renaissance FINAL THOUGHTS AND CONCLUSIONS scholastic approach. Our findings suggest that, as anatomy teaching has moved away from dissec- tion by students, the culture of medicine has be- INTRODUCTION come more inclined towards the disease-based There is a joke that imagines two men driving * Corresponding author: Prof. Bernard J. Moxham. Cardiff their car aimlessly in the countryside. They are lost. Seeing a local farmer, they stop the car and School of Biosciences, Cardiff University, Museum Avenue, Cardiff CF10 3AX, Wales, UK. Tel: +44 (0)29 20874031 ; Fax: +44 (0)29 20875964. E-mail: [email protected] Submitted: 28 May, 2014. Accepted: 25 June, 2014. 219 History of Anatomy Teaching Fig. 1 (Left). William Hogarth: The Reward of Cruelty ; plate 4 from the suite The Four Stages of Cruelty (1751 CE). Tom Nero, the fictional hero portrayed in Hogarth’s suite of prints, is hung for murder and, as here depicted, he is being anatomized with the noose still around his neck and a dog licking his heart. The prints were intended to be a form of moral instruction, although it was only 1 year after he produced the print that the Murder Act of 1752 in Britain legally permitted public dissection of criminals. The image is clearly a pastiche of the frontispiece of Vesalius’ Fabrica but here the students seem uninterested by the results of the dissection! (Public domain artwork). Fig. 2 (Right). Thomas Rowlandson: The Resurrection Men (1775 CE). A vivid portrayal of the evil trade of body snatching (Burking). (Public domain artwork). ask for directions to London. The farmer replies: Furthermore, since medicine has had a longer “Well, sirs, if I were you I wouldn’t be starting from provenance, with other healthcare professions here!” So, in terms of the teaching of anatomy, (such as dentistry) appearing much later as sepa- where is ‘here’ and how did we get ‘here’? Where rate professions, inevitably much of our focus is on we are in the first decades of the 21st century is anatomy in a medical context. the easy question to answer. For the education of It appears to us that anatomy has had both a healthcare professionals, including anatomical ed- glorious and an inglorious history. Glorious be- ucation, we are in a phase of experimentation. A cause it laid the foundations for all the biomedical variety of educational ideologies abounds and sciences, because it established the scientific and what once was a global acceptance of the im- linguistic basis for medicine and other healthcare portance of anatomy, namely through dissection disciplines, and because it allowed the culture of and a firm grounding in the biomedical sciences at medicine to shift from an overemphasis on disease the start of a healthcare course, no longer applies1. and abnormalities to health and normality. Above How we got ‘here’ is the purpose of this article. In all, its history is glorious because it was an essen- essence, we describe events in an historical con- tial feature of the Renaissance that allowed aca- text and show that the evolutionary path taken until demia to abandon the scholastic approaches reli- the latter part of the 20th century has now given ant on the study of long-established texts and ide- way to a more revolutionary phase. We do not see as so that scientists moved towards observation, it as our business to spend much time asking why experiment and the questioning of prevailing dog- this has happened. That is a question for the read- ma 3. Inglorious because of the way in which anato- er to answer. my historically was used as a punishment for crimi- To pose a further question: what is anatomy? nals (Figure 1), because of the stigma that some The name is derived from both the Greek societies placed upon the invasive nature of the (anatemnein ) and the Latin ( anatomia ), meaning to discipline and its procedures, because of the im- cut up (dissect) parts. In today’s terms, for all moral ways by which bodies were often obtained healthcare studies, anatomy is concerned with the for anatomical examination (e.g. by Resurrection- structure (morphology) of the human body. For the ists) 4 (Figure 2), and because of what was thought purposes of this article, we will give an account of to be a gory anatomical spectacle 5. Most particu- the historical development of the teaching and larly, for the perception amongst many in the learning of only gross (or topographical) anatomy 2. healthcare professions that it is an ‘old-fashioned’ 220 B.J. Moxham and O. Plaisant discipline where everything that needs to be and should be objectively and dispassionately known is known and where it is claimed that its evaluated has disappeared because of political practitioners tenaciously hold on to outmoded edu- necessities (or niceties) or because of a postmod- cational principles 6. We will explore these notions ernist narrative approach that sees equal validity mainly by an historical approach that is partly for any analytical approach and/or takes an overtly chronologically based and partly conceptually social constructivist view. In our opinion, the result based. We will therefore follow the development of is the establishment of educational ideologies that pedagogic philosophies, evaluate the reality be- seem to care little for subject concerns, for student hind the view that there are ‘traditionalist’ and learning, or even patient welfare. The history of ‘modernist’ approaches, and assess the relation- anatomical education exemplifies such processes ship between anatomical research and teaching. and gives concern about the learnèdness, abilities, At this point it is necessary to momentarily di- professionalism, and even safety, of present day gress by considering whether history is, in Henry recipients of medical/healthcare training 11 . As Ford’s terms, bunk! This belief implies that history learning and challenge have been removed, so should be ignored, that novelty is all, and that no has professional competency and, perhaps more lessons are to be learned from the past. One might damaging, the potential respect of the public and also infer that historicism (a progressive direction of society towards the healthcare professions 12 . It for history as espoused by, for example, Hegel and is our belief that anatomy has been at the forefront Marx) is invalid 7. Whatever one’s view, it is clearly in dealing with these changes, this should not sur- the case that medicine and other healthcare pro- prise scholars of history… it was ever thus. fessions have moved from the occupation of, and for, the privileged few to that of, and for, the many ANATOMICAL EDUCATION PRE- and to a point where nowadays the ‘mass’ higher RENAISSANCE (UNTIL CIRCA 1450) 13 education systems present in many countries have had a significant effect on clinical and anatomical The earliest anatomists education 8. This is an issue that needs to be borne ‘The Dark Ages’ and ‘Lost in the mists of time’ in mind as we recount the history of anatomical are expressions often used to describe our poor education. understanding of history prior to the Renaissance. 14 So what are our hypotheses or, more meaning- Not all was ‘dark’ however . We have some ap- fully for the approach we have adopted, from preciation of the history of anatomy, particularly in whence do we, the authors, come? Where are our relation to the growth of anatomical knowledge, but initial biases and prejudices? In answer, we defy we have scant knowledge concerning the early the notion that education shows no progress, there history of the teaching and learning of anatomy.