surgical anatomy through ages
DESCRIPTION
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 studentTRANSCRIPT
19 April 201019 April 2010
Surgical anatomy through the Surgical anatomy through the agesages
Surgical anatomy through the Surgical anatomy through the agesages
Dr Sanjoy SanyalDr Sanjoy SanyalConsultant surgeon and ProfessorConsultant surgeon and Professor
Medical University of Americas, Nevis Medical University of Americas, Nevis St. Kitts-Nevis, W.I.St. Kitts-Nevis, W.I.
[email protected]@gmail.com
Introductory presentation for 1st year medical students
ContentsContents Timeline: Walking down the centuriesTimeline: Walking down the centuries
GreeceGreeceItalyItalyEnglandEnglandModernModern
Interesting historical highlightsInteresting historical highlightsReligious restrictions to dissectionsReligious restrictions to dissectionsSocio-legal implications of restrictionsSocio-legal implications of restrictions
Early anatomical depictionsEarly anatomical depictions Modern anatomy depictionsModern anatomy depictions Concluding famous quotesConcluding famous quotes
TimelineTimeline
Oldest known medical scienceOldest known medical scienceAncient (early) anatomyAncient (early) anatomy: 16: 16thth century century
BCE to 2BCE to 2ndnd century AD (Greece; ended century AD (Greece; ended with Galen)with Galen)
Early (medieval) anatomyEarly (medieval) anatomy: 14: 14thth to 16 to 16thth century (Started in Italy)century (Started in Italy)
1717thth-18-18thth century anatomy century anatomy (Italy) (Italy)1818thth-19-19thth century anatomy century anatomy (England) (England)Modern anatomyModern anatomy: Last 100 years: Last 100 years
Timeline cont’dTimeline cont’dGreeksGreeks
Alcmaeon and EmpodoclesAlcmaeon and EmpodoclesHippocratesHippocrates: Father of Medicine: Father of MedicineAristotleAristotleHerophilus / Erasistratus: Herophilus / Erasistratus:
11stst human dissection human dissectionGalenGalen: Dissected monkeys : Dissected monkeys
Considered Father of Ancient AnatomyConsidered Father of Ancient AnatomyHis publication was equivalent of ‘Gray's His publication was equivalent of ‘Gray's
Anatomy’ of ancient world for 1500 yearsAnatomy’ of ancient world for 1500 years
Timeline cont’dTimeline cont’dNot much progress after fall of Roman Empire; Not much progress after fall of Roman Empire;
Marked the hiatus between 2Marked the hiatus between 2ndnd to 14 to 14thth century AD century AD ItalyItaly: Centre of Anatomy (Bologna, Padua): Centre of Anatomy (Bologna, Padua)
Mondino de Liuzzi, Alessandro AchilliniMondino de Liuzzi, Alessandro AchilliniAndreas VesaliusAndreas Vesalius: Dissected human bodies : Dissected human bodies
and disproved many of Galen’s work because and disproved many of Galen’s work because they were animal models; Considered as they were animal models; Considered as Father of Modern AnatomyFather of Modern AnatomyM. Realdo ColomboM. Realdo ColomboGabriele FalloppioGabriele Falloppio
Giovanni Filippo IngrassiasGiovanni Filippo Ingrassias
Students
Fabrica Fabrica title page title page Andreae Vesalii Andreae Vesalii
Bruxellensis, scholae Bruxellensis, scholae medicorum Patauinae medicorum Patauinae professoris, de Humani professoris, de Humani corporis fabrica Libri corporis fabrica Libri septem septem
((Andreas Vesalius of Andreas Vesalius of Brussels, professor at Brussels, professor at the school of medicine the school of medicine at Padua, on the fabric at Padua, on the fabric of the Human body in of the Human body in seven Booksseven Books))
Ves
aliu
s’ F
abri
ca
Vesalius’ workVesalius’ workThe The FabricaFabrica is known for is known for
its highly detailed its highly detailed illustrations of allegorical illustrations of allegorical human dissectionshuman dissections
Su
rger
y in
16
Su
rger
y in
16thth
ce
ntu
ry H
olla
nd
cen
tury
Ho
llan
d
