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A DISSECTION OF ANATOMY
DENIS DOOLEY B.A., M.R.C.S.
Her Majesty's Inspector of Anatomy
Dupliciter delectatus sum hanc orationem dare quia commemorat
nomina Arris et Galis, et opportunitatem mihi dat anatomiam dissectare
in hac Christi Anno milesimo nongentesimo septuagesimo secundo.
I have commenced this lecture in Latin as a compliment to the early
lecturers in anatomy in London, who were constrained to give the first
part, if not all, of their lectures in Latin. I would also like to remind
you of a meeting on 28th April 1828 in London with Mr. Henry
Fig. 1. 'The Anatomy Lesson by Dr. Tulp', painted by Rembrandt 1606-69
(Leipzig). (Note the error in attachment of flexor tendons.) Dr. Tulp is still
remembered by the valve which bears his name, the ileocolic valve.
Warbur,ton (Member of Parliament for Bridport) in the chair at which
the famous Sir Astley Cooper, President of the Royal College of Sur-
geons, said in reply to a question that 'without dissection there can
be no anatomy, and that anatomy is our Polar Star, for without an-
From the Arris and Gale Lecture delivered on 10th May 1972
(Ann. Roy. Coll. Surg. Engl. 1973, vol. 53)
13DENIS DOOLEY
Fig. 2. By Leonardo da Vinci (1452-1518).
y .4 ft i A.-v SA:
L
Fig. 3. Bv Vesalius (1514-64).
14A DISSECTION OF ANATOMY
atomy a surgeon can do nothing, certainly nothing well'. Members of
the Anatomical Society (including William Blizard, Benjamin Brodie,
and others) also stated their conviction at the same meeting 'of the
importance of anatomical knowledge to health, maintenance of life
and happiness of the community'.
Anatomy might be said to have had its beginnings in the Egyptian
practice of embalming their dead. Hippocrates (496-370 BC) and
Aristotle (385-322 BC) are two of the earliest anatomists of whom we
know, but it is doubtful if they ever dissected a human body. Herophilus
of Calcedon (about 300 BC) is said to have dissected 600 bodies, some
.>NU
Fig. 4. Original anatomy theatre at Padua (model).
possibly of living prisoners. He is said to have been the first to give a
description of the human body from an actual dissect-ion. Galen probably
did dissect, though much of his knowledge must have come from his
experience as a surgeon to the gladiators, and much dissection was
done on animals.
Frederick II of Sicily brought about the rebirth of practical anatomy
in Europe about the year AD 1213, when he issued a decree forbidding
the practice of surgery to anyone who had not passed an examination
in human anatomy and decreed that lectures and dissections should
be conducted at intervals of every 5 years. The encouragement of the
15DENIS DOOLEY
Church to artists gave a great impetus to the study of anatomy. Michel-
angelo, Rembrandt, and many others all left paintings or drawings with
an anatomical interest. Perhaps the most famous are the drawings of
Leoniardo da Vinci (1452-1519).
The Anatomy Act 1832
The nefarious murders of Burke and Hare were the main impetus
to the public reaction which eventually brought about the Anatomy Act
of 1832. Although this Act was severely criticized by Thomas Wakicy,
editor of the Lancet, and by the professors and students at the time, and
suggestions have been made since for amending it, this is the Act under
which, with minor modifications made in 1871, bodies are still obtained
for dissecting rooms throughout the country. Originally there were three
Inspectors, but today there is only one to cover the whole of Englaind,
Scotland, and Wales. The duties of Her Majesty's Inspector of Anatomv
deal with the day-to-day problems of the Act in so far as it concerns all
the medical schools with a special interest in facilities for the teaching
of anatomy to undergraduate and postgraduate students.
The acquisition of material for dissection has not always been easy.
