|Year : 2016 | Volume
| Issue : 1 | Page : 135-143
Archives of anatomy from the 17th to 21st century
Venkatesh Gokuldas Kamath, Ramakrishna Avadhani
Department of Anatomy, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
|Date of Web Publication||2-Jun-2016|
Venkatesh Gokuldas Kamath
Department of Anatomy, Yenepoya Medical College, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
The article provides an insight into the history of anatomy and anatomical teaching from the 17th to 21st century. A form of teaching that commenced by expressing the anatomical intricacy using paintings, sketches, and models evolved into museums with formalin-preserved specimens, corrosion casts, plastination, and finally culminating in the contemporary museums with electronic screens and audiovisual aids. Anatomical teaching has evolved with time from blackboard teaching to use of overhead projectors, imaging, demonstrations, and simulation. Anatomy is a science which, to be expressed in all its grandeur, requires a combined teamwork of anatomists, renowned artists, modelers, technicians, and computer experts. The latest three-dimensional viewing capabilities will certainly be applied to teaching anatomy in future. This will enable a medical student to understand anatomy more appropriately in all its dimensions.
Keywords: Anatomy museums, formalin preservation, models, modern pedagogy, plastination
|How to cite this article:|
Kamath VG, Avadhani R. Archives of anatomy from the 17th to 21st century. Arch Med Health Sci 2016;4:135-43
| Introduction|| |
Teaching medical students, the structural disposition of organs, their histological complexity, and development, has been a challenging task for anatomists since centuries. Before invention of photography, the anatomists were solely dependent on artists and modelers to express the findings of dissection. Anatomy museums have also played a significant role in educating public regarding the intricacy of the human body. Early anatomy was expressed in the form of paintings and models prepared by renowned artists under the guidance of eminent anatomists and surgeons.
| A Teamwork of Anatomists, Surgeons, and Craftsmen|| |
Early anatomy flourished in an esthetic manner under the craftsmanship of artists and modelers guided by anatomists and surgeons. This association is evident in the works of Clemente Susini (1754-1814), Jan Wandelaar (1690-1759), and Gaetano Giulio Zumbo (1656-1701). Clemente Susini prepared over 2000 models during his career based on the dissections of the anatomist, Francesco Antonio Boi. The museum of anatomical waxes at University of Cagliari, Sardinia, Italy, houses some of the best models prepared by the modeler. Jan Wandelaar was an artist and engraver who assisted the Dutch anatomist, Bernhard Siegfried Albinus. He carved magnificent wax models showing biological systems, muscle masses, and cross-sectional models known for their true to live appearance. The collection is displayed at La Specola Collection in Florence. Established in the year 1775, the collection includes a life-size female figure called the “Medical Venus” that reveals the body structures. Gaetano Giulio Zumbo is known for the first colored wax models prepared in the late 17th century in association with the French surgeon, Guillaume Desnoues. The artists and modelers developed interests in learning dissection as their service was essential in illustrating anatomy to the medical students. Leonardo da Vinci (1452-1519) and Michelangelo (1475-1564) were two such artists, who significantly contributed to anatomy. Michelangelo, by the age of 18, performed his own dissections as is depicted in the article, “Michelangelo: Art, anatomy, and the kidney.” The Italian physician Guido da Vigevano is known for his contribution to neuroanatomy in the 14th century. His textbook “Anathomia” displays six plates showing for the 1st time several neuroanatomical structures and techniques such as trephination. A manual of anatomical dissection was written, printed, and published for the 1st time by Mondino de Liuzzi during this period. Fabricius painted over 300 paintings by 1600 and made the “Tabulae Pictae” a famous Atlas More Details of anatomy. Ercole Lelli (1702-1776) made models showing surface muscles called “Notomies,” which are exhibited in “The Museum of Human Anatomy of the University of Bologna,” which is one of the most ancient museums.
