Human anatomical science and illustration: the origin of two inseparable disciplines

Challenges to sourcing human bodies for teaching and research in Africa: Are the challenges insurmountable?

The teaching and learning of human anatomy by dissection has existed for thousands of years. Over the centuries, evolving ethical considerations for the sourcing of human bodies for dissection have resulted in a transition from the use of unconsented individuals to that of body donors and the institution of body donation programmes around the world. However, major challenges on the African continent have resulted in the continued use of unconsented or unclaimed bodies and the ethical dilemma for African anatomy departments regarding their use. Some of the key difficulties in sourcing donor bodies which exist on the African continent emanate from religious, cultural, societal trust and other confounding factors. This manuscript explores the challenges and suggests ways in which some of these constraints may be overcome.

Art and Neurosurgery: The Importance of Medical Illustration

Art in neurosurgery has been a critical part of the discipline for centuries. Numerous cultures, such as ancient India, China, and Egypt, and more contemporary scientists, such as Leonardo da Vinci, Max Brödel, and Norman Dott, have significantly contributed to medical illustration. Today, advancements in three-dimensional technology have allowed for the creation of detailed neuroanatomy models for surgical planning and education. Medical illustrations are also used for research and outcome documentation as they help visualize anatomy and surgical procedures. Its use in education, surgical planning, and navigation remains integral to the advancement of neurosurgery. This review demonstrates the invaluable contribution of art in neurosurgery and how it has enabled continuous progress in the field.

Students' Perception of Newly Experimented "Rangoli Art" in Anatomy Education: A Pilot Study

Art and drawing have a well-established history with the teaching and learning of anatomy, as symbolized by Leonardo Da Vinci's Vitruvian Man. However, its efficacy relatively declined in modern anatomy education. The purpose of this study was to survey students' views regarding the "anatomy Rangoli-making activity" and to discern if this art form may be implicated in anatomy education. In this group activity, the basic anatomical drawing of the specific structure was made on the floor, and then the different structures in the illustration were filled with relevant powdered Rangoli colors. The present study was conducted on seventy-eight first-year medical students who were willing to participate in the study. A mixed questionnaire regarding their opinion on the "anatomy Rangoli-making activity" was designed and feedback was taken from the students. The majority of the students replied that the Rangoli-making activity was interesting, promoted team spirit, and improved confidence to draw and understand the concept of the diagrams. The students agreed that it is an innovative method of anatomy learning. Almost 99% of students suggested incorporating such art activities in anatomy learning for future students. The enthusiastic response of the students to this activity is encouraging to introduce such art base activities in anatomy education and learning. Future multicenter studies on this learning method may be planned to check its efficacy.

Profiting from public dissection: A new era of unethical practices

Historically, adverse events have reflected poorly on both the practice of dissection and the perception of the discipline of anatomy. The recent public dissection of a body donor is a regression to an unethical historical practice and was strongly denounced by anatomists around the world. The individual whose donated body was sourced from a 'for-profit" company in the United States had not given consent for a public dissection. This violates the ethics surrounding consent and body donation and potentially places the future of body donor programs in jeopardy as it compromises community frameworks around epistemic trust. Recent guiding frameworks by international anatomical associations on the ethical use of bodies have cemented the way in which body donor programs should operate. This viewpoint reflects on past and current events pertaining to public dissections and questions how these indignities may influence the public's interaction with human bodies. The authors argue that public dissection should be prohibited as it is against social mores. Social pressure should be applied to individuals or companies who wish to profit from unethical anatomical practice and legislation prohibiting public dissection should be introduced in those countries where it does not yet exist.

Cone Beam Computed Tomography (CBCT) Technology and Learning Outcomes in Dental Anatomy Education: E-Learning Approach