Even so, available records show that in 1832 there were 14 'medical
schools' in London, and 607 bodies were dissected (Table I). These
TABLE I
NUMBERS OF BODIES MADE AVAIL[ABLE FOR DISSECTION IN THE SCHOOLS OF
LONDON, 1832-41, AND SOURCES FROM WHICH THEY WERE OBTAINED
Source 1832-3 1834-5 1836-7 1838-9 1840-1
Unions 445 293 361 267 260
Hospitals 135 191 186 159 128
Prisons 15 14 25 14 14
Hulks 8 73 38 35 76
Asylums 4 11 12 4 6
Total 607 582 622 479 484
No. of schools 14 16 17 18 16
schools included Guy's, St. Thomas's, The London, and Bart's, and
the private schools of Mr. Grainger, Mr. Carpue, Mr. Bennett, Mr.
Dermott, Mr. Sleigh, Mr. Tyrrell (Aldersgate), and The Windmill. The
number of students was about 700, but it was said even then that there
would have been more if there had not been a 'brain drain' abroad.
In 1910 there was considerable difficulty in obtaining all the dis-
secting material wanted. A meeting was called at the Royal College of
Surgeons and an Anatomical Supply Committee was set up 'anent the
problem and to recommend a possible and efficient remedy'. The out-
come of the meeting was that in 1912 a deputation led by the Rt. Hon.
16A DISSECTION OF ANATOMY
Fig. 5. Mezzotint for Carrington Bowles, 1771.
Christopher Add-ison went to the House of Commons, pointing out
the disastrous effects of inefficient teaching of anatomy. The Home
Secretary was 'most impressed' but unwilling to change the Act.
After World War I in 1918 the overcrowding of the dissecting rooms
forced the issue and the administration of the Anatomy Act was trans-
ferred from the Home Office to the Ministry of Health on 17th May
1920. The gravity of the situation at this time can be judged by the
following figures for 1918:
University of Cambridge ................. 280 students, 3 subjects
University of Liverpool ................. 250 students, 2 subjects
University of Cardiff .......... ....... 220 students, 2 subjects
University of Manchester ................. 250 students, 6 subjects
University of Bristol .......... ....... 118 students, 2 subjects
The majority of these bodies were non-bequests.
Presernt-day supply of bodies
The most interesting fact to note about the present-day position is
the immense increase in bequests. In 1946 the total number of bodies
dissected in London medical schools was 200, of which 33 were be-
quests, whereas in 1969 the number was 242 bodies, of which 238
were bequests.
17DENIS DOOLEY
In 1969 the supply of bodies to the schools of anatomy in London
ranged from 30 to Guy's to 5 to the Royal College of Surgeons and 2
to the Royal Army Medical College.
Time allocated to dissection
Perhaps one of the most interesting features of the teaching of an-
atomy today can be seen in the change given to the time allocated to
anatomy and dissection. With an adequate supply of bodies, second
thoughts are being given to their best use (Table II). It is only fair to
say, of course, that hours allocated to dissection or teaching are not alone
entirely significant, and must be considered carefully together with teach-
ing methods. As I see it, developments in the future teaching of anatomy
are inseparable from developments and changes in the whole of medical
education. Now man has put his foot on the moon nothing will be the
same again, even in the training of medical students.
TABLE II
COMPARISON OF HOURS ALLOCATED TO ANATOMY AND TO DIssECTION IN 1945
AND 1970
Name of Studen1ts Hours allocated Hours allocatel
school to anatomy to dissectioni
1945 1970 1945 1970 1945 1970
Oxford 84 99 720 368 576 192
King's College 116 124 600 410 400 20(0
Aberdeen 151 114 1,060 615 690 356
(likely
to reduce
to 400)
Medical education
For the second if not the third time in this century the medical schools
throughout the world are entering a rapid period of change and de-
velopment. In 1910, as Flexner reminds us, in Great Britain anatomy
began and ended with dissection, which was supervised by surgeons
'active or on their way to activity'. Since 1925 the study of function
has increased and attached itself to the study of form. The next period
of change came during the 1950s and throughout the 1960s. Many of
those concerned with medical education began to re-examine their
methods.