This period until the discovery of formalin in the mid-19th century was a time when anatomical knowledge was expressed exclusively through sketches, paintings, and models. Formalin discovery revolutionized anatomical teaching as it enabled long-term preservation of body parts. The anatomists could now preserve their dissection, and hence, dissection and demonstration emerged as the main pedagogy in the 19th century. [Figure 1] depicts portraits of eminent anatomists. [Figure 2] depicts the anatomical lessons of Dr. Nicolaes Tulp originally painted by Rembrandt, in 1632, which clearly indicates the association between artists and anatomists. [Figure 3] depicts a section with models of various body parts.
|Figure 1: Portraits of eminent anatomists. Courtesy Sri Devaraj Urs Medical College Anatomy Museum, Kolar|
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|Figure 2: The anatomical lessons of Dr. Nicolaes Tulp, originally painted by Rembrandt, in 1632 which clearly indicates the association between artists and anatomists|
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|Figure 3: A section with models of various body parts. Courtesy Yenepoya Medical College Anatomy Museum, Mangalore|
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| Formaldehyde Discovery and Emergence of Dissection in Anatomical Pedagogy|| |
Walker in his book “Formaldehyde” describes that Alexander Mikhailovich Butlerov (1828-1886) deserved to be remembered as the person who discovered formaldehyde. The book describes that formaldehyde was first prepared by Butlerov in 1859 as a product during an attempted synthesis of methylene glycol. In 1859, he published an accurate description of formaldehyde solution, formaldehyde gas, and formaldehyde polymer. He noticed the characteristic odor of the formaldehyde solution thus produced but was unable to isolate the unstable glycol as it decomposed immediately to give formaldehyde and water. The ease with which methanol gets oxidized from formaldehyde to formic acid and hence to carbon dioxide and water made the isolation of formaldehyde a difficult process. In 1868, August Wilhelm Von Hofmann solved this practical problem by passing a mixture of methanol vapors and air over a heated platinum spiral and prepared formaldehyde, thereby conclusively identifying it.
Ferdinand Blum is renowned for his studies on formaldehyde and its diverse applications. Blum diluted one part of commercial reagent with nine parts of water to give a 4% weight/volume solution with effective bactericidal properties. In his second paper on formaldehyde, Blum reported the excellent fixative properties of formaldehyde and the excellent staining results that were obtained using hematoxylin and aniline dyes. His reports solved a major problem in the development of histopathological techniques.
The concept of long-term preservation of the anatomical structures never existed before formalin discovery. It was accepted that the decomposition and disintegration of cadaver were an inevitable process before 1868 which prompted an early dissection, identification of structures, artistic sketching, and recording of findings. The invention of formalin gave a new dimension to anatomical teaching as it enabled gradual dissection without haste before the medical students. The dissected body parts could be preserved in museums for public viewing, and this fact is evident in the 19th-century museums which display formalin-preserved specimens. [Figure 4] depicts embryology specimens preserved in formalin. Consequently, the role of artists and modelers declined in the mid-19th century as is evident in the article “Artist versus Anatomist, Models against Dissection: Paul Zeiller of Munich and the Revolution of 1848” by Hopwood. Paul Zeiller (1820-1893) was a modeler who confronted the Professor of Anatomy of those times, claiming that the models created by him could prevent the practice of dissection of corpses as the practice of dissection was against religious sentiments. However, the time was changing and so was the acceptance of the common man who was now prepared to compromise strict religious views for scientifically understanding himself. The society was now prepared to amend the existing laws pertaining to dissection for the benefit of mankind. The article “Capital punishment and anatomy: History and ethics of an ongoing association” by Hildebrandt stated that the bodies of executed criminals were the only source of bodies for dissection between the 13th to early 17th century. In the late 17th century, some countries made unclaimed bodies legally available for scientific dissection. The British system abandoned the practice of use of bodies of executed people in the 19th century. The “Anatomy Laws” were finally passed in 1913 in America and London to put an end to illegal trafficking of cadavers, which was then rampant due to increasing demand for cadavers in new medical colleges. These laws were also passed in other countries worldwide which allowed unclaimed bodies to be consigned to medical institutes for dissection. The article “Modern grave robbers” by Ochani et al . stated that the practice of grave robbery which was rampant in the 18th century is still prevalent in several developing countries due to scarcity of skeletons because of religious interference.
