The document discusses the significance of cadaveric dissection in medical education, highlighting its historical importance and ethical considerations. Cadavers serve as essential tools for teaching anatomy, allowing students to understand the human body in a respectful and detailed manner. The document also addresses the need for body donation awareness and proper conduct in dissection halls to promote ethical educational practices.

1. ________________________________________________________________________
a
Department of Anatomy, Government Medical College, Nandurbar, Maharashtra, India.
b
Department of Anatomy, Government Medical College, Nagpur, Maharashtra, India.
++
Assistant Professor;
*Corresponding author: E-mail: drharrywan@gmail.com;
Chapter 12
Print ISBN: 978-81-19102-33-4, eBook ISBN: 978-81-19102-34-1
The Cadaver as Our First Teacher
Harish Wankhede a++*
and Dipti Nimje b++
DOI: 10.9734/bpi/rdmms/v4/4527C
ABSTRACT
Medical care is growing fast in technical tools so focus of medical education has
become more centered on procedures. Cadaveric dissection is an ancient
learning tool for medical students. The dissection of a body must be carried out in
a respectful manner to show gratitude towards the deceased person till very end.
Cadaveric dissection has been the paradigm of anatomy teaching since
centuries.
Keywords: Cadaver; embalming; anatomy act; dissection; teacher.
1. WHY CADAVER IS OUR FIRST TEACHER [1,2,3]
- Anatomy is the true essence of basic subjects which gives the medical
students their very first exposure to human body and helps them
overcome their inhibitions. It was Susruta's belief that
for one to be a skilful and erudite surgeon, one must first be an
anatomist.
- Cadaver is first teacher in medical education and without its availability
medical education would come to standstill and are therefore the valuable
gift to medical education because cadavers can’t be manufactured like
other study material.
- Cadaveric dissection has been the paradigm of anatomy teaching since
centuries.
- Practice of cadaveric dissection help students to grasp the three
dimensional anatomy and innumerable variations.
- Cadavers are required for studying the human anatomy in all disciplines of
medical science.
- Students in our country have got enormous opportunity of
dissecting cadavers and learning, especially in government medical
colleges.
- It is very interesting to know that the medical students of Thailand speak
of the cadavers as ‘Ajarn Yai’ which means ‘Great Teacher’.

2. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
187
2. USE OF CADAVER TO STUDY HUMAN ANATOMY: A
HISTORICAL ASPECT [4,5]
Maharishi Susruta (6th Cent BC):
- The Susruta Samhita was written by the famous physician and surgeon
Susruta in the 6th century BCE.
- He is called as Father of Surgery.
- In Susruta's work, it is evident that considerable thought was given to
anatomical structure and function, as Susruta was a proponent of human
dissection; his texts include a systematic method for the dissection of the
human cadaver.
- There is also compelling evidence suggesting that the knowledge of
human anatomy was revealed by both inspection of the surface of the
human body and through human dissection, as he believed that students
aspiring to be surgeons should acquire a good knowledge of the structure
of the human body.
- Interestingly, in neither the writings of Susruta or of Charaka are there any
indication that animal dissection was practised. Their anatomical
knowledge, therefore, appears to have been gained from human
dissection.
- Moreover, their writings show a considerable familiarity with the bones of
the human body.
- The Sarirasthana in Susrut Samhita is made up of 10 chapters regarding
the study of human anatomy. According to the Susruta Samhita, medical
students should be taught the art of making cuts in the body of a
puspaphala (a kind of gourd), alavu (bottle-gourd) or ervaruka (cucumber)
prior to dissection of human cadavers.
Herophilus (335-280 BC):
- Father of Anatomy.
- Was one of the first to dissect the human body and doing public
dissections on human corpses.
- Herophilus studied the ventricles (cavities) of the brain; traced the sinuses
of the dura mater to their junction, known as the torcular Herophili. He
described the floor of 4th ventricle of brain as calamus scriptorius.
- He described and named the organs duodenum and prostate gland.
- He was first to measure the pulse, for which he used a water clock.
- Herophilus wrote at least nine works, including a commentary on
Hippocrates, a book for midwives, and treatises on anatomy and the
causes of sudden death, all lost in the destruction of the library of
Alexandria (AD 272).
Leonardo da Vinci (1452-1519AD):
- One of the greatest painters of all time.
- His most famous art work was Mona Lisa, The Last Supper, Vitruvian
Man.

3. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
188
- His most penetrating anatomical study began in 1506 with his dissection
of a 100-year-old man, whose peaceful death he had just witnessed.
- His earlier dissections and drawings were of animals and many of his first
human images were anatomically inaccurate and based on studies done
by Galen (129-216 AD).
- He dissected around 30 corpses.
- da Vinci must have been an extremely skilled dissector; his post-mortem
material was not chilled, embalmed or fixed. Fine dissection of the brain
and other soft tissues must have been a huge challenge.
- da Vinci was accused of ‘unseemly conduct’ (and perhaps witchcraft) and
his anatomical studies were ceased.
Andreas Vesalius (1514-1564 AD):
- Was a 16th-century anatomist, physician, and author of one of the most
influential books on human anatomy, De humani corporis fabrica (On the
Fabric of the Human Body).
- Vesalius is often referred to as the founder of modern human anatomy.
- He studied the theories of Galen and developed an interest in anatomy,
and he was often found examining excavated bones in the charnel houses
at the Cemetery.
- Previously anatomy had been taught primarily from reading classical texts,
mainly of Galen, followed by an animal dissection. And no attempt was
made to confirm Galen's claims.
- Vesalius, in contrast, performed dissection as the primary teaching tool,
handling the actual work himself and urging students to perform dissection
themselves. He considered hands-on direct observation to be the only
reliable resource.
Pandit Madhusudan Gupta (1800-1856 AD): [6]
- He was a Ayurvedic practitioner who was also trained in Western
medicine and is credited with having performed India's first human
dissection at Calcutta Medical College (CMC) in 1836 along with his four
students, almost 3,000 years after Sushruta under the guidance of
Professor Henry Goodeve. He was fundamental in gathering Indian
support for practical anatomy and in breaking down Hindu taboos on
touching the dead.
3. ETHICS AND CADAVER DISSECTION [7]
- According to principle of autonomy each individual should have
autonomous control over the disposition of his or her body after death.
Means what should or should not be done with his or her body at death,
despite of social need or public interest.
- This principle was overlooked, in fact ignored till 1950s in society. And
unclaimed bodies has become the integral part of anatomical study.
- Use of human cadavers for teaching and training purposes is surrounded
by ethical uncertainties out of which main ethical concern lies in respect to
human life.

4. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
189
- Dissection hall is the ideal place to introduce concepts of humanistic care
and values immediately, laying a foundation for their clinical training.
- Bombay Act No. XI of 1949 passed by Law & Judiciary Department. Now
called as Maharashtra Anatomy Act .
- It is a act to provide for the supply of unclaimed bodies of deceased
persons and, for donation before death by a person of his body or any part
of his body after his death to hospitals and medical and teaching
institutions for therapeutic purpose or for the purpose of medical education
or research including anatomical examination and dissection. Whereas it
is expedient to provide for the supply of unclaimed bodies of deceased
persons.
4. SOCIAL VIEW OVER USE OF CADAVERS IN MEDICAL
TEACHING AND BODY DONATION [8,9]
- With increasing number of medical colleges over India the demand of
cadavers for education and research is growing.
- Many religions support the idea of body donation.
- Guidelines are issued under Anatomy Act for accepting bodies for
donations in medical colleges through a willed body program.
- In a survey it was found that only 32% general population is aware of body
donation and only 20% of it is willing to donate their bodies.
- Factors such as social awareness, cultural attitude, and religious believe
and customs related to postmortem ritual, fear of donated body will not be
treated with respect and dignity and unacceptability of dissection on body
influences the person decision to become body donor or to donate
relative’s bodies.
- To overcome this factors efforts are taken by medical college staff and
social workers jointly to change the mindset of society through body
donation awareness campaigns, proper guidance and assistance
regarding body donation.
5. EMBALMING
- Embalming is a process of treatment of a dead body so as to protect it
from decay. Embalmment is defined as the ‘treatment (of a dead body) –
with special chemicals – so as to protect from decay’
History:
- The beginnings of the art and techniques of embalming are associated
principally with ancient Egypt, where, as in parts of Asia and South
America, a dry soil and climate encouraged its development.
- In ancient time embalming methods were well described in 5th century BC
by Greek historian Herodotus. During the middle Ages embalming was
done by specialists who employed the elaborate Egyptian method.
- Leonardo da Vinci, who dissected at least 50 cadavers for study,
developed a method of venous injection for preserving them that
anticipated modern embalming procedures.

5. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
190
- Development of modern embalming: Embalming by arterial injection as a
mortuary practice is considered to have begun in England in the 18th
century. The technique had actually been developed by William Harvey in
experiments leading to his discovery of the circulation of blood, during
which he injected coloured solutions into the arteries of cadavers.
- For cadavers embalmed for dissection by medical professionals, students,
and researchers the first priority is for long-term preservation, not
presentation. Medical embalmers use anatomical wetting fluids that
contain concentrated formaldehyde (37–40%, known as formalin) or
glutaraldehyde.
- The first documented embalming of a human cadaver with formaldehyde
is believed to have occurred in 1899.
Embalming procedure [10,11]:
Anatomical embalming is performed into a closed circulatory system. The fluid is
usually injected with an embalming machine into an artery under high pressure
and flow, and allowed to saturate the tissues. The venous system is generally
opened and the fluid allowed to drain out initially, although many anatomical
embalmers do not use drainage technique.
Anatomical embalmers may choose to use gravity-feed embalming, where the
container dispensing the embalming fluid is elevated above the body's level, and
fluid is slowly introduced over an extended time, sometimes as long as 24hrs.
No separate cavity treatment of the internal organs is given.
Anatomically embalmed cadavers have a typically uniform grey colouration, due
to the high formaldehyde concentration mixed with the blood. This grey
discoloration is also known as "formaldehyde grey" or "embalmer's grey".
Types of embalming procedure:
1) Arterial embalming: It involves the injection of embalming chemicals into the
blood vessels, usually via the right common carotid artery. Blood and interstitial
fluids are displaced by this fluid. Excess arterial solution and blood clots are
expelled from the right jugular vein referred to as drainage. The embalming
solution is injected with a centrifugal pump or gravity method. The embalmer
massages the body to break up circulatory clots so as to ensure the proper
distribution of the embalming fluid. This process is known as a single-point
injection.
2) In cases of poor circulation of the arterial solution, additional injection points
like axillary, brachial, or femoral arteries, with the ulnar, radial, and tibial vessels
if necessary are used for injecting fluids. This is called as multi-point injection
method.
In some cases draining from a different site from injection (i.e. injecting arterial
fluid into the right common carotid artery and draining from the right femoral vein)
is referred to as a split embalming.

6. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
191
In many cases, an embalmer use to perform pre-injection were water is injected
from artery and vein is cut open to remove clots and residual blood.
2) Cavity embalming: The embalmer makes a small incision just above the
navel and pushes the trocar into the abdominal cavity. The embalmer then fills
the cavities with chemicals (known as Cavity Chemicals) that contain
formaldehyde, which are also delivered to the chest cavity via the trocar inserted
through the diaphragm. The incision is sutured closed.
3) Hypodermic embalming: It is a supplemental method which refers to the
injection of embalming chemicals into tissue with a hypodermic needle and
syringe, which is generally used as needed on a case-by-case basis to treat
areas where arterial fluid has not been successfully distributed during the main
arterial injection.
4) Surface embalming: An another supplemental method, utilizes embalming
chemicals to preserve and restore areas directly on the skin's surface and other
superficial areas as well as areas of damage such as from accident,
decomposition, cancerous growths, or skin donation.
 Later 3 procedures are used additive to the arterial embalming.
Aims of embalming for anatomical purposes are:
The thorough and complete preservation.
The softness of the tissues, as they are found in the unembalmed subjects. The
colour of the muscles and organs, the securing at least of a brown dark colour for
the muscles.
The distension and the colouring of the arteries.
Composition of embalming fluid: [12,13]
- Components of embalming fluids can be grouped as preservatives or
fixatives, germicides (disinfectants), modifying agents [buffers, surfactants
(wetting agents like glycerine), anticoagulants], dyes, vehicles and, finally,
perfuming agents.
- Composition and quantity of embalming fluid used for embalming varies
from region to region depending upon the climatic conditions of that region
and type of dead body (thin or fatty).
Compositions of embalming fluid: Formaldehyde (37-40% w/v)- 1ltr Methyl
Alcohol/ Spirit- 1.5 ltrs Phenol/ Carbolic crystals- 800gm Glycerin- 500ml
Tap water- 3ltrs Eucalyptus oil- 10ml Eosin- 5ml
Natekar’s embalming fluid: Glutaraldehyde (2%)- 5ltrs; Methyl Alcohol/ Spirit-
2ltrs; Glycerin- 500ml; Centrimide (Antifungal)- 500ml; Eosin- 50ml; Tap water-
5ltrs; Eucalyptus oil- 25ml; Eosin- 50ml

7. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
192
Cavity embalming fluid:
Formalin- 5-6ltrs
Methyl Alcohol/ Spirit- 1ltr
Glycerin- 500ml Salt- 200gm Thymol- 50gm Tap water- 3-4ltrs
6. CARE OF CADAVER
- Cadavers are preserved by injecting the embalming fluid though it requires
utmost care once dissection starts because fluid starts oozing out once
incision is taken.
- Cadaver and its dissected part should be kept moist at all times specially
during dissection in dry weather.
- Cadaveric dissected parts should be covered with cotton gauze rolls
dipped in embalming fluid.
- Dissected cadavers should be properly dipped in tank filled with
preservative fluid after dissection is over.
7. DISSECTION HALL ETIQUETTES
- Working with human tissue requires respect and sensitivity.
- Following guidelines and rules will help the students to understand their
responsibilities while handling the human tissue in dissection hall.
1) Most of our cadavers are obtained through body donation without any
financial compensation. Hence, it is important to give proper respect to the
cadavers. Any disrespect for the cadaver will be disgraceful act as a
human being.
2) Students should maintain professional conduct while in the dissection hall
and outside of the hall, particularly if anyone wants to discuss anything
related to the cadaver.
3) Cadaver and its parts should be handled with due respect.
4) Articulated skeletons and bones are to be given the same respect as
cadavers because bones are also obtained from the cadavers.
5) Use of cell phones and photographic equipment’s are not permitted in the
dissection hall.
8. DISSECTION HALL MAINTENANCE
- Dissection hall should have limited access. Only students enrolled in the
course should be allowed in the dissection hall.
- Hall needs to be locked when not in use.
- All tissues removed from the cadavers must be collected and places in the
designated containers or tray.
- No body parts, tissues should be taken out of dissection hall.
- Bucket should be placed under the dissection table to drain the fluid
accumulating on the dissection table.
- Ventilation system in the hall should be designed to remove air on to
reduce exposure to the embalming chemicals fumes and odors.

8. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
193
- All fluid of dissection hall should be drain in bio medical sewage drain and
not in the common sewage drain.
- Proper disposal of cadaveric residue and waste should be done and be
treated as biomedical waste and disposed as per biomedical waste
management rules.
9. PERSONAL SAFETY AND SELF-CARE IN DISSECTION HALL
- Cadavers are embalmed with fluid containing formalin, glycerin, phenol
and ethanol. So physical contact with skin and clothing with the cadaver
should be avoided.
- Dress should not drag on the floor or dissection table. Cloths with short
sleeves should be used. If long sleeves, should be rolled up.
- Students should wear disposable gloves while working in dissection hall.
- White apron should be worn while working with the cadaver.
- Contact lenses should not be worn in the dissection hall, because lenses
can absorb chemical vapors.
- Shoes should be used to protect from draining fluid and dropped sharp
instruments like scalpel.
- Long hairs to be secured in place with hair pins, bands, etc before starting
dissection.
- Not to wear finger rings, bangles, wrist watches, threads, etc that comes in
contact with cadaver.
- All backpacks or other personal items should be left outside the dissection
hall or racks provided in the dissection hall.
- Proper use and handling of the dissection instruments should be carefully
maintained.
- Hands and used instruments should be washed thoroughly before leaving
the dissection hall.
10. CONCLUSION
Cadaver is playing an important role in medical education since ancient period
but importance of study on cadaver still exist in present era were technology is
advancing every day. No technology can replace the education received by doing
study on cadaver as every human body itself is unique. So escence of medical
education still exist in cadaveric dissection and cadavers are now also
contributing as a first teacher in medical education.
COMPETING INTERESTS
Authors have declared that no competing interests exist.
REFERENCES
1. Peddawad RG, Manghani PR, Chikhalkar BG. Body donation: Legal
aspects, procedures and precautions. Indian Journal of Forensic and
community medicine. 2015;2(4):234-41.
2. Ajita R, Singh YI. Body donation and its relevance in anatomy learning- A
review. Journal of Anatomical Society of India. 2007;56(1):1-6.

9. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
194
3. Souza AD, Kotian SR, Pandey AK, Rao P, Kalthur SG. Cadaver as a first
teacher: A module to learn the ethics and values of cadaveric dissection.
Journal of Taibah University Medical Sciences 2020;15(2):94-101.
4. Loukas M, Lanteri A, Ferrauiola J, Tubbs RS, Maharaja G, Shoja MM, et
al. Anatomy in ancient India: A focus on the Susruta Samhita. J Anat.
2010;217(6):646-50.
5. Pasricha N, Sthapak E, Bhatnagar R, Siddiqui MS, Jaiswal S. Soft-fixed
embalming: Our experiences. National Journal of Clinical Anatomy.
2020;9(2):43-7.
6. Bose D. Madhusudan Gupta. Indian J Hist Sci. 1994;29(1):31-40.
7. Bombay anatomy act 1949. , Bombay Act no XI of 1949 (The Bombay
Anatomy Act, 1949).
8. Rokade S, Gaikawad AP. Body donation in India: Social awareness,
willingness and associated factors. Anat Sci Educ. 2012;5:83-9.
9. Ballala K, Shetty A, Malpe SB. Knowledge, attitude and practices
regarding whole body donation among medical professional in a hospital
in India. Anat Sci Educ. 2011;4:142-50.
Available:http://bombayhighcourt.nic.in/ libweb/acts/1949.11.pdf
10. Brenner E. Human body preservation – Old and new techniques. J Anat.
2014;224(3):316-44.
11. Britannica, The Editors of Encyclopaedia. "embalming". Encyclopedia
Britannica; 2019.
Available:https://www.britannica.com/topic/embalming
12. Natekar PE, Desouza FM. A new embalming fluid for preserving cadavers.
JKIMSU 2012;1(2):76-80.
13. Pasricha N, Sthapak E, Bhatnagar R, Siddiqui M S, Jaiswal S. Soft-fixed
embalming: Our experiences. Natl J Clin Anat 2020;9:43-7.

10. Research Developments in Medicine and Medical Science Vol. 4
The Cadaver as Our First Teacher
195
Biography of author(s)
Dr. Harish Wankhede, Assistant Professor
Department of Anatomy, Government Medical College, Nandurbar, Maharashtra, India.
Research and Academic Experience: 12 yrs.
Research Area: Anatomy.
Number of Published papers: 13.
Any other remarkable point(s): Working in the subject Anatomy since last 12years and have special
interest in research in Anatomy. This chapter of book is helpful to students as well as faculty of Ist MBBS
as this are new topics introduced in new CBME curriculum and as no specific guideline is given on it. It
will also increase the awearness of body donation among students which may percolate in society in
future.
Dr. Dipti Nimje, Assistant Professor
Department of Anatomy, Government Medical College, Nagpur, Maharashtra, India.
Research and Academic Experience: 11 yrs.
Research Area: Anatomy.
Number of Published papers: 10.
Any other remarkable point(s): Working in the subject Anatomy since last 11years and have special
interest in research in Anatomy. This chapter of book is helpful to students as well as faculty of Ist MBBS
as this are new topics introduced in new CBME curriculum and as no specific guideline is given on it. As
one compulsory question is asked in all summative exams of Ist MBBS this chapter will definetly act as a
guide for students and teachers.
___________________________________________________________________________________
© Copyright (2023): Author(s). The licensee is the publisher (B P International).
Peer-Review History: During review of this manuscript, double blind peer-review policy has been followed. Author(s) of
this manuscript received review comments from a minimum of two peer-reviewers. Author(s) submitted revised
manuscript as per the comments of the peer-reviewers. As per the comments of the peer-reviewers and depending on the
quality of the revised manuscript, the Book editor approved the revised manuscript for final publication.