We are all familiar with the General Medical Council's recommenda-
tions of 1966, the Todd Report of 1968, the Coggeshall and Mills Report
in the USA, and various others in Australia and Canada. As a result
most medical schools and faculties throughout the world are contem-
plating widespread changes in their teaching methods, particularly of
anatomy. No longer are students expected to learn the minutiae, the
almost indescribable, if not easily forgettable, niceties of anatomy now
reserved for postgraduate students. The GMC in 1966 suggested that
18A DISSECTION OF ANATOMY
undue emphasis on details of anatomy was undesirable, that it was not
even necessary to dissect the whole body, that instruction in human
anatomy, physiology, and biochemistry should include human genetics,
growth, and development, -and that instruction be given at an early stage
in sociology and biometric methods.
Anatomy in the new medical schools and centres
Nottingham. The new medical school at Nottingham was the first
to be established in the United Kingdom in this century. Forty-eight
students began their course of studies there in October 1970. The courses
are carefully planned so as to avoid the need to acquire unnecessary
amounts of factual information imposed by some traditional systems.
The first two years in the basic sciences will provide an understanding
of the structure and function of man, his place in the community, growth
and development, and behaviour and emotions in response to the many
forms of environmental stress. The relevant material is presented in a
series of courses taught interdepartmentally. Of the 1,120 hours available
for teaching during this part of the course, only 100 hours are available
for teaching topographical anatomy in the dissecting room. What is
unique in the course is the third year, which is given to a special study
of one subject in depth, which for many will be anatomy. At the end
of the third year a Bachelor of Medical Science degree will be given
before the student proceeds to the B.M., B.S. course.
Ectopic anatomy departments. Perhaps one of the most interest-
ing developments in this country in the past few years is the establish-
ment of what one might call new ectopic anatomy departments mainly
for the use of postgraduate students. The recognized undergraduate
schools generally have found it impossible for many reasons to provide
regular Primary Fellowship courses. The main centre for postgraduate
teaching has for many years been the Institute of Basic Medical Sciences
at the Royal College of Surgeons, but the number of student places
is limited and it is inaccessible to many. The establishment of further
postgraduate centres throughout the country will no doubt play a
great part in continuing the education of surgeons and other specialists
in the future.
Southampton General Hospital. The opening of a new purpose-
built anatomy department at Southampton General Hospital in 1968
was of historical interest in that it was the first such department to be
established actually in a National Health Service hospital and maybe in
any hospital at any time since the passage of the Anatomy Act. I have
records of the appointment of a Mr. Roper as licensed teacher of an-
atomy to the Exeter Hospital in 1871, of Mr. Barker to the Royal
19DENIS DOOLEY
Fig. 6. Anatomy dissecting room, 18th century. The Windmill School of
W. Hunter (Rowlandson).
Fig. 7. Dissecting room, Birmingham,- 1972. (Stainless steel dissecting tables).
20A DISSECTION OF ANATOMY
Bath Hospital in 1873, and of the famous Mr. Choyce to the Seamen's
Hospital in 1906, but there is some uncertainty as to whether cadavers
were actually dissected on the hospital premises.
In 1966 the Wessex Regional Hospital Board decided that the time
had come to establish its own postgraduate anatomy centre. Professor
J. A. Keen (late of Durban) was appointed and initially ran the course
with the aid of 'models and bottles' until the new anatomy department
was opened in 1968 adjacent to the Department of Pathology in the
hospital. It is only 1,700 square feet (158 m2) in area and includes a
dissecting room, anatomy classroom, and various offices. Regular courses
are now run for those taking the primary examinations of the Royal
Colleges, including surgeons, anaesthetists, and gynaecologists. It is of
considerable interest that although the foundation stone of the new
medical school at Southampton was laid only in February 1970 and
the school inaugurated by Sir Keith Joseph in October 1971, the first
students to the new school started their studies as undergraduates in
this small anatomy department in October 1971. The medical school
is now open for undergraduates, but the teaching of postgraduates is
still continuing in this centre.
The new medical school, the second to be created in this century
in the U.K., has a syllabus under which much of the early teaching
will be conducted on the block system, whereby physiologists, anato-
mists, and pathologists will combine in the teaching. The students are
introduced to patients from the very outset.
Plymouth General Hospital. In February 1968 the first course for
the Primary Fellowship was inaugurated in Plymouth, most of the con-
sultant staff being involved in giving lectures and demonstrations.