|Figure 4: Embryology specimens preserved in formalin. Courtesy Kasturba Medical College Anatomy Museum, Manipal|
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| Invention of Dry Preservation Techniques|| |
The concept of dry preservation dates back to mummification in Egypt. The article by Saeed et al . described the various methods of preservation of bodies from the ancient Egyptian era to the 21st-century plastination. However, in mummification, the anatomical structures and relations cannot be visualized and studied. Preservation that demonstrates intricate anatomical details and relations requires scientific planning and approach, which utilizes a variety of resins and other substances which percolate the tissues and harden it without appreciable shrinkage and distortion. This approach was applied by anatomists in preserving brain slices, minute specimens such as skull bones and insects and in demonstrating the lumens of ureters, renal vessels, bronchial patterns, and other vasculature. Honore' Fragonard the eminent French anatomist prepared several dry anatomical specimens between 1766 and 1771 that have miraculously survived till today. In the 18th century, most of the French anatomists injected the vascular system with a colored mixture of wax, animal fat, and plant resins, and the body was dehydrated by immersion in a bath of alcohol. However, the procedure of the classical technique was not revealed by Honore' Fragonard. The technique of corrosion casts was applied to demonstrate the lumen of vessels and airways by anatomists such as Swammerdam, Boyle, Pecquet, Leiberkuhn, Hyrtl, Schiefferdecker, and Huntington. Govard Bidloo was perhaps the first to inject lungs with a complex alloy of bismuth and mercury. In 1906-1907, Robinson prepared paraffin casts of ureteral calyces. In 1926, Sincke described a technique of staining formalin-fixed brain slices using iron chloride and potassium ferrocyanide which distinguished the gray and white matter, and this technique was subsequently modified and perfected by Mulligan. The technique of Mulligan was modified by Roberts and Hanaway using the copper sulfate-phenol-ferrocyanide technique. The iron alum-tannic acid steps were eliminated; potassium ferrocyanide was substituted, and the number of wash times was reduced, thus simplifying the technique. Brain slices were also preserved by paraffin naphthalene impregnation. Naphthalene dissolves paraffin and renders opacity and white color to white matter and thus distinguishes it from gray matter. Histological sections can be taken from the slices even after several months which demonstrate excellent staining properties without appreciable shrinkage or distortion. Puckett and Neumann prepared vascular casts using vinylite resins as injecting agents which are durable, rigid, and most valuable in demonstrating vascular system in anatomy classes. A cast of entire vascular system of cat has also been successfully prepared by this technique. Sakla has described a method to preserve anatomical specimens in a dry state and the muscles, nerves, and vessels are also well appreciated in this technique. Perelygin and Krylova described a technique of embedding delicate and fragile specimens such as small skull bones, insects, and butterflies in organic glass (methyl methacrylate) without distortion of form and color. O'Sullivan and Stewart developed a freeze drying technique of dry preservation and produced specimens of larynx and intestinal arcades. Silva et al . have described a technique for the study of vascular anatomy of the liver by injecting a solution of acrylic into the portal vein and inferior vena cava. The surrounding soft tissues were then eroded using hydrochloric acid. The liver vasculature was thus visualized. The techniques mentioned above of dry preservation were perhaps the inspirational factors for the German anatomist, von Hagens, to dedicate his efforts toward plastination. The various attempts at dry preservation are summarized in [Table 1].
