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Capstone 1


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Capstone 1

  1. 1. NORTHERN ILLINOIS UNIVERSITY The Anatomy of Anatomy Education A Thesis Submitted to the University Honors Program In Partial Fulfillment of the Requirements of the Baccalaureate Degree With Upper Division Honors Department of Biological Sciences By Michael J. Mangino DeKalb, Illinois May 12, 2007
  2. 2. HONORS THESIS ABSTRACT THESIS SUBMISSION FORM AUTHOR: Michael J. Mangino THESIS TITLE: The Anatomy of Anatomy Education ADVISOR: Dr. Daniel R. Olson ADVISOR’S DEPT: BIOS DISCIPLINE: Anatomy Education YEAR: 2007 PAGE LENGTH: 14 BIBLIOGRAPHY: Yes ILLUSTRATED: No PUBLISHED: No COPIES AVAILABLE: Hard Copy ABSTRACT: The knowledge of human anatomy can be traced back for millennia to times of great philosophers such as Plato, Socrates, and Aristotle. The discipline has been embarked upon a journey riddled with tribulations and disputations until the early 1700’s and has endured provocations to remain steadfast in the midst of technological advancements. The following thesis covers a vast expansion across time and does not give favor to any particular time period. Rather it takes into account how contributions of those who founded the discipline advocated further understanding into a science that touched upon issues of morality and pressed forth following Socrates’ guiding rule: “Know Thyself.” 2
  3. 3. There are seven definitions of the word “anatomy” ( The general form that most often comes to mind is “the bodily structure of a plant or an animal or of any of its parts.” Anatomy can also mean “a detailed examination or analysis.” The context that follows will reveal how the foundations for anatomy education were laid. Knowledge of this subject can be extended by an overview of the history and philosophies involved with the exploration of human structures, a brief glance at some educational theory and methods, and an outline of the various methods used to teach anatomy in the twentieth and twenty-first centuries. The pillars which uphold the discipline today were not erected all at once and without expense. The knowledge of human anatomy may often be taken for granted and credit not given to those who possessed the desire to obtain knowledge of the unknown. A people without the knowledge of their past history, origin and culture is like a tree without roots. - Marcus Garvey Before traversing back several centuries to the beginnings of anatomical knowledge, tribute must be given to the rhetoric of what knowledge was considered to be and by what means it was acquired. The Aristotelian sciences would not quite communicate the same ideas of modern scientific knowledge in that it is guided by two main rules of conduct: only what is necessarily the case can be known scientifically and scientific knowledge is knowledge of causes 1. The natural philosophies of Aristotle were used to teach in many different disciplines and were profoundly intertwined with the discovery and teaching of the human structure. Aristotelian techniques were used by ancient physicians such as Hippocrates and Galen as well as anatomists Mondino dei Lucci, Barengario da Carpi, Andreas Vesalius, and William Harvey (French, 1994). One Aristotelian technique was known as demonstrative proof which makes the argument “that a thing can not be 3
  4. 4. otherwise” by way of demonstration (French, 1994). However, this method would prove to be inadequate when the demonstrations were those of living human functioning. Another method that was more readily applied to the field of anatomy took the form of commentary, a process described by French as being a “complex affair” that began with an introduction of the topic (accessus) and applied Aristotle’s four causes to the subject matter: • The material cause: “that out of which”, e.g., the bronze of a statue. • The formal cause: “the form”, “the account of what-it-is-to-be”, e.g., the shape of a statue. • The efficient cause: “the primary source of the change or rest”, e.g., the artisan, the art of bronze-casting the statue, the man who gives advice, the father of the child. • The final cause: “the end, that for the sake of which a thing is done”, e.g., health is the end of walking, losing weight, purging, drugs, and surgical tools. The examples given originated from the Stanford Encyclopedia of Philosophy (Smith, 2006) and can be summarized as follows: the statue is the final cause, the end product of the bronze (material) that gets its shape from the wax casting (formal cause) that was sculpted for it, but the efficient cause, “the primary source of the change or rest,” is ultimately the knowledge of bronze-casting