In Our Time - Anatomy

Episode Date: February 14, 2002

Melvyn Bragg examines the history of mankind's quest to understand the human body. The Greeks thought we were built like pigs, and when Renaissance man first cut his sacred flesh it was an act of heresey. We trace the noble ambitions of medical science to the murky underworld of Victorian grave robbing, we trace 2000 years of anatomical study. From the great showman Vesalius, enthralling the Renaissance Artists in the operating theatres of Italy to the sad and gruesome pursuits of Burke and Hare, Anatomy is mankind's often frustrated attempt to understand the body of man. What role has science, religion and art played in the quest to understand the male and the female body?With Harold Ellis, Clinical Anatomist, School of Biomedical Sciences, King's College, London; Ruth Richardson, Historian, and author of Death, Dissection and the Destitute, Phoenix Press; Andrew Cunningham, Wellcome Trust Senior Research Fellow in the History of Medicine, Department of History and Philosophy of Science, Cambridge University.

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or wherever you get your pods. Thanks for downloading the In Our Time podcast. For more details about In Our Time and for our terms of use, please go to BBC.co.com.uk forward slash Radio 4. I hope you enjoy the program. Hello, the first great anatomist who laid down the principles of the workings of the human body for the next 1,300 years, was Galen. He learned his trade in an unusual arena.

He was physician to the gladiators. Yes, those gladiators, Kirkor Marcus Aurelius, whose physician he later became, The wounds of war of wars provided an opportunity for surgeons to advance their craft. Public superstitions about the cutting up of the body have meant that anatomy has been considered with suspicion, often deemed a vile and repulsive subject. But for some doctors and their students, dissection was the ultimate act of exploration and discovery and formed the bedrock of the science of surgery.

How did anatomists solve the mysteries of the form and function of the body? How did the church react to the cutting up and dissecting of God's greatest work? and how did popular disgust towards the way that corpses were treated affect the development of the science. With me to discuss the history of anatomy is Ruth Richardson, research associate of the Medical Humanities Unit, University College London, an author of Death, Dissection and the Destitute, Andrew Cunningham, whose Welcome Trust Senior Research Fellow in the History of Medicine at the Department of History and Philosophy of Science at Cambridge,

an author of several books on the history of anatomy, including the anatomical Renaissance, and Harold Ellis, Professor of Anatomy at Guy's Hospital, London, an author of a history of surgery. Harold Ellis, how did Galen learn his anatomy? We're talking about the second century AD. How did he learn his anatomy? Well, human dissection wasn't allowed. And so Galen, who actually examined a human skeleton when he went to Alexandria,

that was his only contact with human anatomical material, he had to rely, as most anatomists in that era had to rely, on animal dissection. But from the time of Aristotle, the philosophy was that anatomy was anatomy, and that what you saw in the pig or the sheep or the dog or the barbary ape was what you would see in man. That anatomy was universal throughout, let's say, the mammalian species, so that as he spent most of his time on pig dissection, supplemented by other animals, he said, well, if this occurs in the pig,

this is what you would find, were you to dissect a man? Which, of course, up to a great extent, is true with important exceptions. So what did he find out that was massively right, and certainly an extraordinary way, which we'll discuss a few minutes, right enough to lust, as it were,

for 13, 300 years and more or less unchallenged? What things did he find out that convinced people that here was what became an authoritative text? Almost one can use the word of biblical text, really. Well, he really went through the animal body with great skill and great vigor, carried out vivisection experiments, and established the outline of anatomy as we know it today. Many of the things that are named today were named by Galen, The duodenum, the part of the intestine coming out of the stomach. Duodeca means 12.

Galen said the length of the duodenum is 12 fingers placed together, as it is in the pig. It's not far off that in man. The other great thing about Galen was he was an extraordinary showman. He put on public exhibitions of vivisection to the populace. he would divide the pig's spinal column and show that the legs would be paralysed, he'd then make an incision higher up

and show the limbs were paralysed. He'd then go higher up and show that the pig couldn't squeak anymore. Higher up, pig would be dead. Very dramatic, very noisy. Brought me to a full stop now you did, Harold. Anyway, Andrew Cunningham, why did Galen hold sway for so long? He was translated into Arabic, translated back into Latin and corruption set in.

