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The Quest for Knowledge of the Body: Anatomy

What is Anatomy?

  • Definition: Anatomy is the study of the structure of the body. Today it appears to be key to the study of medicine, but for much of history it was not very important as structural explanations of disease were considered to be secondary to those of function (physiology). The word anatomy is derived from the Greek word for dissection. While the term still implies cutting, structure (morphology), or the shape, size and relationship of body part is also crucial.
  • While medicine is the study of disease and its treatments, doctors must focus on abnormalities of structure and function to better understand disease. Thus, the rise of the related disciplines of anatomy and physiology.
  • In the past these two pursuits have competed for curriculum time in medical training, laboratory space and resources, and status in the field. However, there is a great deal of overlap between them.
  • It is important to note that abnormal structure does not always imply disease—for example some congenital deformities (extra toes or birthmarks) are not associated with suffering or shortened life-spans.
  • Medical cultures that emphasized the study of anatomy have risen and fallen throughout history: peaked in ancient Alexandria, then declined, then peaked during Renaissance, then declined, and then peaked again in the nineteenth century. The present form of medical education in the West still reflects anatomies status in the 1800s.

European Anatomy Mannequin Made of Ivory (Early 16th Century)

Themes in the History of Anatomy

  • Three themes recur throughout the history of anatomy:
  • 1) Ambivalence, or ‘approach-avoidance’. The issue of whether or not anatomical dissections were allowed—often conflicted with religious or cultural aversions to the idea of cutting up dead bodies.
  • 2) ‘The gift of art to medicine’: The expression of anatomical knowledge relied on visual forms of communication.
  • 3) Anatomical study separate from medical wisdom. The pursuit of anatomy in art or science did not always (in fact seldom) implied an equal status in medicine.

Sixteenth-Century Spanish Anatomy Illustration

Anatomies of the Ancients

  • Egyptians: While embalmers did extract organs from the body, they had little real knowledge of anatomy. Egyptian art, both statuary and pictorial, does display a fairly good knowledge of surface and underlying structures (large bones and basic muscles). However, while both embalmers and artists did have some anatomical knowledge, from what we know, Egyptian physicians did not, or at least did not use anatomy in their practice. Their understanding of disease was largely physiological, and they had only the most basic understanding of the major organs and their functions.
  • Ancient Greece: Greek sculpture reflects incredibly accurate knowledge of surface anatomy, with attention to underlying bone and muscle structures. Physicians, however, were not very interested in anatomy. Dissection of humans was forbidden, and funeral practices centred on cremation (no corpses). Function was more important than structure—and the balance of the four humours was key. Hippocratic works do have some discussion of the treatment of fractures and dislocations—therefore extensive knowledge of bones and joints. In Alexandria, dissection of the bodies of criminals (alive or dead) was permitted after 300 B.C.—some new knowledge of lymph and vascular structures gained. However, these public demonstrations were not only to instruct, but also to horrify the populace.

Early Medieval Illumination of Man’s Anatomy

Galen’s Legacy

  • Galen: While dissections were again forbidden, Galen did gain some anatomical knowledge through his work treating injured gladiators and their wounds, and via his experiments and dissections of animals (pigs and rhesus monkeys). His writings became the authoritative view for the next 1000+ years, as his teleological perspective that all structures were ‘created’ for a specific purpose corresponded with the basic philosophy of the Church. While his successors did carry out some rare and ritualized dissections, they were not done to challenge Galen’s authority or to seek truth, only to confirm his writings.
  • Middle Ages: In the early Middle Ages, a few manuscripts contained anatomical illustrations (based on Persian and Arabic scholarship, which in turn was based on ancient Greek writings). In these stylized diagrams, the figures often squat froglike to expose their genitals, interior of their limbs, and strange internal systems representing organs, bones, muscles, and nerves.
  • Basic works and images such as ‘Zodiac Man’ tried to explain the relationship between the body and the external world and even to indicate auspicious times and sites to treat. Such figures synthesized information from the classical age, folk lore, astrology, and pseudo-sciences of the growing universities.