that has been acquired and culminated by the artisan, who is merely a medium through which that knowledge is given form. The encyclopedia expands these four causes to the science of nature as being “concerned with natural bodies insofar as they are subject to change” and the factors that explain natural change to be matter, form, that which produces the change, and the end of this change. This will be seen in William Harvey’s methods regarding the motion of the heart and the circulation of the blood. The next step in the process of commentary was to divide the text into shorter sections and the author’s arguments analyzed one by one (expisito) by where the text’s organization was shown. The author may then be quoted and questions (quaestiones) 4
  5. 5. and/or doubts (dubia) about each section may be raised which the commentator resolved to come to a judgment (determination). French notes that these philosophical techniques were used in education to bring about consensus to generate an agreed knowledge among educated men. Commentary was probably the most widely accepted and utilized method when teaching from anatomical texts and the method by which the material was reviewed by other anatomists in order for consensus to be held. This consensus, French notes, was often strengthened by demonstrations at which highly respected noblemen were present. Galen often expedited the acceptance of his medical theories by such tactics and was among the first to be held in authority with respect to anatomical function and structure despite the fact that many of his observations, in fact, were deemed to be incorrect by others who studied human form as well. Now that the process of how knowledge was considered to be knowledge and how it was passed on, a review of a select few physicians, anatomists, and their contributions to the field of anatomy may be held in higher esteem. The study of living organisms can be dated as far back as the fifth and fourth centuries B.C. Hippocrates, known now as the founder of medicine, used examination and reasoning throughout his practice and it is believed that he was the first to adopt these methods (Amour, 1966). He is said to have held the belief that diseases had natural causes instead of supernatural punishments (Armour, 1966). He possessed a great ability to diagnose and cure which gained the trust of his patients. A philosophical reasoning he had determined from observations was his belief in the existence of four humors; blood, phlegm, yellow bile, and black bile and that there needed to be balance between them in order to maintain health. Although the four humors have long since been dismissed, it is his use of observation and reasoning that remains at the foundation of medicine today 5
  6. 6. (Armour, 1966 & French, 1994). Like Aristotle, Hippocrates was concerned with natural functions as was Galen. Galen was a Greek physician to the gladiators in the second century A.D. whose notoriety also had him appointed physician to his emperor, Marcus Aurelius (French, 1994. According to Roger French in his accord of early Western medicine, it was Galen’s ability to relate a “good story” to the ailments of his patients and the sometimes painful remedies to the structure and functioning of the body that confidence was instilled in him. Although educated in the ways of early philosophies, Galen ultimately sought out a better understanding of anatomy by performing comparative dissections on apes and pigs which lead to a finding that overturned a long held belief that arteries and veins were empty and carried air. He established instead that the arteries and veins of living animals in fact carried blood (French 1994, History World n.d.). This finding lead Galen to believe that blood flowed in a back-and-forth motion. Another of Galen’s landmark philosophies was that of the heart’s function and what would today be considered circulation. He stated that blood originated in the liver and was transported to the right auricle to by the vena cava and emptied into the right ventricle (French 1994). From here Galan thought blood to provide nourishment to the lungs via the pulmonary artery. His account thus far is fairly accurate until his explanation of how blood enters the left ventricle. He concluded that blood crossed the inter-ventricular septum through tiny pores to enter the left ventricle which he said contained spirit to then be distributed amongst the remainder of the body parts (French 1994). He believed the heart to be in diastole when the pulse was felt externally and associating the ‘suction’ of blood into the right ventricle to that of air being drawn into the lungs (Davenport 2002). 6