E-learning is an educational method that improves knowledge innovation by sharing relevant images for advanced learning, especially in a pandemic state. Furthermore, cone-beam computed tomography (CBCT) is a method that gathers medical or dental diagnostic images. This study aimed to analyze the effectiveness of dental anatomy education through a CBCT technology tool, through teachers' and students' perspectives, adjusted according to the disruptions caused by the Covid-19 pandemic. A cohort study and longitudinal exploratory analysis were performed. Forty undergraduate first-year dental students, from the University of Coimbra in Portugal, were selected as per the inclusion and exclusion criteria. Two different teaching methods were applied during an identical time-period: face-to-face lectures complemented by physical models (T1 cohort) and webinar lectures complemented by CBCT images (T2 cohort). Learning outcomes were then studied according to theoretical and spatial orientation contexts. A self-reported survey that focused on students' satisfaction, stress, and support was studied. Both teaching methods were analyzed with paired sample student's t-test and Pearson Correlation Confidence intervals 95% with P < 0.05. Furthermore, exploratory factor analysis (EFA) was used for self-reported satisfaction survey validity and reliability analysis. The learning outcomes between T1 and T2 cohorts were statistically significant, (P < 0.001) corresponding to differences with a large effect degree (r > 0.60). Students' satisfaction, as measured on a six-point Likert scale, was positively influenced by the webinar lectures supplemented with CBCT images (T2 cohort) in a learning context (4.95 ± 0.5) and future applications (5.92 ± 0.27). In conclusion, the webinar approach with CBCT images was more effective and better learning method for teaching dental anatomy.

Drawing in Veterinary Anatomy Education: What Do Students Use It For?

In contrast to medical education, information on the use of arts as a learning approach is scarce in veterinary anatomy. The aim of this prospective, questionnaire-based study was to survey students' use of drawing in various aspects of veterinary anatomy learning (self-study, examinations, preparation for, and reflection on cadaver dissection). The quantitative data showed that first-year students with artistic preferences used drawing significantly more often in most aspects of anatomy learning than students with no such preferences, apart from the reported use of drawing in examinations and for reflection after cadaver dissection. The lack of significant correlations of the reported use of drawing in examinations with any other study variable provided support for the author's observation that student-generated drawings are not as commonly used in examinations as previously. In contrast to the study hypothesis, previous university studies did not correlate significantly with any aspect of the use of drawing in anatomy learning. None of the reported uses of drawing addressed the benefits of drawing in learning the comparative anatomy of animal species, a characteristic distinguishing veterinary anatomy from human anatomy. Qualitative student feedback indicated that encouragement and teacher-produced images would increase the use of drawing as a learning approach even if the implementation of drawing into the curriculum is not feasible. Conclusions from this study were implemented through self-directed learning in anatomy courses that replaced the canceled cadaveric dissections during the COVID-19 outbreak and also through the ongoing drawing workshops to further advance the use of drawing in veterinary anatomy learning.

Bygone theatres of events: A history of human anatomy and dissection

Over the last four millennia, the discipline of anatomy and its relationships with medicine and society have evolved dramatically. Human dissection, the perennial tool for anatomical discovery and education, has both guided this evolution and matured alongside it. Soon after the first cadaveric dissections recorded in ancient Greece, China, India, and Persia, clear endorsements of its practice fell largely silent in the anatomical record for 1,500 years before reappearing in Europe at the dawn of the Renaissance. Between the 13th and 18th centuries CE, the performance of anatomical dissection became a popular form of education and public entertainment, and the demand for human cadavers steadily increased among European anatomical schools while supply remained limited by legal statute. This gave rise to an informal group of amateur and professional body snatchers called the Resurrectionists and, later, inspired the Anatomy Act of 1832 CE. In the 20th and 21st centuries CE, voluntary body bequeathal programs have enabled the practice of human dissection to continue in academic centers as a cornerstone of anatomical education, now with a newfound focus on the development of affective skills. This article provides an abridged account of anatomy's development, highlighting key moments in its growth, the valuable contributions of many different societies to the discipline, and the important roles of several luminary anatomists of antiquity. Within the broader context of this history, it offers an overview of anatomical dissection's evocative past, spanning from its inception to its present-day practice.

Historical Advancements and Evolution in Understanding Human Anatomy and Pathology: The Contribution of the Middle Ages

Dissections and autopsies are critical for understanding human anatomy, pathology, and uncovering mechanisms of disease. This review presents an historical journey from ancient times until the late Middle Ages. The major steps and developments are summarized with key figures and events presented.

From Ancient Texts to Digital Imagery: A Brief History on the Evolution of Anatomic Illustrations

In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.

The mediums of dissemination of knowledge and illustration in neurosurgery: unraveling the evolution

The earliest evidence of man's attempts in communicating ideas and emotions can be seen on cave walls and ceilings from the prehistoric era. Ingenuity, as well as the development of tools, allowed clay tablets to become the preferred method of documentation, then papyrus and eventually the codex. As civilizations advanced to develop structured systems of writing, knowledge became a power available to only those who were literate. As the search to understand the intricacies of the human brain moved forward, so did the demand for teaching the next generation of physicians. The different methods of distributing information were forced to advance, lest the civilization falls behind. Here, the authors present a historical perspective on the evolution of the mediums of illustration and knowledge dissemination through the lens of neurosurgery. They highlight how the medium of choice transitioned from primitive clay pots to cutting-edge virtual reality technology, aiding in the propagation of medical literature from generation to generation across the centuries.

