In the Beginning: Human Anatomy

Anatomy is one of the oldest branches in medicine. Without knowledge of it the diagnosis and treatment of diseases are inconceivable. Many advances in medicine and surgery can be directly linked to a better understanding of the structure and function of the human body. Our understanding of the structure of the human body has evolved over millennia from the earliest speculations to the beginning of the scientific era.

From fossil discoveries that were made in Ethiopia and elsewhere, we know that a bipedal human-like creature emerged more than four million years ago. Not long after, before the Old Stone Age, he began to create such astonishing works of art which will continue to fascinate us. Among the earliest are the remarkable cave pictures that were done during the Ice and Stone Ages. For example, in France and Spain, life-size drawings of man and large mammals, painted on the walls and ceiling of damp caves, have survived for thousand of years. What is the significance of these pictures? Art historians believe that these palaeolithic drawings were done as part of some magical or religious rituals, or might have evolved from hunting stories and myths.

Intriguing is the silhouette of more than 200 human hands depicted in a cave in Gargas, Southern France. Most of the hands revealed mutilation of one or more fingers, and only 10 appeared to be complete. The remaining hands have not been well preserved to determine whether they are intact or mutilated. The age of the pictures has been estimated from a period between 60,000 and 40,000 BCE, but the people it originated from, and the reasons for the mutilation, and for depicting the hands, remain a mystery.                              

carved female figurespirit figure
Carved female figure                          Spirit figure (Australia, c.9,000BCE)

(Laussel, France, c.20,000BCE)

Among the earliest sculptures of the human form is this paleolithic limestone figurine, known as the Venus of Willendorf. It is about 4.5 inches high and is dated from between 25,000 and 30,000 BCE. The head is almost faceless, but the pendulous breasts and a protuberant abdomen are symbolic of a fertility goddess. Similar carvings have been discovered in other parts of the world.

 

trephination skull
Trephination of the skull

We can only speculate as to when man first peered into the interior of the human body - might it have been from some terrible hunting accident or from such injuries inflicted in battle that ripped open the body surface? From archaeological evidence we know that about 10,000-5,000 BCE, prehistoric man purposefully bore opens a human skull and the patient survived. By the New Stone Age period (3000-2000 BCE), trephination of the skull was widely practiced in Western Europe, as well as in South America and Asia.

 

The ancients believed that evil spirits can live in the head, and most likely trephination was carried out in cases of epilepsy, mental illness, or severe headaches. The hole that was drilled in the skull allowed the evil spirits to escape, so much so that leaders of the clan would have a few holes drilled in their skull so that evil vapours could continuously escape. Of the 10,000 well-preserved pre-Inca mummies discovered in Peru, more than 500 showed evidence of a trephination, some on several occasions, all over the cranium and varying in size. It has been estimated that at least 50% survived the procedure. These early neurosurgeons would have seen the meninges, superior longitudinal sinus, and the gyri on the surface of the brain.

 

In ancient Mesopotamia, temple priests predicted the future and interpreted natural events from observations made of the internal organs of sacrificial animals. The priests made clay models of the liver and lungs of the sheep and different parts were carefully marked out with appropriate cuneiform scripts. These were often used for instructing their disciplines.

 edwin smith papyrus

 Edwin Smith papyrus

The earliest Egyptian papyruses, first written between 3000-2500 BCE, are essentially surgical documents. Listed are incantations, medications and prescriptions for the treatment of diseases.  Some knowledge of the internal organs was probably first obtained from the ritual practice of embalming and mummification which, according to ancient Egyptian beliefs, ensured everlasting life and preserve the body for the next world. The brain, lungs, liver, and intestines were removed and placed in four canopic jars. The heart was left undisturbed in the body because it was considered to be the seat of the soul.

The oldest anatomical records we know of are the fragments found in the medical section of the Egyptian papyruses. Diseases of the eyes (cataracts), haemorrhoids, rectal prolapse, intestinal parasites, abdominal pain, fractures, and various urological conditions are mentioned. Numerous anatomical terms are listed with references to various parts of the body.  

In ancient India healing became entwined with devotion to the Gods. The inhabitants of the Indus valley

developed a rational approach to the practice of healing. This was based on keen observation, nutrition, and the use of herbs, in addition to surgery. Many diseases and treatments, as well as surgical procedures, are recorded in two of the surviving four Vedas, compiled about 1500 – 500 BCE.

Long before the Aryan invasion from the Northwest, an ancient civilization flourished in

 susruta and nasal surgery nasal surgery 

Susruta and nasal surgery (Source: The Gentleman’s Magazine, London 1794

the Indus valley with orderly laid-out settlements, baths, advanced social organization, and good sanitation.

The classic Hindu medical manuscript, Susruta Samhita, was composed in AD 200. It contains large sections devoted to surgery, description of more than 100 operations and the instruments used, and an extensive materia medica of medicinal plant. Knowledge of human anatomy would have been required for many of the surgical procedures recorded in this manuscript. These included cataract extraction, repair of torn ear lobes and cleft lip, removal of stones from the bladder, suturing of the intestines, tonsillectomy, and Caesarean section. Susruta was a surgeon who lived in the holy city of Kashi

(Varanasi)  during  6th century BCE.

