Clinical Anatomy (A Problem Solving Approach) Neeta V Kulkarni
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1INTRODUCTION2

ANATOMY—PAST, PRESENT AND FUTURE1

 
ANATOMY IN BRIEF
Anatomy is a branch of medical science that deals with understanding the structural organization of the human body so that the doctor knows (to quote few examples) which structure is affected in disease, which structure is examined by him/her and which structure is being cut during surgery. The deep interest in this branch of medical discipline is evident right from the dawn of civilization. The history of human anatomy occupies a prestigious place in 19th and 20th centuries as this science was even then thought of as one of the cornerstones of medical education. The term anatomy is Greek meaning to cut up. In older times anatomy and dissection were synonymous, so to do anatomy was considered to do dissection. However, now we know that dissection is one of the techniques to learn gross anatomy. The development of anatomy as a scientific discipline is a journey of ups and downs. It can be divided into various eras and centuries so that we get a glimpse of the chronology of the developmental landmarks and also about the trials and tribulations faced by the great scientists in the pursuit of the scientific knowledge of the subject.
 
Greek Era
Hippocrates of Greece (the father of medicine and founder of anatomy) is the first name in the period spanning 469 to 399 BC. He believed that illness has a physical cause and performed dissections on both animals and human. Herophilus (335 to 280 BC) from school of Alexandria in Egypt was the first to perform dissection of human body in public.
 
Roman Era
Claudius Galen described as prince of physicians ruled the medical science from 130 to 200 AD. He wrote extensively on human anatomy based on his dissections on monkeys and pigs. His authority on the subject remained unchallenged for several centuries.
 
Dark Ages
The period extending from 3rd to 13th centuries is called dark ages because there was no progress in science and arts in Europe.
 
Fourteenth Century
An Italian anatomist, Mondino (1276 to 1326) was credited as restorer of human anatomy as he taught anatomy by doing dissections on human bodies and wrote a book called Anathomia based on his observations.
 
Renaissance (15th and 16th Centuries)
This is a period when both arts and science were revived and flourished. Leonardo da Vinci (1452- 1519) was an artist, painter, mathematician and anatomist, all rolled into one. Vitruvian man was his most famous anatomical drawing of a geometrically proportionate human male. He was the inventor of cross sectional and illustrative anatomy.
Andreas Vesalius, a German anatomist and surgeon performed extensive dissections on executed criminals after obtaining special permission from the Pope. He was the first to describe accurate anatomy in his treatise in Latin called de fabrica humani corporis.
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Fig. 1.1: Andreas Vesalius—Father of modern anatomy
Vesalius truly challenged Galenean dogmas. Vesalius is aptly called the father of modern anatomy (Fig.1.1).
 
Seventeenth Century
William Harvey was credited with discovery of circulation of blood. It is reported that Harvey dissected his own freshly dead family members (father and sister) before burial to confirm his findings. Marcello Malpighi pioneered the use of microscope to understand the histological structure of human tissue (a beginning of microscopic anatomy).
 
Eighteenth Century
This is a very thrilling century as far as anatomy is concerned. Formalin as preservative was accepted world over. In England and Scotland, medical schools began to open and it became a tradition to rely on executed criminals for dissection. Anatomy museums came into being for which more cadavers were necessary. The shortage of cadavers led to crimes of grave robbing and resurrectionists flourished in 18th and 19th centuries. There are stories of medical students and professors indulging in grave robbing! The famous Hunter brothers, John Hunter and William Hunter were surgeons and self-learned anatomists. They built well known anatomy museums in London and Glasgow. Another epoch making event was the understanding of development of human organs. Von Baer was credited with the title of father of modern embryology based on his work in that field.
 
Nineteenth Century
In London and Scotland, it became a practice to obtain bodies for medical schools and for doctors interested in research, with the help of body snatchers. William Burke and William Hare in 1828 committed 15 murders of boarders who were late for paying rent in their boarding house (to sell their bodies to medical schools). To put a stop to this illegal trade, the Parliament in Great Britain passed Warburton Anatomy Act in 1832 under which only the unclaimed bodies were allowed for dissection apart from donated bodies. Dissection of human cadavers by medical 5students was made compulsory. Another epoch making discovery of the century was X- ray discovered by Rontgen in 1895 (a beginning of radiological anatomy). Henry Gray (1827 to 1861) was the English anatomist cum surgeon, who published first edition of Gray's anatomy in 1858 containing 750 pages and 363 illustrations.
 
Twentieth Century
With the advent of electron microscope and other technological advances, newer approaches to learning structure along with function were discovered. With the help of newer imaging techniques like CT scan, ultrasound, MRI, PET, etc. more and more emphasis on radiological anatomy was given. In late 20th century virtual reality was used to perform dissection on cyber cadavers.
 
Twenty First Century
Visible Human Project (VHP) created by NLM-NIH USA (National Library of Medicine in National Health Institutes in USA) is an excellent digital image library highly useful in orienting and associating the structures (seen in cadaver) in the exact location in the cross sections of the body. The changes in medical curriculum saw the onset of vertical and horizontal integrations by which one learns to apply the anatomical know­ledge to understand functions and diagnosis and treatment of diseases (a beginning of clinical anatomy). The objective of learning anatomy (prescribed in medical curricula the world over) is to use the anatomical knowledge in learning clinical problem solving skills.