History of Anatomy - Modern Anatomy

Modern Anatomy

Anatomical research in the past hundred years has taken advantage of technological developments and growing understanding of sciences such as evolutionary and molecular biology to create a thorough understanding of the body's organs and structures. Disciplines such as endocrinology have explained the purpose of glands that anatomists previously could not explain; medical devices such as MRI machines and CAT scanners have enabled researchers to study the organs of living people or of dead ones. Progress today in anatomy is centered in the development, evolution, and function of anatomical features, as the macroscopic aspects of human anatomy have been largely catalogued. The subfield of non-human anatomy is particularly active as modern anatomists seek to understand basic organizing principles of anatomy through the use of advanced techniques ranging from finite element analysis to molecular biology.

With increasing demands on the healthcare system and what could be deemed chronic under-training of doctors (numbers of doctors per capita compared to other industrialised countries) during the latter half of the 20th century, medical schools are now facing massive pressure to train as many doctors as possible. This has meant in recent years cohort sizes have doubled and more in size, to try to meet the demand. This has resulted in increased pressure of the facilities at all medical schools in the country. Anatomy is one department in particular that has had to evolve to accommodate the number of students. At Birmingham dissection was once essential to the teaching of anatomy but since the end of the 1980s the medical school has adopted prosection over dissection. At the time new directives from the General Medical Council (GMC) on the direction medical education was the major factor according the current head of anatomy. There are also many other reasons why prosection maybe favoured (discussed below). It has probably now become near impossible to restart dissection at Birmingham even if one wanted to. This is due to the fact that current prosection uses a very similar number of cadavers as dissection previously did. If dissection was to be brought back the number of cadavers would be very large due the current cohort size. To increase provision of prosection the medical school is currently investing in the region of £800,000-900,000 on a new prosectorium. This will allow up to about 40 students to observe prosected material in any one session. The vast amount of money required just to increase the amount of prosection demonstrates that it is no longer possible to carry out dissection at Birmingham (and is the case for many other universities). Prosection makes more efficient use of a cadaver when compared to dissection. A single cadaver when dissecting would be used by up to 5 students whereas prosection allows if necessary and entire cohort to observe the prosected cadaver. Prosection also allows students to observe more than one cadaver whereas in dissection you would tend to just use a single one. Logistically prosection allows more flexibility than dissection as there is no commitment to provide a cadaver per a certain number of students, this in fact create opportunities for cadavers to be used, for example at Birmingham, for Special Study Modules (SSMs) and postgraduate teaching.

Also there are many more aids to teaching anatomy then merely the prosectorium; improvements over the last century in colour images and photographs means that an anatomy text is no longer an aid to dissection but rather a central material to learn from. Plastic models are also regularly used in anatomy teaching sessions and they offer a good substitute to the real thing. One argument against plastic models is that they may provide a false sense of conformity in the human body; there is no doubt quite a difference between a plastic model and a prosected cadaver. Use of living models for anatomy demonstration is once again becoming popular within teaching of anatomy. Anatomy is dynamic, for example the anatomy of the musculoskeletal system is by definition the anatomy of movement. So to provide an example of this to the audience (students) and be able to demonstrate the possible movements is beneficial. Surface landmarks that can be palpated on another individual also provide practice for future clinical situations. It is possible to do this on oneself and a good example of this being implemented is Integrated Biology at the University of Berkeley; students are encouraged to “introspect” on themselves and link what they are being taught to their own body. This may seem like a relatively obvious idea but to formally link it into teaching of anatomy should aid memory recall.

Donations of bodies have also declined in recent years with a marked decline of public confidence in the medical profession. With scandals such as Alder hay and Bristol, people are less confident that their wishes on what will happen to their body will be carried out, so instead have not donated to medical science when in the past they may have. The resultant legislation from these scandals (namely the Human Tissue Act 2004) has tightened up the availability of resources to anatomy departments. Another factor facing body donations is the problems arising from the outbreaks of Bovine Spongiform Encephalitis (BSE) in the late 80s and early 90s and the restrictions of handling of brain tissue that resulted from this. The exact pathology of the human form, variant Creutzfeldt–Jakob disease (vCJD) has meant that patients donating their body who suffered from Alzheimer’s or dementia and of course vCJD means their brains cannot be handled. As the method of transmission of these diseases and the link between them (i.e. is Alzheimer’s vCJD and vice versa) is not fully understood these precautions have to be taken. Very symptomatic patients are also not normally accepted for cadavers. However this means that students are more limited on what they can dissect within the head, this is particularly a problem in medical schools where dissection is still carried out. It is less of a problem where prosection is carried out as the specimen will have already been dissected.