Focused Multisensory Anatomy Observation and Drawing for Enhancing Social Learning and Three-Dimensional Spatial Understanding

The concept that multisensory observation and drawing can be effective for enhancing anatomy learning is supported by pedagogic research and theory, and theories of drawing. A haptico-visual observation and drawing (HVOD) process has been previously introduced to support understanding of the three-dimensional (3D) spatial form of anatomical structures. The HVOD process involves exploration of 3D anatomy with the combined use of touch and sight, and the simultaneous act of making graphite marks on paper which correspond to the anatomy under observation. Findings from a previous study suggest that HVOD can increase perceptual understanding of anatomy through memorization and recall of the 3D form of observed structures. Here, additional pedagogic and cognitive underpinnings are presented to further demonstrate how and why HVOD can be effective for anatomy learning. Delivery of a HVOD workshop is described as a detailed guide for instructors, and themes arising from a phenomenological study of educator experiences of the HVOD process are presented. Findings indicate that HVOD can provide an engaging approach for the spatial exploration of anatomy within a supportive social learning environment, but also requires modification for effective curricular integration. Consequently, based on the most effective research-informed, theoretical, and logistical elements of art-based approaches in anatomy learning, including the framework provided by the observe-reflect-draw-edit-repeat (ORDER) method, an optimized "ORDER Touch" observation and drawing process has been developed. This is with the aim of providing a widely accessible resource for supporting social learning and 3D spatial understanding of anatomy, in addition to improving specific anatomical knowledge.

Berengario da Carpi and the Renaissance of Brain Anatomy

Berengario da Carpi (Jacopo Barigazzi) was born around 1460 in the small Italian town of Carpi near Modena. Berengario’s father, Faustino, was a reputable barber-surgeon who initiated his son early into the art of anatomy and surgery. After his graduation from the University of Bologna in 1489, Berengario rapidly acquired an enviable reputation as a physician and surgeon following the successful treatment of several dignitaries, including Lorenzo de’ Medici, Duke of Urbino who suffered a severe head injury in 1517. While professor of anatomy and surgery at the University of Bologna, Berengario published in 1518 his De fractura cranei, a landmark work on cranio-cerebral surgery. Berengario’s masterpiece, however, is undoubtedly his detailed Commentaria on the famous medieval anatomy treatise of Mondino de’ Liuzzi (ca. 1270–1326) that he published in 1521. A shorter version entitled Isagogae Breves appeared a year later. Besides a facsimile of Mondino’s work, Berengario’s Commentaria contains a wealth of new information, including observations that challenged Galenic physiology. Galen taught that the rete mirabile—a vascular plexus believed to occur at the basis of the human brain—is the locus where the vital spirit is transformed into the more sophisticated animal spirit that is stored in the brain ventricles to be later released at the periphery through a journey within hollow nerves. Courageously, Berengario wrote that despite many attempts he was unable to detect the famous rete mirabile in humans. He also noted that the nerves linked to the brain are solid structures, not hollow tubes, as advocated by Galen. His conclusions were based on a systematic dissection method that he called anatomia sensibilis, a term that emphasizes the sensory over textual versions of the truth. Berengario contributed significantly to human brain anatomy, with a detailed description of the meninges and cranial nerves and the first comprehensive view of the ventricular system, including choroid plexuses, interventricular foramen, infundibulum, pituitary stalk and gland. Berengario, who died around 1530 in Ferrara, should be remembered for his catalyzing role in the transmutation of medieval morphological knowledge into a modern anatomical science based upon direct observation and experimental demonstration.

The history of optic chiasm from antiquity to the twentieth century

PURPOSE

The optic chiasm is an essential structure located at the skull base that stirred over time the curiosity of anatomists, who became more and more interested in its structure and function. Through centuries, the optic chiasm was viewed as a vessel crossing, a way of transporting tears secreted by the brain to the eye, integrating images, or responsible for coordinated eye movements. The paper aims to overview the history of understanding the optic chiasm from the beginnings of antiquity to the twentieth century.

METHODS

We reviewed the literature and studied all the historical sources on optic chiasm and eyes in the works of ancient, medieval, Renaissance authors, and the seventeenth to nineteenth century works.