  7. 7. Galen would go on to publish additional writings about human structure and function such as On the Use of the Parts of the Body based widely on his dissections of apes and observations of various wounds during his role as physician to gladiators. His works carried authority over the centuries by way of seniority and his writings were accepted by the church due mainly to his theme, “each part, each kind of material, has its own natural actions . . . the body was created by a higher agency, which created with wisdom and foresight…” (French, 1994, p. 6) His works revered by medical students and praised upon by anatomists and philosophers were undisputed until the time of Andreas Vesalius in the sixteenth century, over one thousand years later. quot; must be given to observation rather than theories, and to theories only in so far as they are confirmed by the observed facts.quot; - Aristotle, On Generation of the Animals The ancient Greek physician was so highly venerated, according to French as well as others, that if while a teacher and assistant heading a dissection were unable to locate structures on the corpse according to Galen’s descriptions, then the degeneration of the body would be faulted and not his works. Vesalius used vivisection techniques and experiments that had been demonstrated by Galen (Frech 1994); however he would not adhere to Galen’s works in every respect. Galen’s vivisections were more concerned with demonstrating function while Vesalius’ primary focus was structure. Part of Vesalius’ outrage was that he believed that Galen, who had a longstanding reputation as an anatomical fount, had never performed dissection of a human being. He boldly states this in the preface to what is now known as the most detailed anatomical text of his time, De Humani Corpois Fabrica (Garrison & Hast (2003): “…even though it is just now known to us from the reborn art of dissection, from the careful reading of Galen’s books, and from the welcome restoration of many portions thereof, that he himself never dissected a human body, but in fact was deceived by his monkeys… In fact, you will find many 7
  8. 8. things in Galen which he misunderstood even in monkeys, not to mention the most astonishing fact that among the many and infinite differences between the organs of the human body and the monkey Galen noticed only those in the fingers and the flexion of the knee; he would no doubt have missed these as well, had they not been obvious to him without dissecting a human” (Vesalius). There was a great deal of controversy concerning Vesalius’ zealous opinions that placed his integrity into question. Nonetheless his books were the birth of an unrivaled text that made use of a revolutionary form of printing known as woodcut that was able to accurately transfer the numerous meticulously detailed illustrations into seven volumes of anatomical contents (French 1994 & History World n.d). Vesalius’ main focus was on structure and the accuracy with which it was recorded. However, when he says, “In contemporary terms, dissection of the dead body revealed the number, site, figure, property of substance and composition, after which function was to be sought” (French, 1994, pg. 26) he is attesting the relationship between structure and function. The use of dissection for attribution of function would not held in high regards until the time of William Harvey. French documents the beginnings of Harvey’s career and well beyond his determination of the heart’s motion. In 1609 Harvey held the place of physician at St. Bartholomew’s Hospital in England and was appointed lecturer at the College of Physicians in London in 1615. French notes that Harvey’s observations that led to his resolution of the heart’s motion and circulation came not from a desire to prove the long held beliefs of Galen erroneous, but was thought to have come from a desire to adhere to Aristotelian doctrine; to “give an account of the heart’s action as part of proper knowledge about it.” Galen used careful observations that were reinforced by powerful and persuading theories when questions and doubts arose during those observations. (Boylan, 2006). It was Galen’s use of Aristotle’s critical empiricism that enabled Harvey to indisputably show through his own observations and vivisectional experiments that 8