Accommodation has now been made available under the virus lab-
oratory in the hospital. The total area is no more than 700 square feet
(65 m2) and includes a dissecting room and storage facilities. Embalming
is carried out in the Department of Anatomy at Bristol. Mr. Peter Childs,
the first licensed teacher, has now handed over to Mr. William Gall,
who is the present director of this department, very ably assisted by
Professor Gilbert Causey, late of this College.
Nuffield Orthopaedic Centre, Oxford. A small department of an-
atomy has now been established here under Professor R. B. Duthie.
This is used by postgraduate students and offers facilities for dissec-
tion of the cadaver with special reference to orthopaedic problems and
orthopaedic surgical procedures.
Institute of Laryngology and Otology (Gray's Inn Road). Here
is perhaps the most elaborate department of anatomy specially planned
21DENIS DOOLEY
for postgraduate students. It is now possible to provide practical tuition
in all important head and neck surgical procedures utilizing anatomical
subjects. There are four tables, in stainless steel, each with its own
scialytic light, and as many as 12 students can be accommodated on
regular courses of 6 days' duration. All the necessary instruments and
equipment, including Zeiss operating microscopes, are provided. To
ensure that the best use is made of the anatomical material available
the programme for the course in anatomy and surgery of the nose and
throat, head, and neck is planned sequentially to take the students
through the various operations in as logical fashion as possible.
University of Surrey. The new University of Surrey at Guildford
does not include a medical school. It does, however, have a small dis-
secting room under the direction of Professor Peter Davis of the
Department of Human Biology. Courses lead to a B.Sc. in human
biology. There are some who consider that such a course is an adequate
initial training for a medical student.
Other centres. Enquiries and informal discussions for the estab-
lishment of similar anatomical centres for postgraduate studies around
the country are being made. The most recent concern such centres at
Coventry, Rhyl, and Oswestry. I am sure that these centres can con-
tribute considerably to the specialized teaching of topographical an-
atomy with stress on variations for surgeons. It seems right that the
highest standard of facilities, and accommodation for staff, should be
insisted upon, and where possible a close link should be retained witlh
the department of anatomy in the nearest university or medical school.
The future of anatomy
This is the stage anatomy has now reached. Once Crick and Watson
had published their picture of the molecular structure of DNA and
men had walked on the moon nothing could be the same again. Anato-
mists are extending their outlook and modifying their courses and
departments to meet the changing course of events, although some might
say perhaps not fast enough. I would like to suggest that the modern
anatomists are better than they think they are but have regrettably and
frequently failed to convince their surgical colleagues of this fact. For
too long and too often do they appear to have to apologize or explain
themselves away. Sir Kenneth Clark in his book Civilization says, 'It is
lack of confidence more than anything else that kills a civilisation.' Per-
haps anatomists of today would benefit by contemplating this idea
more often and more seriously.
In 1934 Sir Wilfred le Gros Clark, on taking up his appointment at
Oxford, said that he was determined to raise the status of anatomy from
22A DISSECTION OF ANATOMY
the doldrums into which it had fallen to that of a bigger scientific dis-
cipline. He believed that relegation of anatomy to the position of
Cinderella among clinical scientists was primarily due to the preoccupa-
tion of most of those in the profession with the teaching of topographical
minutiae to the exclusion of almost everything else; and before he died
recently he claimed he had achieved his ambition. However, in 1967
Professor R. L. Holmes, in his inaugural address entitled 'The Melan-
choly of Anatomy' at Leeds, found it necessary to question the comments
of some of the critics who considered that anatomy is in a poor
state, 'a dead subject concerned with dead subjects', and had to in-
sist that while anatomy is a discipline basically founded on dissection,
its present liveliness is such that it can hold a place of distinction
in the biological sciences in the widest use of the term. He expressed
the view, which is held by most of his anatomical colleagues, that dis-
section of the body still remains the best if not the only way that students
can gain an understanding of the complex assembly of tissues and organs
which constitutes man.
