Anatomy

(Greek, anatome ).

Literally, cutting up, or dissection; now used to signify the science of the form and structure of living beings. It is a department of biology that is divided into animal and vegetable anatomy. Animal anatomy is further divided into comparative anatomy, that is, the study of different animals for purposes of comparison, and special anatomy which studies the form and structure of a single animal. This last embraces the departments of embryology, the study of the formation of living beings, and morphology, the study of the form and structure. Further important divisions are: physiological anatomy, the study of parts in relation to their functions; surgical or topographical anatomy which considers the relations of different parts, and pathological anatomy which treats of the changes brought on by disease, in various organs or tissues.

HISTORY: GREEK AND LATIN PERIOD

Anatomical knowledge had its beginnings very early in the history of the race. Animal sacrifices led to a knowledge of animal anatomy which was readily applied to man. The art of embalming also necessitated a knowledge of the position of blood vessels and certain organic relations. Even Homer used many terms which indicate a much deeper knowledge of human structures than might be expected thus early. The first real development of anatomy as a science, however, did not come until the time of Hippocrates of Cos, about 400 B.C. The Grecian Father of Medicine knew the bones well, probably because of the ready opportunities for their study to be found in tombs, but did not know the distinction between veins and arteries, and uses the term artiria in reference to the trachea. He used the term nerve to signify a sinew or tendon. Until the time of Aristotle, about 330 B.C., no additions were made to anatomical knowledge. There seems to be no doubt that this Grecian philosopher frequently dissected animals. His description of the aorta and its branches is surprisingly correct. This is the first time in the history of anatomy that the word aorta, Greek aorti , a knapsack, was used. His knowledge of the nerves was almost as little as that of Hippocrates, but he was thoroughly familiar with the internal viscera, and he distinguishes the jejunum or empty portion of the small intestine; the cæcum, or blind gut, so called because it is a sort of cul-de-sac; the colon, and the sigmoid flexure. The word rectum is the literal translation of his description of the straight process of the bowel to the anus. A contemporary of Aristotle, Praxagoras of Cos, was the first who distinguished the arteries from the veins and spoke of the former as air vessels because after death they always contained only air.

All of this knowledge had been gained from dissections of animals. It was at Alexandria in the beginning of the third century before Christ that two Greek philosophers, Herophilus and Erasistratus, made the first dissections of the human body. None of their writings have come down to us. We know what they discovered, however, from the references to them made by Galen, Oribasius, and other medical writers. Erasistratus discovered the heart valves and called them, from their forms, sigmoid and tricuspid. He studied the convolutions of the brain and recognized the nature of nerves which he described as coming from the brain. He seems even to have appreciated the difference between nerves of motion and sensation. There is a claim that he discovered the lymph vessels in the mesentery also. Herophilus applied the name of twelve inch portion of the intestine to the part which has since been called the duodenum. He described the straight venous sinus within the skull which is still sometimes called by his name. He is also said to have given the name of calamus scriptorius to the linear furrow at the lower part of the fourth ventricle.

Nearly three hundred years passed before another great name in anatomy occurred, namely, that of Celsus, who saw the difference between the trachea and the esophagus, described the size, positions, and relations of the diaphragm as well as the relations of the various organs to one another, and added much to the knowledge of the lungs and the heart. He knew most of the minute points in osteology with almost modern thoroughness. The sutures and most of the foramina of the skull and the upper and lower jaw-bones with the teeth, he describes very perfectly. He mentions many small holes in the nasal cavities and evidently knew the ethmoid bone. He even seemed to have distinguished the semi-circular canals of the car. After Celsus, who lived during the half-century before Christ, the next important name is that of Galen, who was born about A.D. 130. Galen was not only an investigator but a collator of all the medical knowledge down to his time. His work was destined to rule anatomical science down to Vesalius and even beyond it, that is, for nearly fourteen hundred years. Galen's osteology is almost perfect. His knowledge of muscles was more incomplete, but it was far beyond that of any of his predecessors. He did not add much to the previous knowledge with regard to blood vessels, though he made the cardinal demonstration that in living animals arteries contained not air but blood. His description of the veins and arteries, however, is rather confused and here his knowledge is most imperfect. His additions to the knowledge of the nervous system are very important. He described the falx and exposed by successive sections the ventricles and the choroid plexus. In general, his description of the gross anatomy of the brain is quite advanced.

