The Emerging Practice of Human Dissection
The Emerging Practice of Human Dissection
According to many sources, human dissection was not allowed by the church, so any dissection performed was primarily on animals. Despite the informative works from authors such as Aristotle (384-322 b.c.), Historia Animalium, and Galen (a.d.130-200), On Anatomical Procedure, their experience was primarily with pigs, dogs, and Barbary apes. Two early practitioners that did use humans in their works are Herophilus of Chalcedon (335-280 b.c.) and Erasistratus (fl. c. 250 b.c.). Herophilus wrote On Anatomy where he described parts of the brain, the uterus, arteries, and veins. The only extant proof that he dissected a human is in his description of the liver. Erasistratus was another early dissector who was accused by two religious writers as having performed dissection procedures on the living, not the dead. Altogether, few accurate images of the interior of the body remained.
One reason there was so much controversy surrounding dissections prior to the fourteenth century had to do with bans and prohibitions. Many sources state that dissection was prohibited by the church but more detailed research reveals information that helps to explain this statement.
At least three reasons for this misinterpretation existed. The first was the fear that mutilation of the body to great extents would result in an inability to be resurrected. The second was the inability of monks to perform surgery, since the church allegedly abhorred bloodshed. Since cutting is done in both surgery and dissection, confusion between the two may explain this. A third reason for the misinterpretation is that the word anatomization was a pejorative word. It meant that the body of a criminal (or other disenfranchised individual) would be mutilated to create a punishment beyond execution, the final indignity: the denial of a Christian burial.
By the twelfth century, the persisting religious rejection of dissection had started to ease. Medical schools in Salerno and Naples were performing and teaching others the skill of dissection. The Salerno school, Civitas Hippocratica, was established in 1140 by Roger II of Sicily. It was here where the first enforced exams were given to surgeons and other dissectors.
A problem to the dissectors was the lack of refrigeration or storage space. Bodies decayed rapidly and during normal time periods there were few deaths. Since towns were small, when someone did die they were neighbors, relatives, or friends. It is reasonable to assume that a certain amount of reticence was involved when one might be required to dissect the body of a friend or relative.
Of course there were instances later in the seventeenth century when it was helpful to know the person and his or her pathology before death, so that an investigation could correlate changes in the postmortem body with symptoms prior to death. But during medieval times, dissection was done to learn about structure and to a lesser degree function. When there was an epidemic such as the plague, dissection was discouraged because of the potential for contamination.
Against this background, came the professionalization of medicine and university medical education. Many medical schools started in institutions that already had a law school. A renewed interest in anatomy was encouraged by its forensic application.
The medical school in Bologna was a place that fostered the growth of understanding the structure of the human body and investigation of unexplained death. It can boast of students such as Henri de Mondeville (1260-1320) and the teacher Taddeo Alderotti (Thaddeus). Mondino dei Liucci, (1270-1326) writer of Anothomia in 1316, studied with de Mondeville under Alderotti and received his degree at Bologna in 1290 (1300 according to some sources). Although Mondino named many organs with peculiar and sometimes redundant names, it was his method of dissection that was unique.
Mondino lectured and demonstrated dissections, but unlike other anatomists he did not read from Galen while dissecting. This was an advantage because none of Galen's errors were repeated. Mondino also performed the cutting himself. The custom had been for the professor to sit far above the dissection bench, allow another person to point to a part, and a dissector (barber or surgeon) perform the cutting. He did make use of a prosector, a woman who prepared parts of the body for demonstration. Alessandra Giliani was a talented individual who cleaned the body and then injected vessels with colored liquids in order to make them easier to study. Then the exterior of these vessels was delicately painted with appropriate colors, red for arteries and blue for veins.
Mondino had to work fast, first demonstrating the organs of the abdominal and thoracic viscera, then the head, and lastly the extremities. Again, without refrigeration or preservation techniques, one can imagine that during the summer, a body after four days would be quite unusable for future demonstrations. The problem of obtaining adequate study material and how best to use it was tantamount to continuing this groundbreaking practice.
Mondino's language was convoluted and difficult to understand. During a time when medical knowledge was borrowed from both Greek and Arabic sources, Mondino's nomenclature was confusing. For example, the sacrum was referred to by several names which appear to be of Arabic origin (e.g. alchatim alhavius, allannis), but other bones of the pelvis, hips, acetabulum, and corpora quadrigemina (four rounded eminences, a part of the midbrain) were all referred to by the same word, anchoe. It is believed that he introduced the term matrix for uterus. Some of his etymological information was untrue also. He stated that the word, colon was derived from the Latin cola (cell) but it was really from a Greek word which meant organ.
A student might only get experience with one cadaver during his entire medical education. This posed the question of how a student might see more examples of the mysteries of the human body. Mondino's book was the only one available and although texts are useful, nothing can take the place of direct observation. The practice of grave robbing began because there were not enough criminals to donate their bodies to each student. Students and professors exhumed bodies from nearby cities, believing that the decedents would be unknown to the dissectors. For skeletons, which were less identifiable, graves still had to be disturbed but there was less anxiety and care involved. Sometimes a skeleton could be obtained from a gibbet, a post with a projecting arm from which the body of an executed criminal was suspended on display. Still there was a lack of suitable specimens to study.
Dissection was not always done in a university setting. Convents and monasteries had their share of bodies that were used by nuns and friars; their objective was to find marks of holiness on the deceased. Although the holy were said to have rubies instead of blood clots and precious gems rather than gallstones, the world view of the prior was quite different than that of the anatomist. Religious individuals were interested in finding the place of the soul and how long it took after death for the soul to leave the body. There was also the belief that a luz bone existed, a structure that could clone or resurrect a new individual from itself.
What seems to be quite unusual to the modern student is the fact that regular public dissections were also performed. A stage was erected with a table and instruments. An announcement was made, sometimes posted in the center of town, and all citizens were invited. The tenor of the audience, rather than serious or scholarly, was ready for entertainment. As the tradition grew, the stages became more elaborate with curtains, elegant lamps, and decor. People dressed for the occasion and youngsters sold refreshments. Dissection theaters by the late Renaissance were akin to operatic productions.
Towards the end of the seventeenth century, rather than prohibit dissection, the church endorsed and encouraged the appropriate study of the human body. It did, however, watch closely to assure that vivisection (dissection of a living person) was not performed. According to Jewish law, nowhere in the Bible—Talmud, post Talmudic, or later rabbinical writings—was there evidence that postmortem examinations to benefit the living were prohibited.
Changes that occurred in both the study of medicine and the public's acceptance of dissection as a valid scientific inquiry were also philosophical. The centuries of crude, early dissection paved the way for surgeons to learn about the way the body works and to help patients who otherwise may not have had a chance at life. A shift from the theological to the humanist now was in its earliest beginnings. Observation was being documented and although few images existed, the emerging practice of human dissection paved the way for the study of physiology, anatomic pathology, the preservation of specimens, new surgical techniques, and the detection of foul play in unattended deaths.
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