Thorax: first published as 10.1136/thx.33.2.153 on 1 April 1978. Downloaded from Thorax, 1978, 33, 153-166 The thorax in history 2. Hellenistic experiment and human dissection R.K. FRENCH From the Wellcome Unit for the History of Medicine, University of Cambridge The first anatomical revolution occurred in Alex- the dead body was essential to the ancient practice andria in the third century before Christ. To that of embalming, an Egyptian technique well known period we can trace the continuous historical line to the Greeks. The Greek philosophers, Plato and of our own ideas on the structure and function of Aristotle, emphasised the distinction between soul the body, important among which are those on the and body:' it was the immaterial soul that sur- thorax. For the first time, the human body was vived the death of the corporeal body, and the systematically explored in an attempt to under- soul, sharing no characteristics with the body, stand its structure, and, with some notable errors could not be affected by the postmortem mutila- from animal anatomy, the only source for 'human' tion of the body; there was no quasi-material after- anatomy in the preceding period, these anatomical life in human form, as so many cultures believed. ideas are recognisably similar to those of to-day. In a word, the old religious taboos no longer The physiological ideas of the Alexandrians, on applied. the other hand, are strikingly different from ours, Of fundamental importance in the development and their subsequent transformation will be exam- of human dissection in Alexandria was the exist- http://thorax.bmj.com/ ined in later articles. ence of a medical school (or schools). Even in the absence of specific cultural taboos, the dissection Human dissection of the body of a person recently dead naturally excites a feeling of revulsion; only in a medical The most important single reason behind this first school, where anatomy is considered a basic medi- anatomical revolution was the introduction of cal science and becomes an established discipline, systematic dissection of the human body. It was is there sufficient mutual support within a group suggested at the beginning of the first article in to preserve an unpleasant practice, a sort of pro- on September 27, 2021 by guest. Protected copyright. this series (Thorax, 33, 10-18, 1978) that human fessional rejection of the normal taboos. Human dissection has been historically very rare and that dissection was a teaching device as well as a re- there were normally a number of taboos operating search tool. against it. We must briefly consider then why it Also associated with the development of medical was that the human body could be dissected in schools were medical and anatomical texts. Galen2 Alexandria. tells us that the ancient method of teaching Alexandria was the city of Alexander the Great anatomy-he was thinking of the Hippocratic and shared fully in the cultural and commercial period-was oral, when the father (or master) exchanges of political empire. A cosmopolitan taught his sons (or apprentices) within the family population, the mixture of Hellenistic and group over a period long enough for the assimila- Egyptian culture, and the patronage of the arts tion of the great detail. Only when this system and sciences by the Ptolemies all contributed to a began to break down and adult men were admitted cultural ferment. The changes that made Alex- into the circle to learn anatomy in a shorter period andria the centre of Hellenistic culture after the was it necessary to write down the anatomy. death of Alexander meant that no single system of Perhaps this increasing formalisation of teaching philosophy or belief held a dominant position, was becoming evident by Aristotle's time, for the nor were its taboos universally accepted. first textbook of anatomy is said to have been Apart from such general considerations, there written by Diocles of Carystos, a contemporary of are a number of particular reasons why human Aristotle.3 Many of the anatomical texts up to dissection should have flourished. The opening of the time of Galen (second century AD) were 153 Thorax: first published as 10.1136/thx.33.2.153 on 1 April 1978. Downloaded from 154 R. K. French school textbooks, or at least the texts of pro- acquiring anatomical knowledge-dissection-was fessional anatomy teachers. A written tradition, disgusting and unnatural. It was, moreover, mis- of course, is open to detailed and precise modifica- leading, since the organs of the body changed in tion, and Galen's own treatment of the work of death. It was undoubtedly to see the organs of the his predecessors is the beginning of textual and living body that the Rationalists employed vivi- anatomical scholarship, upon which later develop- section, a technique that the Empiricists con- ments depended. sidered inadmissible on the grounds of cruelty. A natural result of teaching within a school, as The