Nevertheless, he became a text, and I said earlier biblical, it was the Dark Ages, which let's use that term for the moment, as it were to be going on with, was a time of belief in texts. But why did you think he held swel so long? What did it do with the fact that it got so much right? Can I just add something to what Harold said there, which is that Galen is at the end of Adon tradition, which starts with Aristotle in the 4th century BC.

So there have been hundreds of anatomists between Aristotle, and Galen, and Galen is the only one whose works we have. So he's the only anatomist that we have. But it's still remarkable that for 1,300 years he wasn't tested when he got, as it proved, a great deal wrong. And I'd just like you to comment on why he wasn't tested, and what's going on that he is not tested. Well, no one is setting out to test him,

because here is someone who seems to know everything about their anatomy. And insofar as people are reading the book, and they don't really start reading it in the West until about 1,300. they are trying to master what's in there. They're not trying to test what Gainer says against the body that they're dissecting. Even if they find something different, which looks different to the way in which he described it, they will still stick with the description rather than with what they find before their very eyes. It's like when you learn to look down a microscope.

If what you see down the microscope isn't what your textbook tells you should be there, you change your eyes until you see it. So no one's looking for error and no one's really noticing any significant difference. And there's a very good example of this. Better you say it than me because you'll know much more what you're talking about with relation to the kidneys, isn't that?

Well, the system of teaching was interesting because the great professor would sit in his cathedral, the professorial chair, up high, and it would be some humble porter who actually did the dissection while the great professor read from, Galen. So the porter would expose the smooth kidney of man and the great professor would read, as it says in Galen, notice that the kidneys are lobulated. And if the students wanted to get through finals, they'd write down their notes, the kidneys are lobulated. There's the wretched thing looking at you as smooth as a baby's bottom. Ruth Richardson, can we just leap to Vassalius, who is regarded perhaps after Galen as the great next person and perhaps the foundation of modern anatomy?

We know that people who challenged Galen were one or two of them were burnt at the stake, no less. And Vesalius made 200 corrections, as he called them to Galen. He seems to be politically quite astute. But what did he bring? I mean, how did he, as it were, get away with it and why did he turn to human anatomy and he got a lot of bodies to work on? Can you tell us a bit about that?

I think there must have been a cultural change before Vizalius because the popes were allowing hanged murderers to be dissected. You know, he was working on hanged murderers, the bodies of hanged murderers. So there must have been some kind of a cultural change before that. And of course, once you start doing these things legally and finding there a discrepancy, someone's got to speak out.

It's like the Emperor's New Clothes. Someone's got to speak out, and it happened to be Ves Aalius. And did the hang bodies become available because of a change at the Vatican? There was never any opposition from the church, as far as I know, to dissection, human dissection. The bodies seem to be in the power of the local authorities who had put them to death, who can grant them to universities and colleges of surgeons and physicians. The church is not against and never has been against dissection. In fact, many of the popes have been very much in favour of promoting anatomical dissection.

And the reason for that is because what is being dissected is the highest point of creation, man's body. Even if you're using a murderer, the low life, you're actually demonstrating the highest design, foresight, providence of God in the high point of God's creation. Can I come back to Vassalia? Can you give us some idea, give the listeners some idea, who he was, what his impact was, and how he took it forward? Bessalius comes from Brussels. He's a student in Paris in the 1530s when people are translating Galen's works from the Greek, which they've just recovered, the anatomical works. And his teachers there are trying to check their knowledge of the body against the text. So they're not looking for errors still in Geylon.

and they are publishing this and teaching as many people who can come. Now, the young Vesedis comes, and he's just brilliant at anatomising. He's just simply the best anatomist since Galen. And he gets very excited by this. He's also a showman like Galen had been. And he gets appointed as the demonstrator in Padua of anatomy. And there, he's 21, 22, he starts taking over and acting as if he's the professor. And the students get excited.

by this and he becomes a very fascinating character for the students. And they invite him to go and give the big public dissections in Bologna and in Padua. And there, he argues with the professor. He then starts saying Galen was wrong. Look, I had this human body in front of me. Galen did not have a human body. And I can see that what Gaynor says is wrong. It's wrong in lots and lots of little ways.

But it's not wrong in the project. the Galen had of investigating the human body. So, Vesalius, even he, takes a long time to realize that what he's dissecting isn't what Galen had dissected. What he's dissecting is the human body. And therefore, he can take the body as being what he calls, the true text.