RESULTS

The optic chiasm is a structure that fascinated ancient anatomists and made them develop various theories on its function. In terms of function, the optic chiasm had a history based more on speculation, the seventeenth century bringing its first understanding and reaching the peak in the nineteenth century with the understanding of the anatomical structure of the chiasm and its role in the visual process.

CONCLUSION

The history of the optic chiasm is a fascinating time travel displaying the conceptual transformations that have been made in anatomy and medicine by our forerunners.

The hidden symbols of the female anatomy in Michelangelo Buonarroti's ceiling in the Sistine Chapel

A number of published articles have suggested that each element of Renaissance art contains an inner meaning. Some of these elements include the choice of theme and protagonists, faces selected for the characters, colors used, species of flowers and trees chosen, animals depicted, positions of the elements, posture of the characters and their gestures, juxtapositions in the scenes, and even the very scenario or landscape. All of these elements are thought to have hidden meanings. In this context, this manuscript presents a new hypothesis suggesting that Michelangelo Buonarroti (1475-1564) may have concealed symbols associated with female anatomy in the ceiling of the Sistine Chapel (painted 1508-1512) in Rome. Thus, this paper is useful to better understand the history of anatomy and corroborates recent descriptions that have suggested the possible existence of anatomic figures concealed in many of Michelangelo's works. Clin. Anat. 29:911-916, 2016. © 2016 Wiley Periodicals, Inc.

A reusable anatomically segmented digital mannequin for public health communication

The ongoing development of world wide web technologies has facilitated a change in health communication, which has now become bi-directional and encompasses people with diverse backgrounds. To enable an even greater role for medical illustrations, a data set, BodyParts3D, has been generated and its data set can be used by anyone to create and exchange customised three-dimensional (3D) anatomical images. BP3D comprises more than 3000 3D object files created by segmenting a digital mannequin in accordance with anatomical naming conventions. This paper describes the methodologies and features used to generate an anatomically correct male mannequin.

Michelangelo, the Last Judgment fresco, Saint Bartholomew and the Golden Ratio

Art and anatomy were particularly closely intertwined during the Renaissance period and numerous painters and sculptors expressed themselves in both fields. Among them was Michelangelo Buonarroti (1475-1564), who is renowned for having produced some of the most famous of all works of art, the frescoes on the ceiling and on the wall behind the altar of the Sistine Chapel in Rome. Recently, a unique association was discovered between one of Michelangelo's most celebrated works (The Creation of Adam fresco) and the Divine Proportion/Golden Ratio (GR) (1.6). The GR can be found not only in natural phenomena but also in a variety of human-made objects and works of art. Here, using Image-Pro Plus 6.0 software, we present mathematical evidence that Michelangelo also used the GR when he painted Saint Bartholomew in the fresco of The Last Judgment, which is on the wall behind the altar. This discovery will add a new dimension to understanding the great works of Michelangelo Buonarroti.

Evolution of illustrations in anatomy: a study from the classical period in Europe to modern times

Illustrations constitute an essential element of learning anatomy in modern times. However it required a significant evolutionary process spread over centuries, for illustrations to achieve the present status in the subject of anatomy. This review article attempts to outline the evolutionary process by highlighting on the works of esteemed anatomists in a chronological manner. Available literature suggests that illustrations were not used in anatomy during the classical period when the subject was dominated by the descriptive text of Galen. Guido da Vigevano was first to use illustrations in anatomy during the Late Middle Ages and this concept developed further during the Renaissance period when Andreas Vesalius pioneered in illustrations becoming an indispensable tool in conveying anatomical details. Toward later stages of the Renaissance period, Fabricius ab Aquapendente endeavored to restrict dramatization of anatomical illustrations which was a prevalent trend in early Renaissance. During the 18th century, anatomical artwork was characterized by the individual styles of prominent anatomists leading to suppression of anatomical details. In the 19th century, Henry Gray used illustrations in his anatomical masterpiece that focused on depicting anatomical structures and were free from any artistic style. From early part of the 20th century medical images and photographs started to complement traditional handmade anatomical illustrations. Computer technology and advanced software systems played a key role in the evolution of anatomical illustrations during the late 20th century resulting in new generation 3D image datasets that are being used in the 21st century in innovative formats for teaching and learning anatomy.

Art, anatomy, and medicine: Is there a place for art in medical education?

