University of Maryland School of Medicine - Terrae Mariae Medicus (Baltimore, MD)

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ANATOMY: Its history and role in the evolution of the medical curriculum by Frank H. J. Figge The civilized period of human evokition has been estimated to cover a span of 4500 years. Major medical and scientific advancements have occurred only within the last 415 years, or since the time of Andreas Vesalius and the publication of his great book De Corporis Humani Fabrica or The Structure of the Human Body. It is indeed a classic, and it is considered to be one of the ten greatest contributions to the field of medicine. Long before this, during the years 3000 to 1000 B.C., medicine was very primitive and progress extremely slow, due primarily to man ' s vague and mysterious concepts of death and the hereafter. It was probably not realized that for medicine to advance, it would be necessary for medical practi- tioners to acquire a fundamental concept of mor- phology, the study of the arrangement of parts in human subjects. It was not appreciated that such morphological concepts would be necessary pre- requisites to the understanding of both normal and disease processes. The pre-Alexandrian period, which lasted seven hundred years from 1000 to 300 B.C., was a time when dissection was not actually practiced, but it does mark the era in which anatomy, as a formal discipline, had its beginnings. The spiritual and political climate at this time was not conducive to the practice of human dissection, for it was pre- vented by prejudice and banned by law. At the time of Aristotle, who was the first real compar- ative anatomist, anatomy was a mixture of sym- bolism, conjecture and philosophy derived from observation of open wounds, injuries, and disin- tegrated bodies. Some mammalian anatomy had been learned from the religious sacrifice of ani- mals, but it was admitted by Aristotle that the Inward parts of man are known lea.st of all. In Italy, anatomical knowledge was probably more suppressed than in other areas because it was against Roman custom to perform human dissec- tion. The human body was held in great reverence and a belief in resurrection prevented any prac- tice of physical dismemberment. In the pre-Alex- andrian period, there is some evidence that the Hindus may have actually examined the human body. They were said to have enclosed dead human subjects in bags and allowed them to decompose for nine days in a river. In this way, the internal organs could be separated and examined without a knife. This method was employed because the use of a knife was forbidden by Hindu religious law. It thus appears that the dream of every fresh- man medical student was realized over 3000 years ago ; that is, a method to dissolve fascia. The real birth of anatomy as a science occurred during the period of the Alexandrian School be- tween 300 B.C.-200 A.D. The Greeks did not per- mit human dissection in their own country, but had no objection to its being performed in Alex- andria, Egypt, one of their conquered territories. This city was an important center for learning, and Alexander the Great founded a magnificent educational and medical center there. The reli- gious climate at this time and place .stimulated the initiation of dissection. The Platonic and Stoic schools of philosophy were on the wane, mono- theism and Judaism were flourishing, and the behef in Gnosticism was gaining ground. The Gnostics believed that emancipation came through knowledge and they held the human body in dis- dain. To them, it was merely a cage or prison of the immortal soul. For the many who held this belief, life was an unpleasant prelude to the wel- come of death. Because of their relative disregard for the human body and respect for learning, there developed an enlightened attitude resulting in the first complete dissections of a human subject. Herophilus and Erasistratus were two of the first anatomists to take advantage of this situation. They were active in the establishment in Alexan- dria of a school of Medicine which flourished for more than 300 years. They were thus the fathers of anatomy and must be credited with develop- ing anatomy into a distinct branch of the sciences. Herophilus was the first to open the body after death for the purpose of discovering the character and nature of the disease. He was described as a tireless investigator and a pioneer in dissecting human bodies in public. Initially he asked for and was granted permission to dissect the bodies of two executed criminals. He is reputed to have care- fully dissected from 200 to 600 human specimens. 13

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The Staff of Terrae Mariae Medicus Editor in Chief Susan Legat Associate Editor Louis Olsen Copy Editor William Legat Ph otog niphy Editor SuSAN Legat Photography Robert Torrence Business Manager Harry Brown Layouts SUSAN LEGAT, LOUIS OLSEN, WILLIAM SCHICK Senior Writeups Alan Judman, WILLIAM Legat, Robert Whitlock O rga n iza tions Writeups Louis Olsen Subject Writeups William Legat Dedication to Dr. Dietrich Smith Victoria Whitelock Dedication to Dr. Milton Sachs William Legat Those of us who worked on this book are grateful for the time, energy, and talent contributed by two students of The Johns Hopkins University, William Schick and Micheal Long, both of whom were invaluable in advis- ing, criticising and assembling this work. 12