And the Gaelian text, the written text, is the one which has to be assessed against the body. Now, you have to be pretty pushy, pretty sure of yourself and pretty skilled in dissection to be able to make such a claim and also of course know the text of gain enough by heart which he does.

The artists were getting very involved too, weren't there? I mean Leonardo, as one would expect, was doing anatomy, and there seemed to be in a joint enterprise here. Yes, I think the artists are crucial to the whole history of anatomy. I mean, we use these wonderful illustrations even now, the skeletons weeping on the spade

and leaning, looking sad on a ledge. They're fantastic illustrations of Azaleas ones. And I'm sure when you're an artist and have to draw these things in detail, you have to have a very similar knowledge of anatomy to the actual dissector. I mean, right through the 19th century, the dissectors are doing the drawings.

They're often one of the same person. And yet, Leonardo, the great lady sketch, which is in the royal collection, Leonardo reads Galen and draws what Galen says is in the book, is in the body. And even with his great eye for observation, Leonardo cannot see what we would take to be there in front of his eyes. He can only see what the authority he's reading says is before his eyes.

Can we bring this story back to Britain now, from go up towards Enlightenment? Harold Ellis, was Harvey, William Harvey, who studied in Palli, was he the first considerable anatomist in the world? this country? The British Isles were really a backwater in the time that we're talking about. I mean, there were surgeons in this country, barber surgeons in this country. The amount of contributions they made were small.

The great Thomas Vickery, who was Henry the eighth surgeon, which is about this period, produced a dreadful book of anatomy, which was critical. which was cribbed straight out of Galen and didn't mention Vesalius, even though there was an English translation of Vesalius now available in this country. But Harvey was really our first great medical scientist, trained, of course, much of its time in Padua. And Harvey put together the anatomy of Vesalius with physiological studies, put everything together and

showed the modern concept of the circulation of the heart. At that time, Ruth Richardson, after Harvey in this country, they became a tremendous appetite for that section, didn't they? Yes. Can you just tell us a bit about that, why that built up, Astley Cooper, for instance, until said that the day, he couldn't begin a day. Without cutting a day is wasted,

and he used to go and practice his anatomy before breakfast, which is quite a warmer point when you come to think about it. I mean, I can not practice in the piano before breakfast, breakfast, processing knees, bends or whatever people do before, but practicing anatomy before breakfast. Right, I'm just ready for my am and eggs. But still, it really took off both intellectually and to a certain extent theatrically, isn't it really? Well, I think one thing we haven't mentioned about Harvey is that he's reputed to have dissected both his father and his sister. And that is very unusual, isn't it, Harold? That's unusual. I've not

come across any other anatomist. I have never come across any other enableness. I have never come across any other anatomist that's done that. What does this say about him to you? Well, I think it may say something about the family, which is that they're probably, you know, very much dedication. Yes, absolutely. I mean, Harvey couldn't have come from nowhere. He probably came from a family with an interest in science, and I don't think he'd have cut them up without their agreement, and so, you know... We're talking about donors, right now? We are, we are, and those are unusual donors, because you don't really get much donation until the 18th century, as far as I'm aware, I haven't found any other cases.

Astley Cooper goes up into the 19th century. And that period we're talking about is the Napoleonic War period where you need huge numbers of surgeons to look after the army and where you're getting huge numbers of students and there's lots of money about, there's more bodies about because of body snatching. You know, it's a thriving industry by that stage.

There's an engraving in 1751 called the fourth stage of cruelty. shows that a dissection at the company of surgeons where a corpse appears to scream in horror. Are we still got a superstition there about the corpse being buried whole, about the last judgment when the Trump but calls

you're supposed to rise as a whole human being and meet your soul and meet your maker? But if your legs and arms are missing, you'll be in difficulties. Well, that's a fantastic illustration by Hogarth and it's called the fourth stage of cruelty because the three previous stages are other things that the man has done and he's now been hanged and he's being dissected.

But he shows the dissectors almost as bad as the criminal himself. He thinks they're fairly evenly balanced, I think, if you look at the illustration. And, you know, there's a man going through a bucket looking at his innards and there's a dog looking at the heart in the foreground. And if you look at the history of anatomical illustration, you often find these sorts of things, dogs in the forewerect. and bits of stuff around. And if you read about the history of anatomy,

you know that anatomy rooms were pretty awful places. You know, it's not a pleasant thing to do. And that was the reason it was only allowed to be done legally on hanged murderers. It was viewed with horror by everybody. It wasn't a thing most people wanted to have done to them. It isn't even today. Andrew Cunningham, what about this being buried, what's your comment on that?