For many years art, anatomy and medicine have shared a close relationship, as demonstrated by Leonardo da Vinci's anatomical drawings and Andreas Vesalius' groundbreaking illustrated anatomical textbook from the 16th century. However, in the modern day, can art truly play an important role in medical education? Studies have suggested that art can be utilized to teach observational skills in medical students, a skill that is integral to patient examination but seldom taught directly within medical curricula. This article is a subjective survey that evaluates a student selected component (SSC) that explored the uses of art in medicine and investigates student perception on the relationship between the two. It also investigates whether these medical students believe that art can play a role in medical education, and more specifically whether analyzing art can play a role in developing observational skills in clinicians. An "Art in Medicine" 8-week course was delivered to first year medical students at Brighton and Sussex Medical School. The use of art to improve observational skills was a core theme throughout. Feedback from the students suggests that they believe a strong association between art and medicine exists. It also showed a strong perception that art could play a role in medical education, and more specifically through analyzing art to positively develop clinical observational skills. The results of this subjective study, together with those from research from elsewhere, suggest that an art-based approach to teaching observational skills may be worth serious consideration for inclusion in medical and other healthcare curricula.

The journey of discovering skull base anatomy in ancient Egypt and the special influence of Alexandria

The field of anatomy, one of the most ancient sciences, first evolved in Egypt. From the Early Dynastic Period (3100 bc) until the time of Galen at the end of the 2nd century ad, Egypt was the center of anatomical knowledge, including neuroanatomy. Knowledge of neuroanatomy first became important so that sacred rituals could be performed by ancient Egyptian embalmers during mummification procedures. Later, neuroanatomy became a science to be studied by wise men at the ancient temple of Memphis. As religious conflicts developed, the study of the human body became restricted. Myths started to replace scientific research, squelching further exploration of the human body until Alexander the Great founded the city of Alexandria. This period witnessed a revolution in the study of anatomy and functional anatomy. Herophilus of Chalcedon, Erasistratus of Chios, Rufus of Ephesus, and Galen of Pergamon were prominent physicians who studied at the medical school of Alexandria and contributed greatly to knowledge about the anatomy of the skull base. After the Royal Library of Alexandria was burned and laws were passed prohibiting human dissections based on religious and cultural factors, knowledge of human skull base anatomy plateaued for almost 1500 years. In this article the authors consider the beginning of this journey, from the earliest descriptions of skull base anatomy to the establishment of basic skull base anatomy in ancient Egypt.

Iulius Casserius and the first anatomically correct depiction of the circulus arteriosus cerebri (of Willis)

The circulus arteriosus cerebri is the arterial anastomotic circle at the base of the brain, now better known as the circle or polygon of Willis. The British physician and anatomist Thomas Willis (1621-1675) was the first to demonstrate the physiologic function and observe the clinical significance of the circulus. It has been overlooked, however, that the first accurate depiction of the circulus was provided by the Paduan anatomist Giulio Cesare Casseri (Iulius Casserius) (1552-1616) in two engravings published posthumously in multiple formats, including the Tabulae anatomicae LXXIIX (1627). Casserius was the fifth of the six "Vesalian anatomists" at the University of Padua, Italy, which was the site of the most important discoveries in anatomy in the 16th and 17th centuries. Here we review the life of Casserius, his rise from servant to Girolamo Fabrizio D'Acquapendente (Fabricius) (1533-1619) to Professor of Surgery at the University of Padua, his research in comparative anatomy, and his depiction of the circulus arteriosus cerebri. Although previous authors have commented on Casserius's portrayal of the circulus arteriosus in Table 10 of Tabulae anatomicae LXXIIX, none have discussed Figure 2 of Table 9. This is important because whereas the anterior communicating artery complex is depicted clearly in one table, the accurate course of the posterior communicating arteries is shown in the other. Together, Tables 9 and 10 represent a sophisticated, sequential dissection, which deserves recognition as the first accurate portrayal of the arterial anastomosis at the base of the brain.

The circle before willis: a historical account of the intracranial anastomosis

The circle of Willis is one of the most famous eponymous structures in human anatomy. There is no doubt Thomas Willis at Oxford accurately demonstrated the anastomotic arterial supply at the base of the brain. However, this eponymous name does not reveal the history of the discovery of the ramification, nor does it give credit to the anatomists and artists who have contributed to the understanding of this clinically important structure. This article first traces the story of the discovery of the circle of Willis. Willis' contribution and innovative approaches are then discussed. Finally, despite Willis' not being the first to describe the circle, we explain why he still deserves to retain the eponymous title. The earlier description of the vasculature at the base of the brain was fixated on a nonexistent structure, at least not in humans, named the rete mirabile. The more scientific study of the blood supply to the brain took place during the Renaissance period, which culminated in the work of Thomas Willis in the 17th century.