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MEDIEVAL PERIOD

With the fall of the Roman Empire and the incursions of the barbarians there came an end for at least five or six centuries to all anatomical study. The first signs of a reawakening of interest in anatomy after this long sleep showed themselves at the famous medical school at Salernum. There is no doubt that even during the tenth century Salernum had a reputation as the best place for invalids with ailments that could not be cured elsewhere. Many of the distinguished nobility and members of reigning families found their way down to this little town and its reputation soon attracted medical students. There is a tradition connecting the rise of the school at Salernum with the Benedictine monks whose great monastery of Monte Cassino was not far away. Definite details are, however, lacking. In the eleventh century the medical courses at Salernum began to be regularly organized. At the beginning of the twelfth century regulations for the first State examinations in medicine were made. Anatomy was a required subject, but was studied by means of the pig which was thought to be closely related to man in anatomical structure. Curiously enough this animal is now reassuming a place in medicine as a favourite subject for research and instruction in embryology.

About the middle of the thirteenth century Frederick II made it a rule that the students at Salernum should be present at one human dissection at least each year. About this time the other rising universities of Europe took up the serious study of anatomy and proved successful rivals to Salernum. Montpellier was one of the earliest to make a name for itself, but both Paris and Bologna were not far behind. At Paris before the end of the thirteenth century the famous Hermondaville was giving a series of demonstrations on human cadavers that attracted students from all over Europe, and William of Salicet, at Bologna, attracted quite as much attention. There appears to be no doubt that he made many human dissections, and there is a definite tradition of his having made a medico-legal autopsy on the body of a nobleman in order to determine whether death was due to poisoning. This fact of itself would seem to show that this was not an unusual procedure, since if William were not accustomed to seeing. bodies dissected frequently he would scarcely be trusted as an expert in determining the presence or absence of poison.

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It is very commonly accepted that there was an interruption in the development of anatomical knowledge about the beginning of the fourteenth century because of a papal decree forbidding dissection. The statement that such a decree was promulgated is to be found in nearly every history of medicine published in English, and has been made much of in books on the supposed opposition of science and religion. There was no such decree, however, and the declaration that the development of anatomy was interfered with by the ecclesiastical authorities is founded on nothing more substantial than a misunderstanding of the purport of a decree of Pope Boniface VIII. In the year 1300 this Pope issued the Bull "De Sepulturis". The title of the Bull runs as follows: "Persons cutting up the bodies of the dead, barbarously cooking them in order that the bones being separated from the flesh may be carried for burial into their own countries are by the very fact excommunicated." The only possible explanation of the misunderstanding that the Bull forbade dissection is that some one read only the first part of the title and considered that as one of the methods of preparing bones for study in anatomy was by boiling them in order to be able to remove the flesh from them easily, that this decree forbade such practices thereafter.