|Table 1: Chronologically depicts some of the dry preservation techniques|
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| Invention of Plastination and Its Pedagogic Applications|| |
Plastination was invented in 1978 at University of Heidelberg by von Hagens. The first paper describing this revolutionary method was published by von Hagens himself in 1979. In November 1979, the scientist applied for a German patent. In January 1987, the inaugural issue of the “Journal of the International Society for Plastination” was published. After obtaining the patents, the anatomist first established the Institute for Plastination in Heidelberg, Germany, in 1993. This was then followed by several exhibitions worldwide. von Hagens in his article “The current potential of plastination” stated that there are basically four varieties of polymers that are preferred depending on the intention behind plastination. When the intent is to produce durable plastinates for teaching purpose, silicone is preferred as the specimens impregnated with silicone are resilient, flexible, and durable and involves minimum equipment. When the intent is to produce thick slices of body parts, the second method is preferred using polymerizing solutions such as epoxy-silicone copolymer as these plastinates are rigid and can be polished. The polymerizing solutions give an astonishing contrast to these sections with the adipose tissue appearing bright white, and the rest of the parenchyma is intensely stained. When the intent is to produce 2.5 mm thin transparent slices of body parts or organs, epoxy resins are used and these plastinates are cast between polyester foils and/or glass plates and these can also be used for histological purpose. When the intent is to plastinate brain slices, the polymer of choice is polyester resin as it gives excellent differentiation between gray and white matter. The article by K C N et al . described the four classical steps of plastination which include fixation in 10% formalin, replacement of tissue fluid by acetone by freeze substitution where the tissue is placed in −25°C acetone for 4-5 weeks, forced impregnation of plastic polymer by replacing acetone in tissues using vacuum pumps and hardening of the polymer filled specimen with curing gas. Riederer in his article described the steps of plastination, followed at University of Lausanne, Switzerland. This includes dehydration of tissue which is carried out at room temperature by incubating in increasing concentrations of alcohol from 50% to 100% changing every 3rd day with final three incubations in 100% ethanol. This is followed by replacement of tissue fluid with acetone, followed by replacement of acetone in tissues by plastic polymer using vacuum pumps gradually applied over 4-5 days. Under vacuum, the acetone in tissue is replaced with S10. The last step involves curing using S6 cross-linker and UVA curing in case of thin slices of organs.
The applications of plastination in anatomical pedagogy are diverse as it enables handling of tissue with bare hands without any health hazards such as contact dermatitis and carcinogenicity which is observed with formalin specimens. Moreover, the specimens can be used outside the dissection laboratory for group demonstrations and discussions. Baptista and Conran have developed a technique of plastination of the heart with special emphasis on plastinated heart valves. It was observed that by plastination, the valves of the heart could be placed in the desired position and could be better visualized and studied. The production of a tracheobronchial cast by injecting the trachea with E RTV silicone has been described by Cope. Shimizu et al . have demonstrated a new innovative technique of teaching. The major vessels are irrigated with colored silicone and the neuroanatomical specimens are prepared by careful dissection. Three-dimensional (3D) stereoscopic pictures of the specimen are then obtained which can be viewed using a 3D viewer. The technique can also be applied to museums. Steinke et al . have discovered a new technique of light weight plastination using xylene and silicone and less of resin. Therefore, the method is more cost-effective. In the final step, xylene is substituted with air which reduces the weight of the specimens and also makes them dry and odorless. The University of Torino, Italy, decided to produce plastinated specimens due to decreased availability of organs in Italy due to religion and restrictive laws. The university has successfully produced high quality plastinated specimens of body parts including that of the brain with minimum shrinkage. Updike and Holladay have described a technique of plasticizing where air-dried organs are coated with a commercially available clear plastic compound which infiltrates the full thickness of the walls resulting in flexible models of hollow gastrointestinal organs. [Figure 5] depicts a luminal cast of tracheobronchial tree of sheep prepared by the first author.