  9. 9. Galen’s theories and conclusions about the heart’s motion and circulation of blood were mistaken. Harvey was known to have conducted numerous vivisection experiments with animals which led to the publishing of his findings in On The Motion Of The Heart And Blood In Animals, 1628 (French, 1994 & Harvey,1628). It was here documented that Harvey proposed ideas contrary to Galen’s conception of the heart’s motions. Harvey gives his conclusions as follows: 1. That the heart is erected, and rises upwards to a point, so that at this time it strikes against the breast and the pulse is felt externally. 2. That it is everywhere contracted, but more especially towards the sides so that it looks narrower, relatively longer, more drawn together. The heart of an eel taken out of the body of the animal and placed upon the table or the hand, shows these particulars; but the same things are manifest in the hearts of all small fishes and of those colder animals where the organ is more conical or elongated. 3. The heart being grasped in the hand, is felt to become harder during its action. Now this hardness proceeds from tension, precisely as when the forearm is grasped, its tendons are perceived to become tense and resilient when the fingers are moved. 4. It may further be observed in fishes, and the colder blooded animals, such as frogs, serpents, etc., that the heart, when it moves, becomes of a paler color, when quiescent of a deeper blood-red color. These conclusions led him to believe that the long held beliefs of diastole and systole to be incorrect and that it was forceful contraction that caused the pulse to be felt (Harvey 1628). His newfound ideas of the heart’s motion along with additional vivisection experiments led to the deduction of circulation in his publication De motu cordis (French, 1994). Though Harvey knew his observations accurate and his conclusions correct, he did not want to hastily reveal them to boldly contradict what was considered to be authoritative knowledge that had been accepted for centuries. As French notes, Harvey felt the need to present his findings by obsignatis tabulis, which translates to ‘with properly attested evidence’ or ‘in strict accordance with proper procedures.’ Rather than seeking an agreement or consensus from his audience it seems as though Harvey desired 9
  10. 10. to present his findings in the form of a “practical proposition” by saying “whereby I offer it to you to perceive and judge” (French, 1994, pg. 75). Harvey’s findings were presented in anatomy lectures and were repeatedly disputed in accordance to Aristotle’s natural philosophy and contested based on longstanding principles regarding the heart and its relation to the blood. Some embraced Harvey and yet others rejected him and stood in defense of ancient knowledge. It was not until nearly twenty years after the publishing of De motu cordis that his conclusions were accepted by those who had previously opposed him. From this point until the second half of the 19th century, anatomical knowledge was culminated and its study was considered to generate professionalism among those who aspired to obtain this knowledge (Warner & Rizzolo, 2006). The dissection of cadavers was highly esteemed among medical students and was believed to be a necessary right of passage for them. Even though human dissection was not required to receive an M.D. degree in the mid-19th century, it was still considered to be of value due to the “hands on study [that] was pursued systematically in groups” (Warner & Rizzolo, 2006, pg.404). However, anatomy education was forced to maintain its position within the advents of the scientific method prior to the turn of the century until the 1950’s. Anatomy was not the only discipline to be under duress at this time, rather the entire educational system struggled between traditional and progressive approaches. Although it will not be covered in nearly as much detail as the topic deserves, both the traditional and progressive approaches will be outlined and the position of anatomy education within them will be explored. William Hayes’ book The Progressive Education Movement: Is it Still a Factor in Today’s Schools (Hayes, 2006) does not outline traditional and progressive approaches to education in terms of right and wrong, rather he compares the two and illustrates the view 10
  11. 11. that each holds in regards to matters of curriculum, the teacher’s role, and methods of instruction: 1. The traditional approach to curriculum and educational standards in the U.S. are set by the state. 2. The teacher’s primary function is to give introduce students to content knowledge and skills as outlined in the mandated curriculum. 3. Primary methods involve the use of textbooks and as well as other sources of presentation and assignments. The Progressive approach takes nearly the exact opposite stance on the preceding issues: 1. The progressive approach has a curriculum that is more flexible and is influenced by the students’ interests. 2. Teachers operate by facilitating learning in a wide variety of environments so that it may be promoted by discovery. 