People were very scared of being disabled, but people are also always fascinated by the people. section. Now we have not had this in public. We've not been able to go to it since the, what, 1820s or so, at the latest. And now when we get exhibitions of anatomy, they're absolutely full. All these fascinate us, because we love looking at our insides, though we are traumatized by doing so. Harrell, you wrote about how extraordinary skillful these people were, and I mentioned it in a rather rushed manner. Could you give us some more detail about? but how brilliant these men was men, were as anatomists.

They worked by natural light, perhaps supplemented by candles. They worked naked eye. They hadn't got such things as dissecting microscopes. Their instruments, and we've still got their instruments, are pretty crude. They haven't got disposable scalpelable, scalpel blades. they sharpened the instruments themselves. They hadn't got syringes, as we know them,

and yet they carried out the most wonderful perfusion studies, injecting blood vessels and so on with mercury. Now, I've tried to do it, and I can't. Well, I thought that was a bit difficult. I tried to get some of my assistants to do it, and they found it very difficult indeed. Some of the work they did, we cannot actually reproduce even with,

our skills of today. If you go along to the Hunterian Museum, you'll see some of Hunter's mercury injections. I really don't know how he managed to do it. They had quite extraordinary dexterity. Of course, these were just one or two people in the whole population. It wasn't all the medical students were carrying up these wonderful dissections. It was just these inspired people, Fisalius, Hunter, Asti Cooper.

You talked about the speed at which they work, too. Well, they didn't. They weren't speedy in the dissecting room. they were speedy in the operating theatre. But speed in the operating theatre was based on their absolute intimate knowledge of anatomy. They knew exactly where the, say, the main vessels were lying that needed to be tied in amputating a limb.

So they could remove an arm or a leg in 30 seconds, 60 seconds, because they knew their anatomy. Could you remove an arm in 30 seconds? I've never tried, but I've got to. I was quite quick, but with modern anaesthesia, there's no need to be in such a hurry. Because they didn't have... So part of the speed was justified, well, necessary, because the amount of pain the patient could endure.

Absolutely so. I think that's the other interesting thing is that all the... Every man that we've mentioned, all the names we've mentioned, were primarily doctors. I mean, Galen did... Galen was a doctor. Vesalius was a surgeon. Asty Cooper earned his living as sergeant surgeons of the king.

etc. Why did the anatomy theatre go private in this country as it were? Because of demand. You see that the anatomy schools, University of Cambridge, University of Oxford, the College of Surgeons, would be allowed, let's say, a quota of four executed criminals a year. Well, that just wasn't enough to supply the demands of the medical students and surgeons in training. so the surgeons would then open up a private dissecting class which would be packed with these keen young men they couldn't get hold of bodies

because the small quota was being used by the establishment so they would have to go and find their own cadavers we are obviously everything's pointing towards the grave robbing here and by the so-called resurrectionist Ruth Richardson, you say this started quite early. In fact, there's a reference on Shakespeare's grave. Yes, there is. The reference on Shakespeare's grave, could be taken as a grave robbers keep off.

Yes, he says, curse be he who moves my bones. I mean, I think body snatching goes back a long way. I mean, you look at, if you look at the title pages... Body snatching for anatomy, specifically. For anatomy, yes. If you look at the title pages of a lot of the Renaissance Italian anatomy books, they show sometimes very big public, I mean, open-air things like Vizalius.

But then you also see these little tiny groups around a body in a room which has got curtains and, you know, the windows are closed and you have this sense of secrecy and a small number of people. And so I feel that there were private dissections going on for a long, long time before you find commercial exploitation of a situation. I think people are buying and selling specimens between themselves in the late 17th, early 18th century. There's auctions going on for specimens, for example, between doctors.

Can we illustrate this with reference to Birkenhaer, are the most famous? They first of all took a dead body, as I understand it, and then found that they were paid quite a lot of money and just took a shortcut. Well, there was a long run-up to Birkenhair. They were really the end of it, really. I mean, body snatching had been going on to serve. the commercial schools in Britain right way through the 18th century into the 19th.

