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

Page 18 text:

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

Page 17 text:

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

Page 19 text:

Andreas Vesalius was born in Brussels, Decem- ber 31, 1514, and he stands out as one of the great- est medical men and anatomists of all times. His father, grandfather, and even great-grandfather had been physicians of great reputation. His mother was a talented person who had great faith in her son ' s ability. She had preserved the books and manuscripts of her husband ' s ancestors and made them available to Vesalius. He became very much interested in anatomy at an early age and dissected many small animals. When fourteen, he entered the University of Louvain which was only a few miles from his home. He acquired a background in Greek, Latin, Hebrew, and Arabic. Later he went to the University of Paris where he decided to devote his energy, his talents, and his life to anatomical study and learning. Along with other young students of this time, Vesalius at first accepted the anatomy of Galen, since there was no other. He complained, however, that the students learned less anatomy in the anatomical theatre than a butcher would learn in his shop. He re- belled against the theories and presentations of Galen and surreptitiously visited the old Parisian cemeteries and gallows, gathering an abundance of material, frequently at great peril. He collected skeletons of all kinds and became an expert com- parative osteologist. As might be expected, his book, De Corporis Humani Fabrica, which pointed out the numer- ous errors of Galen, aroused a storm of protest. Sylvius, his former teacher, turned against him, calling him a madman. Columbo, one of Vesalius ' early assistants also tried to discredit the work and deride him. Vesalius became so enraged that he burned the notes he had made in preparation for another book. The first book survived, how- ever, and the second folio edition of De Corporis Humani Fabrica appeared in 1565. We have a copy of this in the Uhlenhuth Collection of Ana- tomical Cla.ssics at the University of Maryland. It can be said that Vesalius was the first physi- cian to break openly with tradition and to derive anatomical descriptions directly from the dissec- tions that he performed. His great work, com- pleted before he was 30, was ultimately accepted and widely used. It also stimulated great progress in anatomical and medical research and, in the fol- lowing centuries, was responsible for the develop- ment of physiology, pathology and many other ofi - ahoots of anatomy. In fact, it was responsible for starting our modern period of medicine on a firm anatomical foundation. The history of anatomy in its relation to the practice of medicine during the past 375 years is astounding because of the pace of discovery. Each new discovery appeared to result in the creation of 10 new problems. During the 16th and 17th cen- turies, Fallopius, after whom the Fallopian tubes are named, published his Observationes Anatomi- cae. In 1590 one of the most far-reaching inven- tions, as far as anatomy was concerned, appeared. The invention of the compound microscope led to the later development of all kinds of subspecialties of anatomy such as microanatomy, embryology, neuroanatomy, pathology, and genetics. A short 26 years later, William Harvey, 1578-1657, be- gan lecturing on the circulation of the blood and in 1628 he published his work, De Motu Cordis. As a student, Harvey attended the University of Padua Medical School where Vesalius had done some of his great work. There he listened to the anatomy lectures of the famous Fabricius of Aqua- pendente in the still extant six-tiered amphithea- ter designed for teaching anatomy. In his later years, Harvey acknowledged his debt to his anat- omy teacher, crediting his discovery of the circu- lation of the blood to the clear-cut demonstrations of valves in veins by his teacher, Fabricius. Malpighi published his first account of the capil- lary system (in the lungs) in 1661, and the capil- laries in the tail of small eels or fish were reported independently by Leeuwenhoek in 1686. The 18th century produced such anatomically important investigators as John and William Hun- ter. The former became one of the greatest com- parative anatomists of his time. During the latter part of the century. The Declaration of Independ- ence was signed, the United States came into being, the first medical school in this country was started at Harvard University (1782) and of primary importance, Jenner vaccinated an eight- year-old boy for smallpox with the exudate from a cowpox pustule of a dairy maid. Jenner was a close friend of John Hunter, who frequently wrote letters goading Jenner, demanding this or that specimen. From Hunter, Jenner received a famous bit of advice (appropriate today for the arm- chair scientist). Why think? Why not try the experiment? This philosophy characterizes the modern period and diff erentiates it from all other periods. It is an experimental period. Percussion was also introduced in the 18th cen- tury by Leopold Auenbrugger, an Austrian. After a great many experiments, he published a paper On Percu.ssion of the Chest. Laennec had been