Dr Paul Lambden Dissection - Constant Contact

nhsManagers.net Briefing 8 July 2017Medicine for ManagersDr Paul LambdenBSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSMDissectionThe fundamental understanding of the human body was mapped out by practitioners ofmedicine over many centuries to understand both normal structure and function and thechanges associated with disease. The word ‘dissection’ comes from the latin verb dessicare –. Until recently, things had changed little for over two centuries.Dissection has been a tool of medicinesince about the end of the fourthcentury BC. Before that time therewere constraints on the ‘mutilation’ ofhuman corpses because the body itselfwas treated as sacred, which resultedin relatively little knowledge of theinner body and some very fancifulconcepts of what might be within. Inthis respect Hippocrates, the father ofmedicine, was denied a key componentof medical knowledge.As in so many aspects of medicine, theGreeks led the way. Aristotle and hisfollowers embarked on a programme ofdissection of both human and animalcorpses and at about that time Dioclespublished the first book on dissection,although it was confined to animals. In280 BC Herophilus investigated thehuman body and gave names to some ofthe structures that he found within. Hedissected the eye and recognised thesignificance of the pulse as a guide toillness.At the same time Erasistratus dissectedthe brain to try to understand theassociationbetween structure and movement. Hedid not agree with the teachings ofHippocrates, saying that he did notaccept the concept of humours. Hethought that arteries were full of air(pneuma) and that the blood he foundwas seapage from organs.For the period of the rule of the Romanempire dissection was banned. Thethirst for knowledge drove physicians touse otherMedicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medicalreader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and shouldnot be regarded as an endorsement of their use.

Restrictions continued to be relaxedand in 1537 Pope Clement VII acceptedthe teaching of anatomy by dissection.The Church was content to allowdissections to occur provided that thebodies were given an apppropriateChristian burial afterwards.cadavers and Galen used macaquemonkeys as a proxy for human anatomyto improve his understanding.The power of the Roman Catholicchurch, driven by the belief of thesanctity of the body and that itbelonged to God, not man, resulted inthe church’s opposition to dissection.Ecclesiastical opposition to dissectionfaded away during medieval times. Thefirst formal dissection of a humancorpse was credited to Mondino Liuzziin Bologna around 1315. During theBlack Death, which occurred between1346 and 1353, the Papacy sanctionedpostmortems to search for the cause ofthe disease. However, dissectionscontinued to be a rarity.Since the middle of the thirteenthcentury there had been post-mortemscarried out by surgeons to discovercauses of death. The corpses selectedfor university and medical schooldissections were generally those ofcriminals and witches.Italy became to centre of medicalknowledge through dissection.Dissections became ever more publicoccasions and spectacles where theanatomist, a professor, would sit in ahigh chair, dressed in ceremonial robesreading from the works of Galen whilstpointing to structures in the body(which was very rarely that of awoman).Leonardo da Vinci drew over sevenhundred and fifty anatomical drawingsduring this period.Anatomy took a step forward with thework of Andreas Vesalius, born in 1545,he rose to become court physician toEmperorCharles V of Rome and Philip II of Spain.He published De Humani CorporisFabrica (On the Structure of the HumanBody) in 1543. This was a beautifullyillustrated andMedicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medicalreader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and shouldnot be regarded as an endorsement of their use.

published his groundbreaking work onthe heart and the circulation of theblood in 1628.detailed book and challenged the workof Galen who had used animaldissections. Vesalius’ work producedsound anatomical data based on firsthand observations.Of course, during this periodanatomical knowledge expandedrapidly but it is clear that, at thattime, knowledge of structure faroutweighed knowledge of function.Developments occurred quickly in Italy.Ambroise Parė developed his surgicaltechniques using the anatomy ofVesalius and other notable physicians ofthe time and later added quickly to thedata with Falloppio at Padua identifyingthe Fallopian tubes. Towards the end ofthe century, Eustachio recognised theEustachian tube and the Eustachianvalve of the heart as well as manyother structures. Eustachio’s pupil,Fabrizio, undertook detailed work onveins which provided the inspiration forthe English physician William HarveywhoThe development of surgery broughtwith it an increasing thirst forknowledge of the body. Centresdeveloped in England and in Scotland,most notably in Edinburgh. Theprogress of training, the expansion ofthe Royal College of Surgeons, thedevelopment of the hospitals and themanagement in those hospitals of themore severely ill and those sufferingaccidents and emergencies proved veryvaluable for the surgeons. Many bodieswere unclaimed after death becausethey had been poor and surgeons andtheir students were able to dissectpost-mortem without restraint.Alongside hospitals, schools of anatomydeveloped boosting the prestige ofsurgery.Surgeons attached to the army alsoobtained a rich source of bodies intimes of war (which was frequent).Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medicalreader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and shouldnot be regarded as an endorsement of their use.

