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Human cadaveric dissection: a historical account from ancient Greece to the modern era.

Ghosh SK - Anat Cell Biol (2015)

Bottom Line: It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy.Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century.Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomy, ESI-PGIMSR & ESIC Medical College, Kolkata, West Bengal, India.

ABSTRACT
The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

No MeSH data available.


Related in: MedlinePlus

A woodcut illustration from Fasciculus medicinae (1491) depicting human dissection in medieval Italy. The anatomist (Lector) over viewing the dissection, which is being performed by a barber surgeon (Sector) under directions from the Ostensor, who is pointing to the part of the body to be dissected. Fasciculus medicinae was edited by Johannes de Ketham, a German physician who practiced in medieval Italy. Image in public domain.
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Figure 1: A woodcut illustration from Fasciculus medicinae (1491) depicting human dissection in medieval Italy. The anatomist (Lector) over viewing the dissection, which is being performed by a barber surgeon (Sector) under directions from the Ostensor, who is pointing to the part of the body to be dissected. Fasciculus medicinae was edited by Johannes de Ketham, a German physician who practiced in medieval Italy. Image in public domain.

Mentions: In Medieval Europe, considerable advances in the field of science could only be achieved during the 12th century and early 13th century, with the setting up of universities in Paris (1150), Bologna (1158), Oxford (1167), Montpellier (1181) and Padua (1222) [12]. From 12th century onwards, the church did not forbid human dissection in general; however, certain edicts were directed at specific practices [13]. One of the significant proscriptions that Pope Alexander III enunciated at the Council of Tours in 1163 was the prohibition of clerics to involve themselves in the studies of physical nature and the canon (directive) was named as "Ecclesia abhorret a sanguine" meaning "The church abhors blood." This was misinterpreted as a ban which prevented clerics from practising surgery or studying anatomy [14]. The Holy Roman emperor Frederick II (1194-1250) took significant measures towards the progress of science which reflected his free thinking outlook. In 1231, he issued a decree which mandated that a human body should be dissected at least once in every five years for anatomical studies and attendance was made compulsory for everyone who was to practice medicine or surgery [15]. This initiative was a giant step towards revival of human dissection in the domain of anatomical sciences and towards the later part of the thirteenth century, the realization that human anatomy could only be taught by the dissection of human body resulted in its legalisation in several European countries between 1283 and 1365 [16]. The new found enthusiasm in human dissection ceased for a short period from about 1299, when Pope Boniface VIII issued a Papal Bull entitled, "De sepolturis" which forbade manipulation of corpses and their reduction to bones. The Bull was aimed to stop the dismemberment of the cadavers and prohibit the trade that had developed involving bones from soldiers killed in Holy wars. It was not meant to impede human dissection and although it stopped the practice of dissection in some of the European countries, did not have any significant impact on the anatomical activities in Italy [17]. By the end of 13th century, the University of Bologna emerged as the most popular institution in Europe for learning medicine, attracting students from the whole of Italy and many other countries [18]. The status of Bologna was further bolstered when it was granted a Bull by Pope Nicolas II in 1292, whereby all students having graduated in medicine from the University were permitted to teach all over the world [19]. All these events ultimately culminated in the first officially sanctioned systemic human dissection since Herophilus and Erasistratus, being performed in full public display by Mondino de Liuzzi (1275-1326) in 1315 in Bologna [11]. The dissection was performed on an executed criminal, probably female and marked its return in the educational setting to study and teach anatomy [20]. The fact that an Italian university was the platform for the revival of human dissection after a prolonged hiatus in Europe, could be attributed to the efforts of emperor Frederick II and Pope Nicolas II. Although there is a possibility that human dissections may have been performed prior to De Liuzzi, most authors suggests that all those cases actually involved autopsies and post-mortems and the first such recorded case in Italy of a human body being opened for investigating the cause of death dates back to 1286 [1721]. During the early 14th century, the religious restraints imposed on dissection and autopsy relaxed significantly though the practice of dissection remained limited [22]. No longer was the church the primary dissuader of anatomical studies, instead public condemnation became the primary obstacle. However the mediating role of the church played a critical role in appeasing the people's social and religious consciences. Religious authorities gave permission as well as clearly delineated and articulated boundaries around the practice of human dissection-this consequently eased the public's anxiety and the procedures were allowed to continue with ever decreasing protests [23]. From De Liuzzi's time human dissections were conducted in the form of regular university sponsored anatomy teaching sessions comprising of four day exhibitions held once or twice a year and were performed on bodies of executed criminals, both male and female, provided to the medical school of Bologna by the local public authorities [9]. These public dissections were strictly standardized as they required the presence of the Lector (lecturer), who read from an authoritative text (usually the Lector was De Liuzzi who referred to Galen's text and later on other eminent anatomists who referred to De Liuzzi's text Anathomia Mondini), the Ostensor who pointed to the part of the body to be dissected and the Sector (surgeon/barber) who performed the dissection (Fig. 1). The whole exercise blindly followed the written text without any attempt to look into the real anatomy visible in the human cadaver which could be due to the fact that the anatomist (the Lector) did not have a close view of the dissected body [24]. However during this period unofficial dissections were also carried out in private houses, which involved informal anatomy teaching between a lecturer and his small group of students [12]. Procurement of cadavers for such private dissections was really difficult and may have led to some malpractice as in 1319 four students of Master Alberto, who was a lecturer at the University of Bologna, were prosecuted for robbing a grave and bringing the corpse to the house where Alberto lectured [17]. Over the