Anatomy, technology, art, and culture: toward a realistic perspective of the brain

In the 15th century, brain illustration began to change from a schematic system that involved scant objective rendering of the brain, to accurate depictions based on anatomical dissections that demanded significant artistic talent. Notable examples of this innovation are the drawings of Leonardo da Vinci (1498–1504), Andreas Vesalius' association with the bottega of Titian to produce the drawings of Vesalius' De humani corporis fabrica (1543), and Christopher Wren's illustrations for Thomas Willis' Cerebri Anatome (1664). These works appeared during the Renaissance and Age of Enlightenment, when advances in brain imaging, or really brain rendering, reflected not only the abilities and dedications of the artists, but also the influences of important cultural and scientific factors. Anatomy and human dissection became popular social phenomena as well as scholarly pursuits, linked with the world of the fine arts. The working philosophy of these artists involved active participation in both anatomical study and illustration, and the belief that their discoveries of the natural world could best be communicated by rendering them in objective form (that is, with realistic perspective). From their studies emerged the beginning of contemporary brain imaging. In this article, the authors examine how the brain began to be imaged in realism within a cultural and scientific milieu that witnessed the emergence of anatomical dissection, the geometry of linear perspective, and the closer confluence of art and science.

The neuroanatomical plates of Guido da Vigevano

✓Guido da Vigevano was an Italian physician and engineer who lived in the 13th and 14th centuries. He was the first scientist who used pictures to illustrate his anatomical descriptions, developing for the first time a close relationship between anatomical studies and artistic drawings. This was further developed in the Renaissance.

In his textbook Anathomia are displayed six plates showing for the first time neuroanatomical structures and techniques: dissection of the head by means of trephination, and depictions of the meninges, cerebrum, and spinal cord. On the surface of the brain painting it is possible to recognize a vague patterning of cortical convolutions. Ventricles are also described and shown. This book constituted the first attempt in the history of neuroscience to illustrate an anatomical description with schematic pictures to achieve a better understanding of such complex structures.

The historical importance of the hand in advancing the study of human anatomy

Anatomy is often considered the foundation of medical science and is basic to the education of health professionals. This report will attempt to summarize the history of anatomy from antiquity to modern times. In addition it will highlight the historical importance of the upper extremity and its relationship to the development of human anatomy as a recognized medical science.

Dissection as a teaching tool: Past, present, and future

Cultural changes, scientific progress, and new trends in medical education have modified the role of dissection in teaching anatomy in today's medical schools. We discuss in this article the role of dissection itself, the value of which has been under debate for the last 30 years. The importance of dissection is considered from different points of view: educational, bioethical, and human values. Included are different opinions from professors and students. Finally, the current practice of dissection is described for some universities in the United States and Europe, showing its use as a learning tool.

Medical illustration: from caves to cyberspace

The human body has been depicted in ancient cave-paintings, in primitively sculpted figures, and through all the ages in various forms of artistic expression. The earliest medical texts were descriptive but not illustrated. Later, as it became clear that knowledge of the human body and all its systems was essential to the practice of healing, texts were accompanied by illustrations which became an integral part of the teaching process. The illustrators included artists, whose interest was primarily artistic, but who were sometimes employed by surgeons or physicians to illustrate their texts. Occasionally, the physicians or scientists accompanied their texts with their own illustrations, and in the last century, medical illustration, in its infinite variety of techniques, has been developed as a profession in its own right. As knowledge was extended, permitted by social and cultural change, as well as by technological advances, the types of illustrations have ranged from gross anatomy through dissections showing the various organ systems, histological preparations, and radiological images, right up to the computerized digital imagery that is available today, which allows both static and dynamic two- and three-dimensional representations to be transmitted electronically across the world in a matter of seconds. The techniques used to represent medical knowledge pictorially have been as varied as the illustrators themselves, involving drawing, engraving, printing, photography, cinematography and digital processing. Each new technique has built on previous experience to broaden medical knowledge and make it accessible to an ever-widening audience. This vast accumulation of pictorial material has posed considerable problems of storage, cataloguing, retrieval, display and dissemination of the information, as well as questions of ethics, validity, manipulation and reliability. This paper traces these developments, illustrating them with representative examples drawn from the inexhaustible store of documents accumulated over more than two millennia.