Such dissection should not be taught, and is not taught in the best
schools, simply as an exercise in manual dexterity but as an approach
to the appreciation of bodily function in health and disease. Fine detail
should not in fact be emphasized for the undergraduate, and the special-
ized knowledge required by surgeons can be taught or reinforced at a
later date. Professor R. M. H. McMinn, of this College, writing in the
British Medical Journal of 18th March 1972, rightly complained that
'anatomy is still the whipping boy of the curriculum in the opinlionl
of many', and would draw their attention to such modern books as Sur-
face and Radiological Anatomy by Professor W. J. Hamilton (Cam-
bridge, Heffer, 1971), which is a magnificent example of the living and
applied anatomy of today.
That there are problems which are being faced up to is hinted at by
the current fashion for choosing other names for departments of an-
atomy, such as the 'Department of Biological Studies' or 'Department of
Human Morphology'. Other evidence is given by the fact that non-
medically qualified staff are taking on senior positions in departments
of anatomy. The young anatomists of today are rightly not, as a rule,
simply teachers of anatomy such as were the teachers of the past but
are electron microscopists, endocrinologists, neurophysiologists, experi-
mental embryologists, and so on. One has only to glance through any
recent copy of the Journal of Anatomy to see the broad spectrum of
their interests, and I quote the titles of some recent articles: 'The
Giganto-cellular Reticular Region and Spinal Afferents: a Light and
Electron Microscopic Study in the Cat'; 'Ultrastructural Studies of
Wound Healing in Mouse Skin'; and, perhaps one of the more inter-
esting, 'The Corticospinal Tract of the Quokka Wallaby'. To those critics
23DENIS DOOLEY
who might censure anatomists for such wide interests I would say that
they may not know just what they are missing themselves by not follow-
ing up such research. Who can say what is hidden under a bat's wing or
what is to be found in the eyes of a gadfly, or what are the functions
of the pineal gland if it is not the seat of the soul?
There is something to be said for serendipity, as I should know who
had the privilege of working with Sir Alexander Fleming, who made a
mountain out of a mould even if he failed to make a fortune. There is
a lot to be said for looking 'beyond the ivory tower' with Sir Solly
Zuckerman and trying to find out what makes us 'crazy apes', as Szent
Gyorgyi would have us believe we are. I would encourage suspicious
surgeons and others to attend the next meeting of the Anatomical So-
ciety. I would even go further and suggest that they visit some of the
more progressive schools, where they would find new methods of teach-
ing anatomy being applied successfully and new techniques with
television, videotapes, and modern methods of histology, with the use
of the electron microscope, being freely used. It is inevitable and essen-
tial that the proper use of audio-visual aids by enthusiastic teachers will
replace many of the older methods of teaching anatomy, even to the
extent of reducing time given to dissection, although I think there should
be a limit to such reduction of time. I say 'essential' in view of the likely
trend towards an increase of students (Table III) and maybe a relative
fall in the number of teachers. This may imply more prosections, but
the demand for bodies for dissection by donation may have to increase.
TABLE III
MEDICAL STUDENTS BEGINNING PRECLINICAL COURSES AT MEDICAL SCHOOLS IN
GREAT BRITAIN (FROM DHSS ANNUAL REPORT, 1970)
Year ended British-based students Other students Total
31 July England Great Britaini England Great Britain Great Britain
1961 1,371 1,788 143 232 2,020
1966 1,728 2,312 110 166 2,478
1971 2,088 2,761 76 112 2,873
I would like to suggest that perhaps there should be in the future
a more distinct differentiation of anatomists into those who want to
teach medical students and include dissection of the human body as
an important part of their curriculum and those who do not. May I re-
mind you what Cardinal John Henry Newman said in his book The Idea
of a University? 'To discover and to teach are distinct functions; they
are also distinct gifts, and are not commonly found united in the same
person. He who spends his day dispensing his existing knowledge to
all comers is unlikely to have leisure or energy to acquire new. Common
sense of mankind has associated the search after truth with seclusion
and quiet. The greatest thinkers have been too intent on their subject
24A DISSECTION OF ANATOMY
to admit of interruption; they have been men of absent minds and idio-
syncratic habits and have more or less shunned the lecture room and
public school.'