The first authoritative history in which this interpretation of the Bull appeared was the "Histoire littéraire de la France ", a work originally issued by the Benedictines of Saint-Maur, but continued by the members of the Institute of France, and it is in one of the volumes of the continuation that the declaration with regard to the interruption of anatomical studies by dissection is made. Not only the Bull itself did not forbid dissection, but a review of the history of anatomy just after its issuance shows that it was not misinterpreted so as to hamper anatomical progress. Within the decade after the date of the Bull, Mondino began to perform at Bologna the series of public dissections of human bodies on which was founded his text-book of anatomy. This was to be the authority on this subject for the next two centuries in Europe. It is sometimes said that Mondino dissected only a few bodies, but Guy de Chauliac, himself a distinguished anatomist later in the fourteenth century, declares that Mondino dissected human bodies a number of times ( multoties is his word). In 1319 there is the record of a criminal prosecution for body-snatching at Bologna, and it is clear that a number of such events had happened before the criminal courts were appealed to in the matter. At this time, according to the statutes of the university, teachers of anatomy were bound to make a dissection if the students supplied the body. De Renzi says there was a rage for dissection at this period and many bodies were yearly stolen for the purpose. In Venice where there was no medical school the authorities, in 1308, ordained that one dissection every year should be made for the benefit of physicians of the city. In Bologna a regular allowance of wine was made by the municipality to the students and others who should be present at dissections, and every student was required to see at least one dissection of a human body during his medical course. Twenty students were to be present at the dissection of male, and thirty at that of female subjects, these being rarer, and manifestly a good opportunity for personal inspection was provided.

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Hæser in his "History of Medicine " says that it is an error to think that Boniface's Bull forbade dissection since the practice was carried on without let or hindrance under ecclesiastical authorities who universally presided over the universities of that day. Hæser quotes Corradi who, in his sketch of the teaching of anatomy in Italy during the Middle Ages, also denies that the Bull of the pope mentioned hampered the progress of anatomical study or teaching in any way. Pagel in his sketch of the history of medicine at the end of the Middle Ages says that Bertucci who died in 1347, and Argelata who died towards the end of the fourteenth century, were both in a position to make public demonstrations in dissection because of the example that had been sat by Mondino. They also performed regular dissections for purposes of investigation and used human cadavers rather than the bodies of animals as had been the case before Guy de Chauliac, the father of modern surgery, attended the dissections at Bologna at the beginning of the fourteenth century and on his return to the south of France encouraged the practice there. He was the surgeon to three popes during the time the popes were at Avignon, yet in his book, written while he was a member of the papal household, he insists on the necessity for the dissection of human bodies if any definite progress in surgery is to be made, and he proposed to have the bodies of executed criminals given over to medical schools and physicians for this purpose. This fact alone would seem to decide definitely that there was no papal regulation, real or supposed, forbidding the practice of human dissection at this time. Baas in his "Outlines of the History of Medicine " shows that dissections were not unusual in Italy, and were also known at other European universities. The bodies of criminals who had been executed were used for this purpose at Prague and also at Montpellier.

Just before the beginning of the sixteenth century there are two names worth mentioning in the history of anatomy. They are those of Zerbi, who traced the olfactory nerves and recognized their function, and of Achilini, who first described the small bones of the ear, mentioned the orifices of Wharton's ducts, and described somewhat in detail the ileocæcal valve and other hitherto not well-known portions of the intestines. Another distinguished name is that of Bérenger of Carpi, who did most of his work at Bologna at the beginning of the sixteenth century. He declared that he had dissected more than one hundred human bodies. In Bérenger is to be found the first hint of modern anatomy. His commentaries on Mondino's work show how much he added to that teacher's instruction. He was the first to mention the appendix, and also to indicate the site of the opening of the common bile duct into the intestine. He added much to the knowledge previously held with regard to the organs of generation and pointed out the important distinction between male and female, that the chest has greater capacity in the former and the pelvis in the latter. He discovered the arytenoid cartilages in the larynx and gave the first good description of the thymus gland. His dissections of the eye and of the ear made anatomical knowledge of these structures, also, much more definite.