course of the 14th century human cadaveric dissection became increasingly common, spreading rapidly to other northern Italian cities. During the middle of 14th century, Universities of Perugia, Padua and Florence made it mandatory to attend at least one dissection for candidates to receive the doctorate degree in medicine [25]. Such measures were also adopted by medical schools across Italy. This led to shortage of cadavers available for public dissection by the onset of 15th century as executions were few in number in Italian cities. Consequently the students attending the dissection in medical schools were required to pay for and also attend the subsequent funeral of the corpse after dissection to encourage local families to offer their dead for anatomical studies. Nevertheless the problem of supply did not appear critical as dissection as a medium of teaching/learning anatomy did not become overwhelmingly popular during the 15th century [26]. In those days dissections functioned like an extension of anatomical illustration and its goal was not to add to the existing body of knowledge concerning human anatomy but to help students and physicians remember the text in which the knowledge was enclosed [27]. However the situation changed dramatically towards the end of 15th century with a remarkable flowering of interest in anatomical studies particularly human dissection. The reasons for this new found enthusiasm in human dissection were the revival of antique art in renaissance Italy with its interest in naturalism, rise of humanist faith in classical scholarship leading to rediscovery of Galen's anatomical treatise and a consequent rise of interest among physicians and scholars in Galen's work and increased availability of printed and illustrated works of anatomy which enthused among general people an interest in medicine and the secrets of the natural world [28]. Accordingly the increasing popularity of anatomy was not confined to physicians or medical students but also involved contemporary artists and even the general population. Italian renaissance artists started to perform their own dissections and the great Florentine painter Antonio Pollainolo (1431/1432-1498) dissected many human bodies in order to investigate the muscles and understand the human body in a modern way. Later on Leonardo da Vinci (1452-1519), Michelangelo Buanorotti (1475-1564), and Baccio Bandinelli (1493-1560) were known to have undertaken detailed anatomical dissections at various points in their career and set new standards in their portrayals of the human figure [29]. Some artists also produced 'écorchés,' studies of the peeled away or ripped apart forms of muscles, to explore their potential for purely artistic expression. The majority of the artists however limited their investigations to the surface of the body-the appearances of its musculature, tendons and bones as observed through the skin. Italian renaissance artists started practising human cadaveric dissection by necessity as they attempted to produce a refined, more lifelike, sculptural portrayal of the human figure in their works [30]. On the academic front the size of the audience increased dramatically in formal university dissections, which now began to assume a truly public character. Initially these larger audiences were accommodated in temporary structures of seats and risers set up in the interiors of churches and later on during the 16th century in anatomical theatres [17]. The first permanent anatomical theatre designed for public anatomical dissections was built by Fabricius ab Aquapendente (1533-1619) in 1594 in the University of Padua. This was followed by the anatomical theatre in the University of Bologna built in 1595 and reconstructed in 1636. The trend spread in other European countries also and anatomical theatres were built in the University of Leiden (the Netherlands) in 1596 and in University of Paris in 1604 (Fig. 2) [31]. Meanwhile the ever growing popularity of human cadaveric dissection which had its roots in the later part of 15th century, attained enormous proportion during the 16th century. Consequently the demand for dissectable bodies quickly escalated beyond the meagre but regular trickle supplied by the local gallows and families swayed by the prospect of a free funeral [32]. Initially the physicians arranged bodies by increasingly recommending post-mortems to the patient's family even when the family itself was satisfied as to the cause of death [17]. However this was not an option for the artists who relied on local hospitals (mostly charitable hospitals) for the corpses of poor foreigners and bodies of those persons who were without their families to worry about their funerary rites [33]. Gradually even these sources proved inadequate to the task and the anatomists began to rely heavily on unofficial or extralegal sources of supply. Consequently, malpractices such as grave-robbing which existed even in 14th century but were rare in those times became increasingly common during the 16th century. The extent of the problem can be gauged by the reports of students attempting to remove corpses awaiting burial or assaulting funeral processions [34]. Even the great anatomist Andreas Vesalius (1514-1564) in his anatomical treatise De humani corporis fabrica, candidly admitted to have resorted to such malpractice in order to ensure an adequate supply of cadavers for the purpose of dissection [35]. In one instance his Paduan students stole a female corpse from her tomb and flayed the whole skin from the cadaver lest it be recognised by her relatives during public dissection [36]. Such unethical anatomical practices led to unsavoury stories being gradually collected around the names of famous anatomists with regards to serious criminal offences like vivisection [27]. Vesalius was accused to have performed dissection on a Spanish aristocrat when the heart was still beating. Gabriele Falloppio (1523-1562) faced an allegation that he had vivisected Spanish twin brothers with syphilis [37]. Although there is no strong evidence to support these particular allegations, nonetheless these were not completely preposterous either and actually reflected the dangerous and unseemly haste with which 16th century anatomists approached fresh cadavers for dissection. Whether or not the hunger for cadavers among the 16th century anatomists actually put the living at risk, it certainly exposed the unprecedented links between anatomists and administrators of criminal justice as they began to influence the time and mode of execution of criminals to suite their requirement of dissection [17]. By the middle of the 16th century, there were clear signs of persistent public concern regarding the anatomical practices in Italy. Initially their reservations were based on traditional issues like funerary ritual and family honour but eventually emerged as a fear of being buried alive and coming under the anatomist's knife [34]. However, such concerns in the public domain co-existed with the well documented popular enthusiasm for the spectacle of human cadaveric dissection [32].


