Surgical anatomy through ages


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Walk down historical timeline of development of surgical anatomy over the ages, down to the modern era, with some interesting anecdotal references, for the first year medical student

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Surgical anatomy through ages

  1. 1. Surgical anatomy through the ages Dr Sanjoy Sanyal Consultant surgeon and Professor Medical University of Americas, Nevis St. Kitts-Nevis, W.I. [email_address] Introductory presentation for 1 st year medical students
  2. 2. Contents <ul><li>Timeline: Walking down the centuries </li></ul><ul><ul><li>Greece </li></ul></ul><ul><ul><li>Italy </li></ul></ul><ul><ul><li>England </li></ul></ul><ul><ul><li>Modern </li></ul></ul><ul><li>Interesting historical highlights </li></ul><ul><ul><li>Religious restrictions to dissections </li></ul></ul><ul><ul><li>Socio-legal implications of restrictions </li></ul></ul><ul><li>Early anatomical depictions </li></ul><ul><li>Modern anatomy depictions </li></ul><ul><li>Concluding famous quotes </li></ul>
  3. 3. Timeline <ul><li>Oldest known medical science </li></ul><ul><li>Ancient (early) anatomy : 16 th century BCE to 2 nd century AD (Greece; ended with Galen) </li></ul><ul><li>Early (medieval) anatomy : 14 th to 16 th century (Started in Italy) </li></ul><ul><li>17 th -18 th century anatomy (Italy) </li></ul><ul><li>18 th -19 th century anatomy (England) </li></ul><ul><li>Modern anatomy : Last 100 years </li></ul>
  4. 4. Timeline cont’d <ul><li>Greeks </li></ul><ul><ul><li>Alcmaeon and Empodocles </li></ul></ul><ul><ul><li>Hippocrates : Father of Medicine </li></ul></ul><ul><ul><li>Aristotle </li></ul></ul><ul><ul><li>Herophilus / Erasistratus: 1 st human dissection </li></ul></ul><ul><ul><li>Galen : Dissected monkeys </li></ul></ul><ul><ul><ul><li>Considered Father of Ancient Anatomy </li></ul></ul></ul><ul><ul><ul><li>His publication was equivalent of ‘Gray's Anatomy’ of ancient world for 1500 years </li></ul></ul></ul>
  5. 5. Timeline cont’d <ul><li>Not much progress after fall of Roman Empire; </li></ul><ul><li>Marked the hiatus between 2 nd to 14 th century AD </li></ul><ul><li>Italy : Centre of Anatomy (Bologna, Padua) </li></ul><ul><ul><li>Mondino de Liuzzi, Alessandro Achillini </li></ul></ul><ul><ul><li>Andreas Vesalius : Dissected human bodies and disproved many of Galen’s work because they were animal models; Considered as Father of Modern Anatomy </li></ul></ul><ul><ul><ul><li>M. Realdo Colombo </li></ul></ul></ul><ul><ul><ul><li>Gabriele Falloppio </li></ul></ul></ul><ul><ul><li>Giovanni Filippo Ingrassias </li></ul></ul>Students
  6. 6. Fabrica title page <ul><li>Andreae Vesalii Bruxellensis, scholae medicorum Patauinae professoris, de Humani corporis fabrica Libri septem </li></ul><ul><li>( Andreas Vesalius of Brussels, professor at the school of medicine at Padua, on the fabric of the Human body in seven Books ) </li></ul>
  7. 7. Vesalius’ Fabrica
  8. 8. Vesalius’ work <ul><li>The Fabrica is known for its highly detailed illustrations of allegorical human dissections </li></ul>
  9. 9. Surgery in 16 th century Holland
  10. 10. <ul><li>Aris Kindt (Aris the Kid), a.k.a. Adriaan Adriaanszoon, was convicted of armed robbery in the Netherlands in early 1600s. He was sentenced to death by hanging </li></ul><ul><li>His body was autopsied by Amsterdam Guild of Surgeons on 16 January 1632 </li></ul>Autopsy was captured in 1632 by Rembrandt in his painting, Anatomy Lesson of Dr. Nicolaes Tulp , which depicts surgeon Nicolaes Tulp at work
  11. 11. Early craniotomy
  12. 12. Timeline cont’d <ul><li>England (19 th century) </li></ul><ul><ul><li>Descriptive Human Anatomy of previous century finalised / systematised </li></ul></ul><ul><ul><li>Histology and Developmental Biology </li></ul></ul><ul><ul><li>Gray’s Anatomy : Henry Gray compiled a single volume for ‘traveling’ doctor </li></ul></ul>
  13. 13. Timeline cont’d <ul><li>America and elsewhere (Last 100 years) </li></ul><ul><ul><li>Evolutionary and Molecular Biology </li></ul></ul><ul><ul><li>Endocrinology </li></ul></ul><ul><ul><li>Genetics </li></ul></ul><ul><ul><li>Radiological anatomy: X-ray, CT scan, MRI, PET scan </li></ul></ul><ul><ul><li>Visible Human Project (National Library of Medicine) </li></ul></ul><ul><ul><li>Photographic, computerized, 3-D, digital, animated depictions </li></ul></ul>