Plastic surgery on the nose probably had its beginnings from this era. Because the nose was cut off as a punishment for adultery rhinoplasty was carried out! Susruta dissected the body in spite of religious laws which prohibited contact with the deceased other than for the purpose of cremation. He also described the human skeleton, types of bones, ligaments, joints, muscles, various organs, and blood vessels.

The Greeks questioned previous ideas about the world and produced new explanations - not just in medicine and science but in many other areas of knowledge. About 500 BCE, Alcmaeon of Croton, a contemporary of the mathematician Pythagoras, pursued some anatomical studies. From the fragments that have survived from his work, we know that he dissected animals with the sole purpose of understanding their anatomy. Alcmaeon discovered the optic nerves and the pharyngotympanic tubes, which was re-discovered by Eustachius in the 16th century. Alcmaeon asserted that the brain, not the heart, was the organ responsible for intelligence. Sleep he attributed to a transient suppression of cerebral blood flow which led to death when it became permanent. He knew that the eyes were connected to the brain and that light entering the eyes was essential for sight.

The contributions of Hippocrates, the father of Western medicine, and other Greek physicians to our knowledge of the human body are numerous and form the foundations of Western Medicine. Hippocrates (460-377 BCE) established the healing art as a science far removed from superstition and magic. He challenged the old beliefs of diseases, and put forward a concept that illness might have natural causes and cures. Hippocrates postulated that anatomy is the foundation of medicine. He believed that one could learn sufficient anatomy by observing wounds and human bones, without the unpleasant task of dissecting corpses.

In the Hippocratic Corpus we find a fairly good account of bones, especially of the skull, including the sutures, and of the joints in the body. One should bear in mind that Hippocrates humoral theory, which postulated that various diseases were the result of dyscrasias of four elemental body humours, could by its very nature not have stimulated any interest in anatomy. Although Hippocrates was familiar with the human skeleton and joints, his knowledge of the internal organs and blood vessels were largely based on speculations.

Hippocrates
Hippocrates

Aristotle (384 - 322 BCE), the greatest natural philosopher from this era, was considered by Charles Darwin as the world's greatest natural scientist. Aristotle studied animals which he also dissected, but his knowledge of the human body was based on speculative ideas. He remarked that the internal parts are not so well known, and those of the human bodies are the least known, So that in order to explain them we must compare them with the same parts of those animals which are most nearly allied.  Aristotle laid the foundation of comparative anatomy and established embryology on a scientific course by his observations of the chick embryo. His preformation theory of embryonic development survived in one form or the other until the 17th century.

Herophilus nad Erasistratus
Herophilus and Erasistratus

In Alexandria, Egypt, the human body was dissected in order to understand

more about its structure. Here, Herophilus (about 300 BCE - ?) and Erasistratus (about 250 BCE - ?) dissected as many as 600 persons and made many original discoveries.

Herophilus is often called the father of anatomy. All of his writings, including his book “On Anatomy” have been destroyed. Herophilus described the delicate arachnoid membranes, the cerebral ventricles, the confluence of venous sinuses (torcular Herophili) near the internal occipital protuberance, the lacteals, the coverings of the eye, liver, uterus, epididymis, and many other structures. The name duodenum is attributed to him. Herophilus differentiated nerves of sensation from those associated with voluntary movement, and he knew that damage of the latter led to paralysis.

The younger Erasistratus was more a physiologist and he formulated functional concepts. Erasistratus regarded the heart as a pump. He described the auricles of the heart, cardiac valves, blood vessels, including the aorta, pulmonary artery and veins, hepatic arteries and veins, renal vessels, superior and inferior vena cava, and the azygous vein. Erasistratus recognized the function of the trachea. He also differentiated the cerebrum from the cerebellum, described the cerebral convolutions, ventricles, and meninges.

Alexandria began its decline with the Roman invasion in 48 BCE, climaxed by the burning of its famous library of 700,000 volumes. At that time the library housed all the learning of the ancient World. Egypt became part of the Roman Empire, and medicine was still nurtured by Greek and other scholars but culturally in a Roman environment. Humandissection was forbidden or not encouraged - a situation that lasted until the late middle ages. Like in some medical schools today, it was declared unnecessary for the training of physicians.