Empiricists argued that the only form of ana- opposed to a father-son line of oral instruction, is, tomical knowledge necessary and proper to a physi- in addition to texts, a comparatively large number cian was that gleaned 'accidentally' from wounds. of students with similar ideas. Future teachers, chosen from the students, would perpetuate these The influence of Aristotle ideas alongside the texts, so that the physical school becomes also a 'school of thought'. The question of the extent of Aristotle's influence Aristotle's Lyceum became a school of peripatetic on the Alexandrian experimenters is not agreed philosophy, opposed to others, like the atomist or among historians, but a brief discussion of the stoic. In the same way the medical schools de- topic will serve to highlight some important issues veloped traditional ideas: from theoretical and to introduce the achievements of the positions already available in the Hippocratic Alexandrians themselves. corpus, and in parallel with the medical schools Wellman and Jaegar argue that there was a that had already been in existence for two or three considerable line of influence from Aristotle centuries on the periphery of the Greek world, through Diocles,6 whom we have already met as there developed in Alexandria, during the period the author of the first anatomical textbook. If it is we are discussing, a number of medical 'sects' indeed true that Diocles thought of himself as a with profoundly different views on the usefulness follower of Aristotle, then his book on human of anatomy in medicine. The Dogmatists or anatomy might well have been designed to fill the Rationalists, inclined to natural philosophy, held most obvious gap in Aristotle's biological works. that it was possible in principle to understand the The fragments of Diocles' work that survive show http://thorax.bmj.com/ processes going on inside the body, and that there- that his anatomy was in fact derived from animals, fore the physician was justified in intervening in and it may be that, like Aristotle, he was unable to these processes to put right what had gone wrong dissect the human body and relied on a in illness. As function was closely related to struc- methodology that consciously extrapolated from ture, it followed that anatomy was a fundamental comparative anatomy to human. All this, how- medical science. It is possible that this attitude ever, is supposition, and all we can say with confi- was reinforced by the observational, empirical, dence of Diocles is that his treatment in general and like Aristotle he and inductive methodology that Aristotle had is like that of Aristotle, on September 27, 2021 by guest. Protected copyright. announced and put into practice in his zoological placed the soul in the heart. On the other hand, works. some important physiological and anatomical It appears that the Rationalists of Alexandria ideas of the Alexandrians and some of their wider took this methodology one step further and beliefs are quite opposed to Aristotle, and practised not only dissection, to discover human Steckerl7 argues that his influence has been over- anatomy, but vivisection,4 to discover the function emphasised. of the human body. In other words, they intro- Whether or not a direct transmission of duced experiment into the descriptive and observa- Aristotelian ideas can be identified, there is no tional method. Both dissection and vivisection doubt of the background importance of his were opposed by the Empiricists,5 who from philosophy. His argument that even terrestrial Hippocratic times had believed that the processes objects were worthy of the attention of a philo- of the body were ultimately incapable of explana- sopher was new to Greek science and a turning tion. The business of the physician was not, there- point within it.8 His programme of analysing the fore, to intervene but to observe; empirical whole natural world encouraged his successor, based on case Theophrastus, to work on plants, at the descrip- medicine emphasised prognosis led history and treatment based on regimen. The non- tion of which Aristotle had stopped short, and empirical physician, rejecting the his student, Clearchus of Soloi, to write a book on investigative bones and muscles, need of a knowledge of function, had no need of the anatomy of the human of structure, and he held not only that another gap in Aristotle's world picture. Clearchus knowledge first of the Alexandrian anatomy was unnecessary but that the means of was contemporary with the Thorax: first published as 10.1136/thx.33.2.153 on 1 April 1978. Downloaded from The thorax in history 2. Hellenistic experiment and human dissection 155 anatomists and may have had access to human Alexandrians, made some dramatic and sophisti- material in Alexandria. Certainly Aristotle's em- cated experiments sectioning the nerves controlling phasis on the primacy of the senses in scientific the motions of respiration.