Human cadaveric dissection: a historical account from ancient Greece to the modern era.

Ghosh SK - Anat Cell Biol (2015)

A woodcut illustration from Fasciculus medicinae (1491) depicting human dissection in medieval Italy. The anatomist (Lector) over viewing the dissection, which is being performed by a barber surgeon (Sector) under directions from the Ostensor, who is pointing to the part of the body to be dissected. Fasciculus medicinae was edited by Johannes de Ketham, a German physician who practiced in medieval Italy. Image in public domain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4582158&req=5

Figure 1: A woodcut illustration from Fasciculus medicinae (1491) depicting human dissection in medieval Italy. The anatomist (Lector) over viewing the dissection, which is being performed by a barber surgeon (Sector) under directions from the Ostensor, who is pointing to the part of the body to be dissected. Fasciculus medicinae was edited by Johannes de Ketham, a German physician who practiced in medieval Italy. Image in public domain.
Mentions: In Medieval Europe, considerable advances in the field of science could only be achieved during the 12th century and early 13th century, with the setting up of universities in Paris (1150), Bologna (1158), Oxford (1167), Montpellier (1181) and Padua (1222) [12]. From 12th century onwards, the church did not forbid human dissection in general; however, certain edicts were directed at specific practices [13]. One of the significant proscriptions that Pope Alexander III enunciated at the Council of Tours in 1163 was the prohibition of clerics to involve themselves in the studies of physical nature and the canon (directive) was named as "Ecclesia abhorret a sanguine" meaning "The church abhors blood." This was misinterpreted as a ban which prevented clerics from practising surgery or studying anatomy [14]. The Holy Roman emperor Frederick II (1194-1250) took significant measures towards the progress of science which reflected his free thinking outlook. In 1231, he issued a decree which mandated that a human body should be dissected at least once in every five years for anatomical studies and attendance was made compulsory for everyone who was to practice medicine or surgery [15]. This initiative was a giant step towards revival of human dissection in the domain of anatomical sciences and towards the later part of the thirteenth century, the realization that human anatomy could only be taught by the dissection of human body resulted in its legalisation in several European countries between 1283 and 1365 [16]. The new found enthusiasm in human dissection ceased for a short period from about 1299, when Pope Boniface VIII issued a Papal Bull entitled, "De sepolturis" which forbade manipulation of corpses and their reduction to bones. The Bull was aimed to stop the dismemberment of the cadavers and prohibit the trade that had developed involving bones from soldiers killed in Holy wars. It was not meant to impede human dissection and although it stopped the practice of dissection in some of the European countries, did not have any significant impact on the anatomical activities in Italy [17]. By the end of 13th century, the University of Bologna emerged as the most popular institution in Europe for learning medicine, attracting students from the whole of Italy and many other countries [18]. The status of Bologna was further bolstered when it was granted a Bull by Pope Nicolas II in 1292, whereby all students having graduated in medicine from the University were permitted to teach all over the world [19]. All these events ultimately culminated in the first officially sanctioned systemic human dissection since Herophilus and Erasistratus, being performed in full public display by Mondino de Liuzzi (1275-1326) in 1315 in Bologna [11]. The dissection was performed on an executed criminal, probably female and marked its return in the educational setting to study and teach anatomy [20]. The fact that an Italian university was the platform for the revival of human dissection after a prolonged hiatus in Europe, could be attributed to the efforts of emperor Frederick II and Pope Nicolas II. Although there is a possibility that human dissections may have been performed prior to De Liuzzi, most authors suggests that all those cases actually involved autopsies and post-mortems and the first such recorded case in Italy of a human body being opened for investigating the cause of death dates back to 1286 [1721]. During the early 14th century, the religious restraints imposed on dissection and autopsy relaxed significantly though the practice of dissection remained limited [22]. No longer was the church the primary dissuader of anatomical