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Celsus, who lived at the time of Christ (42 B.C. -27 A.D.), accused Herophilus of dissecting living human subjects. Celsus, a doctor of medi- cine, is described as an encyclopedist; that is, a compiler of existing knowledge. He claimed that both Herophilus and Erasistratus had not only dissected the dead, but also living criminals from the prison of the king. They were supposed to have opened the bodies while they were breathing in order to observe the position, color, shape, size and relationships of the organs. Celsus was of the opinion that dissecting a dead body was not cruel, as most people think, but rather that it was important and necessary in order to devise reme- dies for all future ages. He drew the line, however, at human vivisection. This permissive attitude toward the dissection of cadavers was lost, how- ever, when the Romans invaded Egypt. While they seemed to enjoy any amount of gladitorial blood- shed and other inhumanities in their arenas, they held that contact with or cutting a dead human subject was a sacrilege. The final blow to the great educational and medical institution of Alexandria was struck by Julius Caesar, who ordered the li- brary to be destroyed and it was burned to the ground. During the late stages of the decline of the Alexandrian School, a Greek by the name of Galen was born in the city of Pergamon in Asia Minor about 130 A.D. The great Asklepieion, a religious, health, and recreational center, was built in the city where Galen was born. It became a medical shrine which had a profound influence on Galen during his youth. As a boy, he studied the various systems of philosophy under the most distin- guished teachers. Galen was attracted to anatomy, which brought him into close contact with reality and he studied under an anatomist by the name of Satyros. Later in Alexandria, he saw two human skeletons that had been assembled there, and from them learned osteology. By the time he was 28 years old, he had devoted 12 years to the study of medicine, which at this time was chiefly anat- omy, and had written a number of medical papers. On returning to Pergamon, he was appropriately honored by being appointed physician to the gladi- ators by the chief priest of the Asklepieion. Since human di.s.section was banned in Greece as well as in Italy, most of the anatomy that he knew was restricted to skeletal structure and what he had learned from animal di.ssection (pigs, sheep, oxen, cats, dogs, horses, apes, lions, bulls, and an ele- phant) . Monkeys and apes, however, were his fa- vorite experimental subjects and were apparently easy to obtain. It is notable that while Galen wrote approximately 500 papers, the most important, De Anatomicis Administrationibus, referred mostly to monkeys and was without illustrations. After Galen, there was little or no original dis- section of either human or animal subjects for the 1000 years of the Dark Ages. It is interesting to speculate how much this situation was influ- enced by the growth of Christianity and its com- petition with other older religions. It is fascinat- ing to wonder just how much the general concept of the Resurrection influenced people ' s attitude to- ward human dissection. Probably not as much as one would suppose, for the Jews certainly did not believe in it, and yet they, as a group with a high sense of social responsibility, are even today most reluctant to have their own bodies dissected after death. Near the end of this 1000-year standstill, or in the early phases of the Renaissance, it was the artist-anatomist that revived the practice of ana- tomical dissection. One of the great anatomists of the European Renaissance was Leonardo da Vinci. William Hunter called him the greatest anatomist of all time. He was, of course, also an artist and during his lifetime he made 779 anatomical draw- ings and 235 plates. He appreciated the value of dissection and was a strong advocate of it. He made many dissections on his own and was able to inspire others to do the same. At the time of his death, he had compiled 120 volumes of notebooks, some of which contained drawings indicating his tremendous imagination and creative ability. Some dissections were also performed in other schools started at the end of the Middle Ages. Mondino directed dissections done by barber surgeons at the University of Bologna (1276-1326). He has been given credit for doing or directing the first dissection of a body in over 1700 years, but he used Galen ' s descriptions. Frederick II, Emperor of Germany and the two Sicilies, was the first to issue an edict legalizing dissections. It was not until Vesalius appeared, however, that Galen ' s anatomy was corrected. This was a period of awakening and exploration. A year after Columbus discovered America, Paracelsus was born. Paracelsus has been called The Stormy Petrel of Medicine. He was opposed to almost everything, but especially to blind obedience to authority. Opposition was in the air and during his lifetime Luther instituted the split with the Roman Catholic Church (1519). All of these events paved the way for Vesalius. 14