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

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introduced to Auenbruggei- ' s methods of direct auscultation (percussion), but he was destined to add the practice of indirect auscultation (the stethoscope). He had observed children scratching one end of a beam and listening at the opposite end. He then set about experimenting with com- pact rolls of paper, then a solid rod ; he finally found that a cylinder with a central channel and a funnel-shaped end worked best. The method to knowledge : observe, hypothesize and then experi- ment. Laennec not only developed the stethoscope but also correlated the findings at autopsy with the sounds heard with the stethoscope during life. He thus learned how to use the instrument to diagnose disease states. It is of interest that the stethoscope was perfected about 8 years after the beginning of the University of Maryland Medical School in 1807. The Medical School was the fifth to be founded in the United States and it is significant that its founding set off mob scenes protesting against human dissection. One of these riots oc- curred in 1788 when Dr. Wiesenthal attempted a dissection, and another in September, 1807, when Dr. Davidge attempted to have students dissect a body in a small building constructed for this pur- pose near his home. Obviously, the long battle for the acceptance of dissection as a necessary part of medical education had not yet been won. In spite of this , dissections have been carried out each year since 1807, and the University of Maryland was one of the first schools to make dissection compulsory (1833), even though there was no Anatomical Law until 1882. The winding stairways and escape hatches in the old building now known as Davidge Hall are mute evidence of the hazards and dangers under which the students and professors worked. The situation today is entirely different. The Anatomical Law legalizes dissection and has been operating well for the past 60 years to supply an adequate amount of material. Because of the great strides made by medicine and popular education, people accept the fact that dissection is indeed ad- vantageous to medical progress and necessary to produce good doctors. There is no longer a fear of mob violence. Many of the educated members of our society recognize the need for anatomical ma- terial and are willing to donate their bodies after their demise for this purpose. Since various social agencies and the government supply money for the burial of indigent people, a scarcity of ana- tomical material has been created in .some areas. and the willing of one ' s own body is becoming an important source, perhaps eventually the only source. The major discoveries made in the 19th and the first part of the 20th centuries are numerous. One that has a profound influence is the invention of the hypodermic syringe by Pravaz in 1851. While this is not in the field of anatomy, its use involves a knowledge of anatomy ; that is, the layers such as skin and superficial fascia through which the needle must pass and the location of veins, arteries, and nerves which it must avoid. There are many other medical specialties that are not regarded as anatomical in nature today, but careful considera- tion reveals that they are either direct offspring of anatomy or are dependent on a knowledge or concept of the structure of the human body. For example, pathology started by Morgagni (1704) (Professor of Anatomy, University of Padua) and cellular pathology started by Virchow (1855) are basically the offspring of anatomy. Cellular pathology resulted from the formula- tion of the cell theory by Schwann in 1839 and the introduction of microscopes into medical schools soon after this. The microscope not only carried anatomy to the cellular level, but also eventually led to embryology, electron microscopy, genetics, and gerontology. Within the past 50 years, the dis- coveries and changes in medicine have been so rapid that they almost defy enumeration. These include great discoveries in physiology, the twin brother of anatomy, and the far-reaching discov- ery of x-rays by William Roentgen in 1895. As x-rays are increasingly used for diagnosis, the need to know anatomy has become more and more essential. Even the tremendous advances in anti- biotics, chemotherapy, anesthesiology, and tran- quilizer drugs require a knowledge of anatomy to appreciate the sites of absorption and action. This great rate of discovery and the accumulation of more and more knowledge has created problems in the medical curriculum; as more subjects are crowded into it, anatomy and other subjects are telescoped to less and less time. Many anatomists are apprehensive lest we attempt to limit the time for dissecting to such a degree that medicine slip as in the Dark Ages to the status of a mediocre empirical profession. Anatomy, as a subject, must be experienced in depth if medical practitioners are to be competent diagnosticians, therapists, or surgeons. Anatomy should be taught as anatomy — by dissection — there is no other way. 16

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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

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