Aris KindtAris Kindt (Aris the (Aris the Kid), a.k.a. Kid), a.k.a. Adriaan Adriaan Adriaanszoon, Adriaanszoon, was convicted of was convicted of armed robbery in armed robbery in the Netherlands in the Netherlands in early 1600s. He early 1600s. He was sentenced to was sentenced to death by hanging death by hanging
His body was His body was autopsied by autopsied by Amsterdam Guild of Amsterdam Guild of Surgeons on 16 Surgeons on 16 January 1632January 1632
Autopsy was captured in Autopsy was captured in 1632 by Rembrandt in his 1632 by Rembrandt in his painting, painting, Anatomy Lesson of Anatomy Lesson of Dr. Nicolaes TulpDr. Nicolaes Tulp, which , which depicts surgeon Nicolaes depicts surgeon Nicolaes Tulp at workTulp at work
Early craniotomyEarly craniotomy
Timeline cont’dTimeline cont’dEnglandEngland (19 (19thth century) century)
Descriptive Human Anatomy of previous Descriptive Human Anatomy of previous centurycentury finalised / systematisedfinalised / systematised
Histology and Developmental BiologyHistology and Developmental BiologyGray’s AnatomyGray’s Anatomy: Henry Gray compiled a : Henry Gray compiled a
single volume for ‘traveling’ doctorsingle volume for ‘traveling’ doctor
Timeline cont’dTimeline cont’dAmerica and elsewhereAmerica and elsewhere (Last 100 years) (Last 100 years)
Evolutionary and Molecular BiologyEvolutionary and Molecular Biology EndocrinologyEndocrinology GeneticsGeneticsRadiological anatomy: X-ray, CT scan, MRI, Radiological anatomy: X-ray, CT scan, MRI,
PET scan PET scan VisibleVisible Human Project (National Library of Human Project (National Library of
Medicine)Medicine)Photographic, computerized, 3-D, digital, Photographic, computerized, 3-D, digital,
animated depictionsanimated depictions
Early historical highlightsEarly historical highlights
(Against operating on humans and (Against operating on humans and handling, and dissecting human cadavers)handling, and dissecting human cadavers)
Italy: Religious taboosItaly: Religious taboos
England: Socio-legal implicationsEngland: Socio-legal implications
Religious restrictionsReligious restrictions Italian Church abhorred spilling of blood Italian Church abhorred spilling of blood Only gallows victims were allowed to be Only gallows victims were allowed to be
dissecteddissectedOnly in Italy (Padua, Bologna) could dissections Only in Italy (Padua, Bologna) could dissections
be performed; Vesalius dissected in Paduabe performed; Vesalius dissected in PaduaOnly in Italy could female cadavers be Only in Italy could female cadavers be
dissecteddissectedOnly certified / Royal anatomists could perform Only certified / Royal anatomists could perform
dissections; for 1-year termdissections; for 1-year termCity councilors sponsored dissections – City councilors sponsored dissections –
charged admission feecharged admission feeAttending dissections was legalAttending dissections was legal
Religious restrictionsReligious restrictionsReprimandReprimandPersecutionPersecution ImprisonmentImprisonmentHouse arrestHouse arrestBanning publicationBanning publicationBurning publicationsBurning publicationsDeath sentenceDeath sentenceGalileo Galilie and Rene Galileo Galilie and Rene
Descartes were 2 such Descartes were 2 such victims of church persecutionvictims of church persecution
Rene Descartes
Galileo Galilie
Socio-legal scenarioSocio-legal scenarioBarbersBarbers: Only were permitted to perform minor : Only were permitted to perform minor
surgeries (lancing abscess, removing corn etc)surgeries (lancing abscess, removing corn etc)
SurgeonsSurgeons: But they needed to acquire skills : But they needed to acquire skills and learn the human bodyand learn the human body
AnatomistsAnatomists: But human cadavers were difficult : But human cadavers were difficult to come byto come by
Body-snatchers
Grave robbers
Thieves
Murderers
Gave rise to
Gave rise to
Took the help of
Criminal gangs