3. Progressive methods utilize a wider array of materials and activities that allow individual and group research. The place of anatomy can lie at either end of this spectrum or anywhere between. While it is true that these issues are the main concerned with public schools (K-12), they have overtones at all levels of education including community colleges as well as state and private universities (Hayes, 2006). Some methods of teaching in institutions of higher education include discussion and, the more familiar, lecture (McKeachie, 2002). He also illustrates how lectures and discussions can be supplemented by writings, peer tutoring, problem-based learning, as well as other methods to better facilitate learning. Anatomy is typically taught, especially in medical universities, using a balance of lecture and discussion and it is almost always complimented with a laboratory that can either consist of the classical dissection of cadavers, plastinated models of skeletons and other anatomical displays, or both (Reidenberg & Laitman, 2002). The lecture is the method of choice for presenting material in anatomy (Clinical anatomy-PO-Meded-99). The underlying structure of the lecture can take two different 11
  12. 12. approaches; regionally (traditional) or by systems (Moore & Daley, 2006, Martini et al., 2003) In the traditional approach the body is divided into seven main regions: head and neck, upper limbs, thorax, back, abdomen, pelvis and perineum, and lower limbs (Moore & Daley). The extremities and organs situated in each region are examined in levels that include a layout of the surface anatomy down to the structures of the bones and the muscles, nerves, arteries, and veins that lie between. This approach is typically reserved for students that are enrolled in medical school or professional programs such as physical therapy, physician’s assistant, dental hygiene, and other positions that require an extensive knowledge of anatomical structure. Courses such as these are extremely rigorous and exhaustively time consuming and present an extensive amount of information in an amount of time that is minimally sufficient. This can lead the student into the undesired realms of rote memorization when deep understanding that is woven with threads of newly acquired knowledge is desired. Unfortunately the same can hold true for the systemic approach. As the name implies, the systemic approach is concerned with the systems of the human body. They include the skeletal, musculature, nervous, integumentary, circulatory, respiratory, digestive, reproductive, lymphatic, and endocrine systems (Martini et al., 2003). This approach is generally taken by undergraduate freshmen and sophomores who are only beginning to obtain a notion of the dedication required to meet the demands of a critical college curriculum. Teaching anatomy based on bodily systems is designed to prepare students who intend on pursuing higher education in which extensive knowledge of human anatomy is a major component. Courses such as this introduce the unfamiliar language that is an intimate part of anatomy and familiarize students with structures that many do not realize even existed. This can be an exciting period where treasures of knowledge can be pulled from a stormy sea of information. 12
  13. 13. However, with the demands of other courses rallying for attention, it also runs the risk of forming a frozen pond which the student either quickly skates across to reach the other side or one that they loose balance on and collide with the ice without ever breaking the surface. Fortunately there have been several advents composed of a wealth of modern technology to supplement the ‘traditional’ of methods lecture and laboratory. Technological advancements are ever changing the face of education and so must anatomy education to meet the needs and expectations of future generations. Many medical schools and other health professions world-wide have responded to the cross- generational differences by supplementing their gross anatomy classes with new imaging technology such as laparoscopy, ultrasonography, multi-planar MRI, and plastianted prosections (Reidenberg & Laitman, 2002). Lectures are being enhanced also by Computer Assisted Learning (CAL) (Elizando-Omana et al., 2004), animated Power Point presentations with digital imaging and recordings of laparoscopic procedures performed on live patients (Reidenberg & Laitman, 2002), and some sing praises to problem based learning groups and peer teaching (Prince et al., 2003, Johnson, 2002). An effort has been made to empirically study the effect that these and additional technologies have on the desired outcome of rigorous anatomy classes. Many of the results confidently support the positive prospects that these additions can bring to the highly respected and irreplaceable art form of human anatomy education. The sect that human anatomy holds in school curricula takes not only an immense level of discipline and dedication, but also a sense of curiosity and courage. This undoubtedly was never truer for those who were given the task of accurately mapping out the uncharted territory that lay beneath our skin. During ancient times when the unknown was feared and ignorance reigned, those who spoke out against what was thought to be true were retaliated upon, outcast, and some were even executed. It was the 13