Medieval Illustration of ‘Zodiac Man’

Medieval Anatomy Lessons—The Body’s Organs

Medieval Anatomy

  • Medieval Treaties on the Body: In 13th and 14th centuries a reawakening of art and anatomy, related to legislative changes (some dissections allowed—often only once or twice a year), the decline of religious teaching, the rise of secular universities, and as reactions to medical threats such as new epidemic diseases. Christianity (due to ties between resurrection and the need for an intact body) still forbade dissection, but the Pope would sometimes grant special dispensations to medical schools such as Montpellier in southern France so that they could dissect (or even vivisect) condemned criminals. However, there was growing tension between schools and the Church authorities.
  • The few legal dissections that were allowed were very ritualized. The professor would sit high above in the background reading from a Latin edition of Galen, while below illiterate barbers would perform the dissection. Thus the wisdom of Galen lived on unchallenged. Also any differences that were noted between the Galenic ideal and the cadaver were easily explained by the imperfection of the mortal’s criminal body.

Late Medieval— Early Modern ‘Wound Man’

Body Systems in Medieval Anatomy

Anatomy in the Renaissance: The Body as Science and Art

  • Renaissance (1400-1600): A period of artistic and intellectual awakening in Europe, combined with a re-appreciation of the works of the Classical world.
  • In addition to changing economic, social and demographic pressures in Europe, the arrival of the plague also led people to question to wisdom of traditional authorities such as Galen. The plague was not described in Galen’s works, and the disease killed both good people and sinners, therefore leading citizens to question the power and views of the Church. The appearance of rotting corpses in the streets of Europe’s cities also led to a decline in peoples’ horror regarding human bodies. In Renaissance art, the body was now glorified, and this resulted to renewed interest in anatomy.
  • Renaissance artists such as Leonardo da Vinci were also often anatomists who performed dissections (in da Vinci’s case somewhere between 10 and 30). Leonardo was interested in the structure of the body and explored several anatomies, including bones, muscles, vessels, nerves and organs. Medical practitioners, however, remained relatively uninterested in anatomy, why? Except for fractures and dislocations, any alterations in structure were still impossible to fix. Thus, attempts to correlate disease to internal organs which could not be treated or altered was seen as a waste of effort.

Public Dissection of Corpse (Italy, 16th Century)

Study of Human Heart by Leonardo da Vinci

Anatomy’s Master and Masterpiece: Andreas Vesalius (1514-1564)

  • Andreas Vesalius published his De Humani Corporis Fabrica (The Structure of the Human Body) in 1543, fifty years after Leonardo’s drawings were composed. Born in Brussels, Vesalius studied medicine at Louvain in Belgium before moving to France where he was taught by a professor who continued to rely on Galen’s ideas. He then moved to Padua were anatomy was more important to medical studies. There he was awarded a doctorate and became a professor of surgery at the age of 23. He then began teaching anatomy, and conducting regular dissections. Although his book was based on his own observations, errors (such as incorrect body proportions, straight spine, shortened ribs and a five-lobed liver) remained, why? Possibly to soften reaction against his future work and to spare himself excess criticism from older, more traditional colleagues. In the cover of his work, we see Vesalius looking out at the reader while he himself dissects the corpse of a women (a mistress of a monk). The symbolism in this image includes: barbers fighting as they are displaced from the table; dogs and monkeys at the sides (Galen’s favorite subjects); and a skeleton at the back in the traditional location of the professor who read Galen while the dissection took place.

Cover of the De Humani Corporis Fabrica, 1543 edition

Anatomy’s Slowly Growing Role in Medicine

  • After the publication and dissemination of Vesalius’ Fabrica scientists began to pay more attention to structure. Work by later anatomists such as Gabriele Fallopio described additional workings and items of the body such as the inner ear, cranial nerves, and fallopian tubes.
  • Later anatomists and illustrators began to place skeletons in forests and other exotic settings, often in decided human (living) poses.
  • However, anatomy still had little to do with practical medicine. In the 16th century, anatomists concentrated on discovery and artistic portrayals of a healthy human form. They did not relate structure to disease. This trend did begin in the 17th century when scientists began to apply the new knowledge about structure to the study of function (physiology). For example, William Harvey’s work on the circulate of blood relied quite heavily on his teacher, Fabrizio’s demonstration of the valves in the veins.
  • Anatomy’s relevance to medicine continued to be ill-defined, why? 1) Continued aversion to human remains. 2) Even doctors who practiced anatomy could not think of how to apply it? Doctors could not diagnose internal changes until their patient was dead, nor could they correct problems anyway.

Anatomy Theatre in Leiden in 17th Century [below]

Male Torso from Side – Leonardo da Vinci [right]