|Figure 5: A luminal cast of tracheobronchial tree of sheep prepared by the first author|
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| Modern Pedagogic Approach|| |
The modern pedagogic practices are planned with an intention to improve the cognitive and clinical skills of the student. Sugand et al . in their article “The Anatomy of Anatomy: A review for its modernisation” have acknowledged the reducing role of dissection and didactic lectures in modern pedagogy. The article elaborately describes the pedagogic revolution that has taken place in the past few decades with more reliance on models, imaging, simulation, and internet with a motive to improve the learning experience. The article states that several leading universities have abandoned dissection completely in favor of multimodal teaching and amidst such a reform in curriculum, there is lack of uniformity and standardization among institutions which certainly is a cause of concern as to its efficacy and result. Modern teaching in universities involves demonstrations, PowerPoint presentations, group discussions, and seminars which enhance the interactive skills of the student. The demonstrations are made using plastinated specimens and models, and the students are encouraged to discuss relevant topics. Vorwerk et al . have developed a technique of producing anatomical facsimile models of the middle and the inner ear including cochlea and semicircular canals using rapid prototyping technologies and high-resolution computed tomography (CT) scans. These models are highly useful in training postgraduate students in microsurgical dissection and cochlear implantation and can also be preserved in museums. Harrild and Henriquez have developed a 3D computer model demonstrating the sequence of events involved in normal conduction in the human atria. Magnussen et al . have developed a 3D model showing the segmental anatomy of the lungs by combining the information from human axial CT scans with information gained from the injection of color-coded dyes into the segmental bronchi of human cadaveric lungs. Modern pedagogic practices encourage the innovation of such new techniques and focus on curricular reforms and their implementation.
| Flourishing Anatomical Display in Museums|| |
The concept of establishing a museum was perhaps with a purpose of educating the common man regarding the anatomical disposition of various organs in the human body. The Surgeons of Edinburg in the year 1699-1763 created a collection of anatomical specimens, pictures, and books called the “Cabinet of curiosities” which was perhaps one of the earliest museums in anatomical history. The museums, their collections, museum techniques, and methods of mounting and display have evolved with time over from the 17th to 21st century. The 17th and 18th century museums such as the Museum of Human Anatomy of the University of Bologna, The Anatomy Museum of Maples, and La Specola Collection in Florence consisted of artistic sketches and models. As formalin was discovered in 1868, the 19th and 20th century museums display formalin-preserved specimens in addition to models, sketches, and paintings. This transition is noted in museums such as the Hunterian Museum, Museum of the Royal College of Surgeons of Edinburg, Turin's Anatomy Museum of University of Turin, Italy, Anatomy Museum of Queen's University of Belfast, Oxford University Museum, and The Pedro Ara Anatomy Museum which are some of the renowned museums. The most famous anatomical collection in the 18th century was that of John Hunter which was housed at his house-cum-anatomy school in London's Leicester Square. The Museum of the Royal College of Surgeons of Edinburg opened to public in 1832 and has the largest collection of pathological anatomy in the United Kingdom. The Turin's Anatomy Museum of University of Turin, Italy, was established in 1739 and houses over 950 neuroanatomy specimens and models of brain. The Anatomy Museum of Queen's University of Belfast established in 1835 has osteology specimens, formalin-preserved specimens, a radiology section, and a section with portraits of all the past Professors of Anatomy and houses a vast collection of paintings of the late 19th century. The Oxford University Museum has a collection of ancient Greek skulls collected by the first anatomy and physiology Professor of the University, Professor George Rolleston (1829-1881). The Pedro Ara Anatomy Museum, founded in 1920 at the National University of Cordoba, Argentina, houses 1211 anatomical specimens. The most valuable work is named the “Old man's head,” made by Professor Pedro Ara in 1928-1929. Owing to its high quality, it remains unaltered despite being displayed for 85 years. The 21st century museums such as Anatomy Museum of Leiden Medical University in the Netherlands and the Museum of Kawasaki Medical School in Japan use electronic screens and audiovisual aids to educate the medical students regarding normal and pathological anatomies. This concept is described as digitalization of museums and involves the use of computer software and related digital technology and equipment for the purpose of medical and public education. The newer museums also store the specimen pictures and related information in computers that can be easily accessed by students, transferred into their I-Pads, and used for learning.
| Conclusion|| |
Anatomy is a science that has flourished over the centuries with novel inventions that have constantly altered its expression. From artistic sketches, paintings, and models in the 18th century to formalin-preserved specimens in the 19th century and to plastination in the 20th century, novel inventions have unveiled newer means of expressing anatomical intricacy. The anatomy museums have also flourished over the centuries and contributed significantly in educating medical students and the public. Anatomical teaching presently encourages a multimodal approach with less emphasis on traditional dissections. The author believes that the 21st century is yet to witness many more novel inventions which will again alter the course of anatomical pedagogy.
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