  14. 14. same philosophies with which the first discoveries of human anatomy were made that pulled anatomical knowledge from the rut of repetitive error. Philosophies of Aristotle, Hippocrates, and Galen (although some of his theories were found to be erroneous, his contributions to the science were insurmountable for his time) were passed down to others who possessed a passion for knowledge for centuries unchanged until it came to those with not only a passion for knowledge, but also tenacity for truth. Included among those are Mondino dei Lucci, Barengario da Carpi, Andreas Vesalius, and William Harvey and others; all of whose names can be accredited to an exhaustive list of contributions that helped to bring knowledge to a vast consensus based on ancient philosophical reasoning, careful observations, innovative experiments, and empirical evidence. Just as the face of anatomy education had undergone structural alterations as time drew nearer to the present, so did the pedagogical methods underlying the foundations education. As anatomy struggled to find its place among the blinding array of emerging sciences, it has grown to harness the technology produced to positively benefit those who strive to master knowledge of the human body. Education is not preparation for life; education is life itself. - John Dewey 14
  15. 15. Resources: anatomy. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved April 02, 2007, from website: Armour R. (1966). It all started with Hippocrates. New York: McGraw-Hill Book Company. Boylan M. (2006). Galen. The Internet Encyclopedia of Philosophy. Retrieved march 10, 2007 from <> Cahill DR, Leonard RJ, Marks Jr SC. (2000). A comment on recent teaching of human anatomy in the United States. [Electronic version]. Surgery Radiology and Anatomy, 22, 69-71. Davenport J. (2002). William Harvey and his legacy. Royal College of Physicians, 2, Nov/Dec, conference report. Elizondo-Omana R., Morales-Gomez J. A., Guzman S. A., Hernandez I., Ibarra R. P., & Vilchez F. C. Traditional teaching supported by computer assisted learning for macroscopic anatomy. [Electronic version]. The Anatomical Record, 278B, 18-22. French R, William Harvey’s Natural Philosophy. New York, NY: Cambridge University Press, 1994. History of Anatomy. History World n.d. Retrieved February 24, 2007 from < groupid=44&HistoryID=aa05> Harvey W. (1628). On the motion of the heart and blood in animals. Modern History Sourcebook (1998), Robert Willis (trans.), URL = <> Hayes W. (2006). The progressive eduation movement: is it still a factor in today’s schools. Maryland: Rowman and Littlefield Education Johnson J. Importance of dissection in learning anatomy: personal dissection versus peer teaching. [Electronic version]. Medical Education,15, 38-44. Prince K. J. A. H., van Mameren H., Hylkema N., Drukker J., Scherpbier A. J. J. A., & van der Vleuten C. P. M. Does problem-based learning lead to deficiencies in basic science knowledge: an empirical case on anatomy. [Electronic version]. Medical Education, 37, 15-21. 15
  16. 16. Martini F, Timmons M.J., Tallitsch R. B., Ober W.C., Garrison C. W., Welch K., Hutchings R. T. (2003). Human anatomy,4th ed. United Kingdom: Pearson Education LTD. McKeachie W. J. (2002). McKeachie’s teaching tips: strategies, research, and theory for college and university teachers. Massachusetts: Houghton Mifflin Company. Moore K.L., Dalley A. F. (2006). Clinically oriented anatomy, 5th ed. Maryland: Lipponcott Williams & Wilkins. Reidenberg J.S., Laitman J.T. (2002). The new face of gross anatomy. [Electronic version]. The Anitomical Record, 269, 81-88. Smith, Robin, quot;Aristotle's Logicquot;, The Stanford Encyclopedia of Philosophy (Winter 2006 Edition), Edward N. Zalta (ed.), URL = < win2006/entries/aristotle-logic/>. Vesalius A. (1542). De Humani Coropis Fabrica. (2003) Garrison D. H. & Hast M. H. (trans. & ed.), URL = <> Warner J. H. & Rizzolo L. J. (2006). Anatomical instruction and training for professionalism from the 19th to the 21st centuries. [Electronic version]. Clinical Anatomy, 19, 403-414. 16