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MODERN ANATOMY

The time was evidently ripe for the coming of the great father of modern anatomy, Vesalius. He was a Fleming, educated originally at the University of Louvain, where he acquired, besides his classical studies, a taste for scientific investigation. He went to Paris to study under Dubois, better known by his Latin name of Sylvius. Though the Sylvian fissure is named after him, Dubois did not accomplish very much original work. The demonstrations were always made on dogs, but Vesalius eked out his knowledge by studying human bones from the cemeteries at Paris. From Paris Vesalius went to Padua where he became professor of anatomy when only twenty-one. After teaching at Padua for some years he was invited to give courses in anatomy at Bologna which was then a papal city. After a time Pisa also called him to a professorship and he seems to have lectured successively in each of these universities for several years. At the age of twenty-eight he had completed his book "De Fabricâ Corporis Humani" which was forever to remain a classic of anatomical knowledge. There were very few portions of the human body on which Vesalius did not throw new light. His new additions to anatomical knowledge are so numerous that they cannot even be mentioned briefly here. Besides the new information he conveyed there was a still more important feature of Vesalius's work. His methods definitely did away with the old dependence on authority in anatomy which had for so long made men cling to Galen, and prevented progress. After the preliminary opposition on the part of the over-conservative, his discoveries proved an incentive to many younger men who proceeded to carry his methods into the investigation of every part of the body. The story often repeated that he was hampered in his researches by the Inquisition and by the ecclesiastical authorities has no foundation in fact.

Contemporary with him were Eustachius, whose memory is perpetuated in the name of the Eustachian tube which he first described in detail, Fallopius, who corrected certain minor mistakes of Vesalius with regard to the bones and the muscles, but who will be known for his discovery of the uterine appendage which bears his name, and finally Columbus, who succeeded Vesalius and corrected certain details of his description of the heart and its appendages, tracing the course of the blood from the right to the left side of the heart, so that he has often been claimed as the original discoverer of the circulation of the blood. Columbus was afterwards called to Rome to be the professor of anatomy in the Papal University. Eustachius was for some years before this physician to the Pope and also a professor in this University. Italy continued to be for centuries the most fruitful field of anatomical investigation. Fallopius was succeeded by Fabricius who is perhaps best known as the professor under whom Harvey, the English discoverer of the circulation of the blood, made his anatomical studies in Italy. Harvey's discovery was not published until 1628, though he had known it for nearly ten years before that. In the meantime Aselli at Pavia, in 1622, had described the lacteal vessels in the mesentery.

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Outside of Italy the distinguished anatomists are rare. Servetus who was burnt by Calvin, in 1553, for his errors with regard to the Trinity in his book on that subject, gave an astonishingly clear description of the lesser or pulmonic circulation. This was published nearly a century before Harvey's work on the circulation. The most important work done outside of Italy was accomplished by Steno, or Stensen, who demonstrated the duct of the parotid gland, described the lachrymal glands, and gave clear notions as to the ovaries. Besides this he demonstrated that the heart was a muscle and not the seat of the emotions that it had hitherto been considered. He became a convert to Catholicity, and eventually a Catholic bishop. Though he was a Dane his work was done in the Netherlands, the second centre of the anatomical interest in Europe. Here during the first half of the seventeenth century Bartholin, Swammerdam, and Blæs made important discoveries. Bartholin's name is perpetuated in the glands described by him; while the latter two called attention to the existence of valves in the veins. In the second half of the century Ruysch, in Amsterdam, first employed injections for anatomical study, while Brunner and Peyer described their glands in the small intestine. Some important work was done in England in the second half of the seventeenth century. Wharton studied the glands of the mouth; Glisson studied the liver and especially the capsule which has since borne his name, and Willis, after whom the arterial circle at the base of the brain is named, made successful investigations of the brain and nerve. The main current of advance in anatomy, however, still remained in Italy. Malpighi's work is the greatest of the century, with the possible exception of Harvey's discovery. Malpighi described the movements of the blood corpuscles, the structure of bone and of the teeth, the Malpighian layer in the skin, and the Malpighian bodies in the spleen and kidney. He also did work in botany, in which the Englishman, Grew, was his rival. A great contemporary in microscopic work was Leeuwenhoeck, who discovered the corpuscles in milk and in blood, and also had some idea of the cellular nature of the skin.