Birken Hare never actually stole a body from a grave ever in their life. They never needed to. They had a, the way they got into it was that Burke and Hare had a sort of lodging house and a bloke died in the lodging house owing them rent, and they wondered how they could recoup the rent. And they decided to sell his body. There were no relatives around to defend his body. and so they took his corpse to, they were carrying it across Surgeon Square apparently. They asked for Dr. Monroe's office, and the student they met said,

don't take it to Monroe, take it to Dr. Knox. And so they took it to Dr. Knox's school. And they were paid, I think it was eight guineas, the first one, and that's a huge amount of money. I mean, they made their money by this. We're talking about the early 18th century. Early 19th century. This is 1828, 1828.

They did this, the first case. and they I mean they had earned their living by this lodging house and by cobbling shoes they were living on pennies these men so eight guineas was a fortune and it was so easy they were said they were complimented on how fresh it was

and they were told to bring more and that was it that was their life they were set after that lured vagrants from then on the next man was someone who was ill and they put a pillow over his face and then the next one they started luring people in giving them nice food

drink and getting them so drunk that they could be smothered and that's how they did it. And of course if you smother a victim with a pillow, it leaves virtually no mark and that was called burking. I don't know if the expression is still used for murdering someone with a pillow. It's a very effective method of killing somebody. I'm not supposed to give out tips like that. I'm so sorry, yes.

It was also used for smothering debate. You know, don't burke debate. Yes. And then were they caught basically as of greed? In one year, about 50, nox. They killed, I think they killed 16 people in all. And the last one, they were found not by the anatomists, who in fact had deliberately concealed identities on some of these bodies.

I mean, there was one boy who was a street boy who had club foot, a boy called Dalf Jamie. And when they knew, when they found out he was missing from the streets, they cut his feet off. And they detached the head. The anatomists did, because they didn't want it known that it was happening in their anatomy room. but they went on buying the bodies from the same people.

What's driving them to... Let this I mean, with a sort of hollow laugh, we're talking about the respectable burgers of Edinburgh. What's driving them to take part in these horrible crimes? Well, I think there's a sense that they're scientists and they're doing very important scientific work that the public doesn't really understand or appreciate, and so they need to defend themselves against exposure.

And I think that's gone on. You know, it's continued into our own time. It's, you know, we can understand it because it's happened even now. Did the Burke and her event change the way the public demanded that anatomy be viewed and legislative for? Well, anatomy, as it were, went into the closet after this period. And it's very difficult for anyone who's not a medical student to see an anatomy. anatomy take place. And after Birkenhaire, there was legislation creating the Anatomy Act of 1832, in which only the poor who die without relatives in workhouses were deemed to volunteer themselves

by not opting out. They were requisitions. Yes. But then later in the 19th century, people do start donating their bodies for dissection after death. Andrew Cunningham, as we come to the end of You've talked about the death of anatomy. Do you think that people know everything they need to know about human bodies? What I... In large, as a cid from cell anatomy. What I meant by that was that anatomy had been the dominant science of the investigation of life, on and off for over 2,000 years, up to about 1800.

But then it got supplanted by some new sciences of investigation, in particular experimental things. physiology, which is created in France, around about 1800, and clinical pathology, again, from the same place and approximately the same dates. Later, embryology. And all of these meant that the experimental, the investigative side of anatomy just ceased to be so important. So that's what I mean by the death of anatomy, that as a discipline, it's faded into the background. I don't think it has really. I think what's happened is that we, because they're saying, many specialisms. They're all part of anatomy, really.

You know, I mean... Sounds like an atheist point of view. But, you know, morbid anatomy was pathology. Embryology was part... I mean, you look at Hunter's Atlas of the Gravid Uterus, and you know that that's anatomy. Embryology is part of anatomy. It's just that anatomy to Galen, to Veselius, to Astley Cooper, included all these things. But now we've specialised to such an extent and kind of taken off these disciplines and left...

This is what I mean. What's left for anatomy is a sort of rump of... what had been there before. Yes. Merely the geography of the body. But the thing is, I mean, I feel that the geography of the body goes right down into the cells, into the DNA. DNA is anatomy. One of the things said by Hunter was that the use of anatomy for students perminarize the heart to a kind of necessary inhumanity. Do you think it still has that usefulness for students of medicine, Harold?

Our medical students survive at the age of 17, 18, 19, straight from school. and there's a tremendous steep learning curve that turns these young men and women into people who can deal with awful injuries and awful diseases and that education starts in the dissecting room. Well, thank you very much. Thank you very much to all of you, and thank you for listening. We hope you've enjoyed this Radio 4 podcast.

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