studies, instead public condemnation became the primary obstacle. However the mediating role of the church played a critical role in appeasing the people's social and religious consciences. Religious authorities gave permission as well as clearly delineated and articulated boundaries around the practice of human dissection-this consequently eased the public's anxiety and the procedures were allowed to continue with ever decreasing protests [23]. From De Liuzzi's time human dissections were conducted in the form of regular university sponsored anatomy teaching sessions comprising of four day exhibitions held once or twice a year and were performed on bodies of executed criminals, both male and female, provided to the medical school of Bologna by the local public authorities [9]. These public dissections were strictly standardized as they required the presence of the Lector (lecturer), who read from an authoritative text (usually the Lector was De Liuzzi who referred to Galen's text and later on other eminent anatomists who referred to De Liuzzi's text Anathomia Mondini), the Ostensor who pointed to the part of the body to be dissected and the Sector (surgeon/barber) who performed the dissection (Fig. 1). The whole exercise blindly followed the written text without any attempt to look into the real anatomy visible in the human cadaver which could be due to the fact that the anatomist (the Lector) did not have a close view of the dissected body [24]. However during this period unofficial dissections were also carried out in private houses, which involved informal anatomy teaching between a lecturer and his small group of students [12]. Procurement of cadavers for such private dissections was really difficult and may have led to some malpractice as in 1319 four students of Master Alberto, who was a lecturer at the University of Bologna, were prosecuted for robbing a grave and bringing the corpse to the house where Alberto lectured [17]. Over the course of the 14th century human cadaveric dissection became increasingly common, spreading rapidly to other northern Italian cities. During the middle of 14th century, Universities of Perugia, Padua and Florence made it mandatory to attend at least one dissection for candidates to receive the doctorate degree in medicine [25]. Such measures were also adopted by medical schools across Italy. This led to shortage of cadavers available for public dissection by the onset of 15th century as executions were few in number in Italian cities. Consequently the students attending the dissection in medical schools were required to pay for and also attend the subsequent funeral of the corpse after dissection to encourage local families to offer their dead for anatomical studies. Nevertheless the problem of supply did not appear critical as dissection as a medium of teaching/learning anatomy did not become overwhelmingly popular during the 15th century [26]. In those days dissections functioned like an extension of anatomical illustration and its goal was not to add to the existing body of knowledge concerning human anatomy but to help students and physicians remember the text in which the knowledge was enclosed [27]. However the situation changed dramatically towards the end of 15th century with a remarkable flowering of interest in anatomical studies particularly human dissection. The reasons for this new found enthusiasm in human dissection were the revival of antique art in renaissance Italy with its interest in naturalism, rise of humanist faith in classical scholarship leading to rediscovery of Galen's anatomical treatise and a consequent rise of interest among physicians and scholars in Galen's work and increased availability of printed and illustrated works of anatomy which enthused among general people an interest in medicine and the secrets of the natural world [28]. Accordingly the increasing popularity of anatomy was not confined to physicians or medical students but also involved contemporary artists and even the general population. Italian renaissance artists started to perform their own dissections and the great Florentine painter Antonio Pollainolo (1431/1432-1498) dissected many human bodies in order to investigate the muscles and understand the human body in a modern way. Later on Leonardo da Vinci (1452-1519), Michelangelo Buanorotti (1475-1564), and Baccio Bandinelli (1493-1560) were known to have undertaken detailed anatomical dissections at various points in their career and set new standards in their portrayals of the human figure [29]. Some artists also produced 'écorchés,' studies of the peeled away or ripped apart forms of muscles, to explore their potential for purely artistic expression. The majority of