The eighteenth century saw the rise of another great series of Italian anatomists. Four names are especially distinguished. Those of Lancisi, who combined clinical and anatomical knowledge ; Valsalva, famous for his work on the ear; Santorini, who added much to our knowledge of the face and its appendages, and Morgagni whose main work was concerned with morbid anatomy, but who also added to knowledge in normal anatomy. In France, Winslow like Steno, a Dane, and like him, also, a convert to Catholicism, wrote the first treatise of descriptive anatomy founded on observation alone, and began the series of text-books which made this century famous. Haller, the first great German anatomist, flourished about the middle of this century. His contributions to anatomy, with wonderful engravings, represent a distinct advance in the methods of studying and teaching anatomy. Two distinguished contemporaries in Germany were Meckel who discovered the diverticulum and Lieberkühn after whom the glands are named. In Great Britain, the Hunters, William and John, did excellent work in this century, and Hewson contributed not a little to comparative anatomy.

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At the beginning of the nineteenth century the most important name is that of Bichat, who unfortunately was cut off at the beginning of his thirties when giving promise of being the greatest anatomical genius that ever lived. In England, the Monros at Edinburgh, and Sir Charles Bell, famous for his differentiation of the nerves of motion and sensation, did excellent work. The important advances in anatomy, however, in this century were destined to be made with the microscope. Schwann discovered that all animal tissues were made of cells and thus opened up a new outlook in anatomy. Not long after, Max Schultze demonstrated that all cellular material, plant or animal, was composed of protoplasm. Following these up, Virchow, studying morbid anatomy rather than normal tissues, still did much to advance anatomical knowledge. The teacher of Schwann and Virchow, Johann Müller, though not as illustrious as either of his great disciples, is the man to whom Germany owes the introduction of methods of investigation that were to be so fruitful for the medical sciences during the next half century. Müller and Schwann were both Catholics, and Schwann continued his work in the Catholic Universities of Louvain and Liège creating special interest in anatomical studies in these places. At Louvain the biological journal of the University, La Cellule , has proved the medium for the publication of many important anatomical advances, especially, towards the end of the century, of some of the work of Ramon-y-Cajal who added so much to the knowledge of brain anatomy. There are many other names that deserve mention in the nineteenth century. Such men as Kolliker, Retzius, Henle, Corty, Deiters, Richard Owen, Goodsir, Huxley, Billroth, and Waldeyer cannot be omitted from any adequate account of this period.

ANATOMY IN AMERICA

The first courses in human anatomy in America were offered in New York City by Drs. John Bard and Peter Middleton, about 1750, and at nearly the same time by Dr. Thomas Cadwallader in Philadelphia. In 1762 Dr. Shippen gave anatomical lectures in Philadelphia, and in 1765, with Dr. John Morgan, he organized a school of medicine as a department of what is now the University of Pennsylvania. Medical schools were founded at Columbia College, New York, in 1768; at Harvard in 1783; Dartmouth, 1797; University of Maryland, 1807; Yale, 1810; Brown, 1811; Transylvania University, Lexington, Ky., 1817. Until the last quarter of the nineteenth century very little more than the training of medical students for their work as general practitioners was accomplished in the anatomical departments of American medical schools. Certain names, as those of the elder Warren, Isaac Wistar, William Homer, deserve to be mentioned.

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The important names in the development of anatomy in America are concerned more with comparative than with human anatomy. Cope and Marsh, Agassiz and Leidy, made names for themselves that were known all over the world. Harrison Allen, Thomas Dwight , and Charles Minot, with J. A. Ryder represent in their various departments discoveries of no little importance. In brain anatomy there has been some excellent work from Burt Wilder, E. A. Spitzka, Llewellys Barker, and W. C. Spiller. In general, however, the period of successful investigation into anatomical problems seems to be only just opening up. Definite arrangements for the carrying on of original research are now generally recognized as necessary appendages of university anatomical departments and much can be expected in the very near future.

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