Socio-legal scenarioSocio-legal scenarioReluctance of society to donate one's self for Reluctance of society to donate one's self for
betterment of medical sciencebetterment of medical scienceWilliam HarveyWilliam Harvey, discoverer of circulation of , discoverer of circulation of
blood, dissected both his father and his sister blood, dissected both his father and his sister The bodies were not donated for dissection with The bodies were not donated for dissection with
altruistic motives altruistic motives They were attained by force, theft, body-They were attained by force, theft, body-
snatching, grave-robbery, even murdersnatching, grave-robbery, even murderPeople do not wish to associate with that kind People do not wish to associate with that kind
of history; Hence laws were enacted of history; Hence laws were enacted
Legal implicationsLegal implications 1752 — England’s Murder Act1752 — England’s Murder Act 1824 — Unclaimed bodies to be used for 1824 — Unclaimed bodies to be used for
dissectiondissection 1825-26 — "Great Inflation": grave robbers 1825-26 — "Great Inflation": grave robbers
charged higher prices for corpsescharged higher prices for corpses 1832 — Anatomy Act: allowed use of 1832 — Anatomy Act: allowed use of
unclaimed pauper bodies from hospital for unclaimed pauper bodies from hospital for sale and dissectionsale and dissection
1834 — Poor Law Amendment Act1834 — Poor Law Amendment Act TODAY TODAY — All bodies for dissection in — All bodies for dissection in
teaching institutions are by donationsteaching institutions are by donations
Modern cadaver dissection tableModern cadaver dissection table
Autopsy dissection in progressAutopsy dissection in progress
Ear
ly a
nat
om
y d
epic
tio
ns
Ear
ly a
nat
om
y d
epic
tio
ns E
arly anato
my d
epictio
ns
Early an
atom
y dep
iction
s
WoodcutWoodcut
Wood engravingWood engraving
Hand coloringHand coloring
Metal etching with acidMetal etching with acid
Metal mezzotintMetal mezzotint
CopperplateCopperplate
LithographyLithography
Modern anatomical depictionsModern anatomical depictions
Color drawings / diagrams, Color drawings / diagrams, Photographic demonstrationPhotographic demonstrationSynthetic modelsSynthetic modelsRadiological depictionsRadiological depictionsDigital radiographyDigital radiography3-D digital reconstruction3-D digital reconstructionAnimated depictionsAnimated depictions
Th
ora
cic
visc
era
Th
ora
cic
visc
era
Th
oracic viscera
Th
oracic viscera
An old depiction of thoracic cage (left) vs. a modern depiction of same (right)
Photography
Syn
thet
ic m
od
el o
f b
rain
Syn
thet
ic m
od
el o
f b
rain
Skeleton – student demonstrationSkeleton – student demonstration
Pla
in X
-ray
man
dib
le /
cer
vica
l sp
ine
late
ral
view
– a
bu
llet
is
lod
ged
in
sid
e!
DIC
OM
ch
est
x-ra
yD
ICO
M c
hes
t x-
ray
Vis
ible
Hu
man
Pro
ject
–
Nat
ion
al L
ibra
ry o
f M
edic
ine
3-D
dig
ital
re
con
stru
ctio
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iversity of
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lorad
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An
imat
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imated
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““Science Science knows no knows no country, country, because because knowledge knowledge belongs to belongs to humanity, humanity, and is the and is the torch torch which which illuminates illuminates the world.”the world.”
--Louis --Louis PasteurPasteur
"Don't be afraid to "Don't be afraid to take a big step. You take a big step. You can't cross a chasm can't cross a chasm in two small jumps."in two small jumps."
--David Lloyd George--David Lloyd George
"You've made it this far. Keep going a little longer and you'll see the sun rise on a "You've made it this far. Keep going a little longer and you'll see the sun rise on a beautiful new day." beautiful new day." --Ralph Marston--Ralph Marston