the artists however limited their investigations to the surface of the body-the appearances of its musculature, tendons and bones as observed through the skin. Italian renaissance artists started practising human cadaveric dissection by necessity as they attempted to produce a refined, more lifelike, sculptural portrayal of the human figure in their works [30]. On the academic front the size of the audience increased dramatically in formal university dissections, which now began to assume a truly public character. Initially these larger audiences were accommodated in temporary structures of seats and risers set up in the interiors of churches and later on during the 16th century in anatomical theatres [17]. The first permanent anatomical theatre designed for public anatomical dissections was built by Fabricius ab Aquapendente (1533-1619) in 1594 in the University of Padua. This was followed by the anatomical theatre in the University of Bologna built in 1595 and reconstructed in 1636. The trend spread in other European countries also and anatomical theatres were built in the University of Leiden (the Netherlands) in 1596 and in University of Paris in 1604 (Fig. 2) [31]. Meanwhile the ever growing popularity of human cadaveric dissection which had its roots in the later part of 15th century, attained enormous proportion during the 16th century. Consequently the demand for dissectable bodies quickly escalated beyond the meagre but regular trickle supplied by the local gallows and families swayed by the prospect of a free funeral [32]. Initially the physicians arranged bodies by increasingly recommending post-mortems to the patient's family even when the family itself was satisfied as to the cause of death [17]. However this was not an option for the artists who relied on local hospitals (mostly charitable hospitals) for the corpses of poor foreigners and bodies of those persons who were without their families to worry about their funerary rites [33]. Gradually even these sources proved inadequate to the task and the anatomists began to rely heavily on unofficial or extralegal sources of supply. Consequently, malpractices such as grave-robbing which existed even in 14th century but were rare in those times became increasingly common during the 16th century. The extent of the problem can be gauged by the reports of students attempting to remove corpses awaiting burial or assaulting funeral processions [34]. Even the great anatomist Andreas Vesalius (1514-1564) in his anatomical treatise De humani corporis fabrica, candidly admitted to have resorted to such malpractice in order to ensure an adequate supply of cadavers for the purpose of dissection [35]. In one instance his Paduan students stole a female corpse from her tomb and flayed the whole skin from the cadaver lest it be recognised by her relatives during public dissection [36]. Such unethical anatomical practices led to unsavoury stories being gradually collected around the names of famous anatomists with regards to serious criminal offences like vivisection [27]. Vesalius was accused to have performed dissection on a Spanish aristocrat when the heart was still beating. Gabriele Falloppio (1523-1562) faced an allegation that he had vivisected Spanish twin brothers with syphilis [37]. Although there is no strong evidence to support these particular allegations, nonetheless these were not completely preposterous either and actually reflected the dangerous and unseemly haste with which 16th century anatomists approached fresh cadavers for dissection. Whether or not the hunger for cadavers among the 16th century anatomists actually put the living at risk, it certainly exposed the unprecedented links between anatomists and administrators of criminal justice as they began to influence the time and mode of execution of criminals to suite their requirement of dissection [17]. By the middle of the 16th century, there were clear signs of persistent public concern regarding the anatomical practices in Italy. Initially their reservations were based on traditional issues like funerary ritual and family honour but eventually emerged as a fear of being buried alive and coming under the anatomist's knife [34]. However, such concerns in the public domain co-existed with the well documented popular enthusiasm for the spectacle of human cadaveric dissection [32].

Bottom Line: It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy.Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century.Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomy, ESI-PGIMSR & ESIC Medical College, Kolkata, West Bengal, India.

ABSTRACT
The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

No MeSH data available.


Related in: MedlinePlus