  14. 14. Early historical highlights <ul><li>(Against operating on humans and handling, and dissecting human cadavers) </li></ul><ul><li>Italy: Religious taboos </li></ul><ul><li>England: Socio-legal implications </li></ul>
  15. 15. Religious restrictions <ul><li>Italian Church abhorred spilling of blood </li></ul><ul><li>Only gallows victims were allowed to be dissected </li></ul><ul><li>Only in Italy (Padua, Bologna) could dissections be performed; Vesalius dissected in Padua </li></ul><ul><li>Only in Italy could female cadavers be dissected </li></ul><ul><li>Only certified / Royal anatomists could perform dissections; for 1-year term </li></ul><ul><li>City councilors sponsored dissections – charged admission fee </li></ul><ul><li>Attending dissections was legal </li></ul>
  16. 16. Religious restrictions <ul><li>Reprimand </li></ul><ul><li>Persecution </li></ul><ul><li>Imprisonment </li></ul><ul><li>House arrest </li></ul><ul><li>Banning publication </li></ul><ul><li>Burning publications </li></ul><ul><li>Death sentence </li></ul><ul><li>Galileo Galilie and Rene Descartes were 2 such victims of church persecution </li></ul>Rene Descartes Galileo Galilie
  17. 17. Socio-legal scenario <ul><li>Barbers : Only were permitted to perform minor surgeries (lancing abscess, removing corn etc) </li></ul><ul><li>Surgeons : But they needed to acquire skills and learn the human body </li></ul><ul><li>Anatomists : But human cadavers were difficult to come by </li></ul>Body-snatchers Grave robbers Thieves Murderers Gave rise to Gave rise to Took the help of Criminal gangs
  18. 18. Socio-legal scenario <ul><li>Reluctance of society to donate one's self for betterment of medical science </li></ul><ul><li>William Harvey , discoverer of circulation of blood, dissected both his father and his sister </li></ul><ul><li>The bodies were not donated for dissection with altruistic motives </li></ul><ul><li>They were attained by force, theft, body-snatching, grave-robbery, even murder </li></ul><ul><li>People do not wish to associate with that kind of history; Hence laws were enacted </li></ul>
  19. 19. Legal implications <ul><li>1752 — England’s Murder Act </li></ul><ul><li>1824 — Unclaimed bodies to be used for dissection </li></ul><ul><li>1825-26 — &quot;Great Inflation&quot;: grave robbers charged higher prices for corpses </li></ul><ul><li>1832 — Anatomy Act: allowed use of unclaimed pauper bodies from hospital for sale and dissection </li></ul><ul><li>1834 — Poor Law Amendment Act </li></ul><ul><li>TODAY — All bodies for dissection in teaching institutions are by donations </li></ul>
  20. 20. Modern cadaver dissection table
  21. 21. Autopsy dissection in progress
  22. 22. Early anatomy depictions Early anatomy depictions
  23. 23. Woodcut Wood engraving
  24. 24. Hand coloring Metal etching with acid
  25. 25. Metal mezzotint Copperplate Lithography
  26. 26. Modern anatomical depictions <ul><li>Color drawings / diagrams, </li></ul><ul><li>Photographic demonstration </li></ul><ul><li>Synthetic models </li></ul><ul><li>Radiological depictions </li></ul><ul><li>Digital radiography </li></ul><ul><li>3-D digital reconstruction </li></ul><ul><li>Animated depictions </li></ul>
  27. 27. Thoracic viscera Thoracic viscera
  28. 28. An old depiction of thoracic cage (left) vs. a modern depiction of same (right)
  29. 29. Photography
  30. 30. Synthetic model of brain
  31. 31. Skeleton – student demonstration
  32. 32. Plain X-ray mandible / cervical spine lateral view – a bullet is lodged inside!
  33. 33. DICOM chest x-ray
  34. 34. Visible Human Project – National Library of Medicine
  35. 35. 3-D digital reconstruction University of Colorado
  36. 36. Animated depiction Animated depiction
  37. 37. <ul><li>“ Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world.” </li></ul><ul><li>--Louis Pasteur </li></ul>
  38. 38. <ul><li>&quot;Don't be afraid to take a big step. You can't cross a chasm in two small jumps.&quot; </li></ul><ul><li>--David Lloyd George </li></ul>
  39. 39. &quot;You've made it this far. Keep going a little longer and you'll see the sun rise on a beautiful new day.&quot; --Ralph Marston