Operations to treat wounds oftensubsequently became dissections toestablish the extent of the fatalinjuries.Anatomy and dissection developedfurther and by the 18th Century, it hadbeen recognised as key to theunderstanding of the body andanatomical structure. John Hunter wasa pre-eminent anatomist of his day.Born in 1728, in Scotland, he initiallythe mechanism of evolution (Darwinpublished the Origin of Species nearly acentury later in 1859).Hunter is said to have had 14,000specimens which were later housed inthe Royal College of Surgeons (manydestroyed by a World War II Germanbomb). He established a dissectionschool in Leicester Square and,following his death in 1793, studentsfound that the body on the dissectingtable the following morning was hisown.Hospitals developed museums forcollection of specimens and trainingpurposes.worked with his brother who developedan anatomy school in Covent Garden inLondon. He reputedly did over 2,000dissections in the twelve years that heworked in his brother’s school. After aperiod in the army he returned toLondon and developed his anatomyinterest. He became surgeon at StGeorge’s Hospital and pioneeredobtaining consent to do post-mortemdissections, including of the rich andfamous. He also used grave robbers andpurchased a large sum of money for theskeleton of Charles Byrne, the “IrishGiant”. He also did a huge amount ofwork onanimals and recognised that humansand animals came from commonancestors, though he did not work outPerhaps one of the best-known is theGordon Museum at Guy’s Hospital inLondon.A collection of specimens had beenstarted at the hospital in 1802 but themuseum was established in 1826 withdonations, notably from Robert Gordon.Not only does it have thousands ofspecimens illustrating all pathology butit also houses an amazing collection ofover 200 wax models of dissectionsproduced by Joseph Towne.They are anatomically accurate andhave been an extremelyMedicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medicalreader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and shouldnot be regarded as an endorsement of their use.

Many students, when questioned aboutdissection, felt it aided learning andmade anatomy more interesting. Othersdid not like the smell, found it timeconsuming or just boring.Those views may, of course, beinfluenced by the aspirations ofstudents and whether their interestswere more with a medical or a surgicalcareer.valuable educational resource for over150 years.Dissection became a central part nofmedical training at the medical schoolsin the nineteenth century and so itcontinued until the latter part of thetwentieth century.Shortage of specimens and questionsabout the value of systematic teachingof anatomy by carrying out thedissections has resulted in the omissionof, or a significant reduction in the useof cadavers.It would be a considerable loss ifdissection did not continue as part ofthe undergraduate curriculum and it isto be hoped that, amongst all the otherlearning techniques available, it retainsa place, echoing the learning ofgenerations of physicians and surgeonsfor two-and-a-half thousand years.paullambden@compuserve.comIn parallel, the earlier involvement ofpatients in education, the developmentof problem-based learning and ofcourse the explosion in models andcomputerised three-dimensionaltraining aids had dramatically changedthe facilities available for learning therelationship of bodily structures.As someone who did eighteen monthsof dissection as a pre-clinical student,for me it was a positive experience andwas the first interaction betweenmedical study and the human body.Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medicalreader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and shouldnot be regarded as an endorsement of their use.

the teaching of anatomy by dissection. The Church was content to allow dissections to occur provided that the bodies were given an apppropriate Christian burial afterwards. Italy became to centre of medical knowledge through dissection. Dissections became ever more public occasions and spectacles where the anatomist, a professor, would sit in a