Anatomists might be likened to the workers in a harvest field. First
came the reapers, including the earliest anatomists of Europe such as
Vesalius, Fallopius, and Harvey. Then came the gleaners-such were the
anatomists of the last century, the Hunters and Monros. Some would
have us believe that the modern anatomists a,re the geese merely con-
triving to gather up the remaining grains well scattered here and there,
but they forget that the reapers may have missed a whole field and the
gleaners failed to have recognized many of the ears of corn for what
they were, and indeed that geese can lay golden eggs. Who will stand up
and deny that anatomy may hold the secret the world is looking for?
Sir George Pickering, Master of Pembroke College, Oxford, has sug-
gested that anatomists may solve, at some time in the future, the problem
of world population. Professor Marcus Nabholtz, an authority on cell
hybridization, would go even further and suggest that genetic analysis
of man will lead to better understanding of genetic diseases and disease
generally, and even eventually to an understanding of the biological
foundation of human behaviour and intelligence. One development of
cell hybridization could be that whole new organs will be grown from
a single cell and used to replace diseased ones in the body. It is not
difficult to predict that such discoveries and others, such as quinacrine
fluorescence in the identification of chromosomes by their stripes, could
have important influences on many sociopolitical problems of our time.
Problems
There can be no questioning of the fact that one of the outstanding
problems of the future will be that of finding sufficient suitable staff
for the teaching of anatomy. Several memoranda stressing the need for
medically qualified anatomists have recently been published. The Brit-
ish Medical Association has stated that 'almost all the teachers in
anatomy and at least 75%/, of physiologists should have had clinical
experience sufficient for full medical qualification'. I would be the last
to decry the very substantial and outstanding contributions of non-
medical men and women to research and their distinction as teachers. I
would still suggest, however, that medically qualified biologists may
have more to offer preclinical medical students. Perhaps it would be
fairer to put it another way round and say it must be more difficult for
non-medically qualified biologists to teach and inspire the doctors and
surgeons of the future. I would not deny that there are some non-
medically qualified men who have no peer as head of their
departments of anatomy, and there may well be more in the future.
Perhaps their charisma suits them best as directors of departments,
particularly of research.
25DENIS DOOLEY
I am convinced that without a necessary and urgent readjustment
of the recognition given to anatomists for the very essential work they
do, bringing them into line with consultants in the National Health
Service, the time may shortly come when there will be far too few of
them to give adequate training to the surgeons and physicians of
the future.
As far as I am myself concerned, I am convinced that my profes-
sional shadow as Her Majesty's Inspector of Anatomy will not die,
which is reassuring, since G. K. Chesterton once said that 'men who
lose their shadows lose their souls'. I think Her Majesty will always
need an Inspector of Anatomy. I expect there will be changes, possibly
in the Act itself or a combination of the Anatomy Act with the Human
Tissue Act (1961). I am confident that the public will continue to be
anxious to bequeath their bodies for the benefit of science and am
grateful to them, since without such generosity advances in surgery and
medicine in this country could be seriously hampered. It is reassuring
that in London, Cambridge, and Aberdeen monuments are being erected
in appreciation of those who bequeath their bodies for anatomical ex-
amination and research.
I would like to end as I began by agreeing with John Abernethy that
'anatomy is the foundation of all medical knowledge' and with the belief
of those early members of the Anatomical Society in 'the importance
of anatomical knowledge to the health, maintenance of life, and happi-
ness of the community'.
As Cicero once said, 'Haec studia adulescentiam aluunt, senectutem
oblectant, secundas res ornant, adversus perfugium ac solacium
praebent, delectant domi, non impediunt foris, pernoctant nobiscum,
peregrinantur, rusticantur. Quod si ipsi haec neque attingere neque
sensu nostro gustare possemus, tamen ea mirari deberemur etiam cum
in illis videremus'-'these studies are the food of youth, the charm
of age, they are the ornament to prosperity and lend a refuge and
comfort to misfortune. At home they are a pleasure, abroad no hin-
drance, they are with us by night, upon our joumeyings, in our country
seats. If we cannot of ourselves dissect or with our own faculties dabble
in such pursuits, then we ought to view with admiration when we see
them carried out by others.'
DIXI
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