The greatest figure of the time was the physician Claudius Galen (AD131 - 201). Galen was not only a great physician but also a celebrated anatomist. Galen's work was recorded into numerous complex treatises covering all conceivable aspects of man’s knowledge. He even published a guide to his writings, entitled “On his own Books”. Galen wrote more than 130 medical treatises, of which 80 have survived, and these classic works became the unquestionable repository of medical knowledge for more than a thousand years after his death. Galen must have gained valuable insight from treating the wounds of the gladiators, but many of his anatomical descriptions were wrong because of his reliance on animal dissection. Nonetheless, Galen made many important contributions to medicine. He accurately described the consequences of spinal cord damage at different levels. He observed loss of sensation and paralysis of all muscles supplied by nerves originating from the spinal cord following complete resection below that level. Galen showed that in addition to the diaphragm other muscles were involved in respiration. Moreover, he left us a detailed description of the origin and course of the phrenic

Galen

Nerve. Galen’s discovery of the recurrent laryngeal nerve led him to understand something of voice production in the larynx.  He described a rete mirabile (a marvellous network) at the base of the human brain which does not exist in man but in hoofed animals. According to Galen, this was the seat of man’s animal spirit which later became transformed into vital spirit. He also misrepresented the shape of the human heart, branches from the aortic arch, the location of the kidneys, the shape of the liver, as well as other anatomical structures.

How influential were the teachings of Galen? In 1559, The Royal College of Physicians of London made one of its members, Dr.John Geynes retract his statements that there were 22 inaccurate passages in the works of Galen. In 1595, Dr. Edward Jordan, a medical graduate of the University of Padua, was required to read five of Galen’s works before being admitted to Fellowship, and in the same year a

Dr.Thomas Rawlins was failed by the College because his knowledge of Galen was inadequate. It is tempting to believe that Galen ushered a long and dark period in the history of medicine, including anatomy, but one should take into consideration the dismal era during which he lived.

For a fitting tribute to Galen, I would like to cite the remarks of a great medical scholar, linguist, and Galen translator - Hunain ibn Ishaq of Baghdad (A.D. 809-873), who upon completing his translation of Galen’s 15th book commented: “this excellent, outstanding work which is one of the compositions of a man who performed marvellously, and revealed extraordinary things, the master of the earlier surgeons, and the lord of the more recent savants, whose efforts in the practice of medicine have been unequalled by any of the prominent since the days of the great Hippocrates - I mean Galen. May God Almighty be merciful to him!”.

Galen was the most celebrated physician and the last of the great medical scholars of antiquity. His work had a profound influence on medical progress, despite many errors. Through his voluminous writings Galen has left for posterity the medical accomplishments of an era that would have all but forgotten.

Mondino de Luzzi and med student
Mondino de Luzzi (1276-1326) and medical student

There are records of the practice of human dissection throughout the Middle Ages. A decree of the Holy Roman Emperor Frederick II (1194-1250) in 1213 authorized that a human body should be dissected at least once every five years for anatomical studies. Attendance was a requirement for the practice of medicine or surgery. In 1315, the first public dissection of a human body for medical teaching was carried out at the University of Bologna by the anatomist Mondino de Luzzi (1276-1326). Mondino compiled one of the earliest anatomy books. Mondino’s Anathomia was a modest manual of 44 pages, without any illustrations, but it became the most popular textbook for medical students for almost two

centuries.

autopsy
 
An autopsy during  the  14th century
Leonardo da Vinci
 
Leonardo da Vinci (1452-1519) 

PHOTO TBA
Leonardo’s drawings of the shoulder region and arm
          

Many famous artists of the early renaissance period, including Leonardo da Vinci (1452-1519), dissected the human body in order to depict the beauty of the human form, both accurately and naturally. Leonardo’s dissection led him to the study of the internal structure of the human body and the pursuit of anatomical studies for its own sake. In more than 750 magnificent drawings, he depicted different parts of the human body from different perspectives and with stunning beauty. Leonardo’s anatomical drawings and manuscripts were to remain hidden and unpublished for almost three centuries.

Leo

medieval

Medieval figure of the female viscera

Andreas Vesalius
Andreas Vesalius (1514-1564)

 Andreas Vesalius (1514-1564) was born in Brussels. He studied medicine in Paris and Padua. Vesalius obtained his Doctor of Medicine degree from the University of Padua in 1537, and on the following day he was appointed Professor of Surgery at the University, and also with the responsibility for teaching anatomy to the medical students. Vesalius carried out the dissections himself and enthusiastically demonstrated the parts of the body. It was customary for the professor to sit at a higher level in a pulpit and read from a Latin text while another person carried out the dissection.

The publication of Vesalius’s book, De Humani Corporis Fabrica, in 1543, revolutionized anatomy because it was profoundly original. It was a large book of folio size, 659 numbered pages with 277 plates accurately depicted the structure of the human body. Vesalius’s book ushered a new era in the history of medicine because it was based on direct observations, as well as sound scientific principles. Publication of De Humani Corporis Fabrica marked the end of Galenism and the beginning of modern medicine.

The beginnings

HUMAN ANATOMY: THE BEGINNINGS
By
T.V.N. Persaud,
Professor Emeritus

REFERENCES:

Persaud, T.V.N.: Early History of Human Anatomy. Charles C. Thomas, Springfield, Illinois, 1984.
Persaud, T. V. N.: A History of Anatomy. The Post-Vesalian Era. Thomas, Springfield, Illinois, 1997.