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

A South African case study on anatomical embalming for human body donation programmes with toxicological considerations

Body embalming, a practice with deep historical roots across various cultures, forms the backbone of contemporary human body donation educational programmes. In this study, we explored current embalming practices within six South African human anatomical dissection programmes, focusing on the use and volumes of key chemicals-formalin, phenol, and alcohol-and their associated health risks and potential toxicity. We measured and compared aspects of embalming practices such as the duration of body preservation and the annual intake of bodies. Variations in embalming practices and chemical ratios across different South African universities were found. However, the consistent use of formalin, phenol and alcohol were observed across all six programmes. Formaldehyde concentrations used in South African dissection programmes were within the generally acceptable international range. Regarding arterial embalming, South African dissection programmes showed widespread adherence to international embalming practices, with one programme using a substantially lower concentration of formalin. The dual nature of formaldehyde as both an effective preservative and a recognised carcinogen was underscored in relation to human health regarding chemical toxicity. Phenol, like formaldehyde, was consistently used as it is important for the inhibition of bacterial and fungal growth. Alcohol was also consistently used, but there was much greater variation in its volume across South African institutions. Our data showed a slight positive relationship between storage duration and the volumes of formalin and phenol in human embalming fluid. South African regulators enforce stricter exposure limits than those set by the World Health Organisation and various European agencies. While South African institutions operate within internationally acceptable ranges of chemical use that both maximise preservation and minimise toxicity, we acknowledge that these data are preliminary. Further investigation is encouraged to ensure embalming practices effectively protect all those involved and support the educational goals of human anatomical dissection programmes in South Africa.

Public human dissection and societal connect of anatomical sciences: A glorious association in the past but ethically forbidden practice at present

Under the futuristic vision of anatomical sciences, a strong societal connection is mandatory. The anatomical practice experienced robust societal participation through public human dissection from the 16th century onward. With a perspective to explore the intersection of spirituality with anatomy, the present study analyzed this momentous period. From a spiritual perspective, the study also reflects on two relevant but presently uncoupled entities of public human dissection and societal connection through the prism of current regulations. Strong representation from the general public during public human dissection was primarily driven by spiritual proclivity and an endorsement from religious authorities. To regulate large gatherings and maintain academic sanctity, anatomical theaters emerged as dedicated spaces for such a merger. With time and growing financial support, the theaters transformed from temporary structures to elaborate architectural marvels, further propelling already robust societal connections associated with the practice. Nevertheless, a confluence of multiple factors led to the violation of spiritual principles and a consequent decrease in societal participation from the early 18th century, eventually culminating in the demise of such spectacle. Presently, public human dissection-when done-is mostly conducted for commercial gains and in contravention of ethical norms. It is against the essence of spirituality and harbors a bleak prospect for societal connection. Contrastingly, measures adopted to promote societal participation (mostly related to body donation) were quite effective and followed the principles of spirituality. Societal connections served anatomy in the past and can lead to its advancement if approached through a righteous path.

From generosity to gratitude: Exploring Islamic views on body donation, human dissection, and honoring the gift of life

Human dissection is an ancient pedagogical method that is still relevant in modern anatomy curricula. The body procurement process for dissection purposes has undergone significant evolution from the medieval era until now, whereby body donation has become the main source for human bodies in medical education. The appreciation ceremony for body donors is an excellent way to promote a body donation program, whereby both dissection and appreciation ceremonies are effective in inculcating professional behaviors and altruism among medical students. Despite the benefits of dissection and such ceremonies, conflicting ideas about the acceptability of these methods exist among Muslim scholars and students. Hence, this article provides a theological Islamic interpretation of human dissection, body donation, and appreciation ceremonies from four sources of Islamic law-the Qur'an, Hadith, Idjmaa, and Qiyas-to justify Muslims' involvement in the aforementioned. It is important to note that the fundamentals of Islam are submission to the will of the one and only God, Allah Subhanahu wa ta'ala (SWT) and recognition of Prophet Muhamad (peace be upon him) as the last messenger of God. Therefore, the actions of a Muslim are strongly based on faith and virtue.

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.

Responsible research in the practice of anatomy: Attributes relevant to body donors and human tissues sourced from them

Responsible Research involves setting moral examples before fellow academicians and the society as a whole. The concept of Responsible Research applies appropriately to ethical sourcing and handling of human tissues. The present study was undertaken to analyze present situation regarding implementation of attributes of Relevant Research in relation to body donors in anatomical research. A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline & PubMed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar) for this study. The following attributes of Responsible Research were identified for possible intervention: the fact that research was conducted on human tissues from body donors and details regarding ethical handling thereof may be explicitly mentioned in method section; expression of gratitude towards body donors by authors may be included in acknowledgement section; editor's and publisher's note in support of adoption of attributes of Responsible Research may be included in published research. Adherence to best practices in terms of ethical guidelines requires anatomists to embrace a responsible approach in research from an inclusive perspective. Accordingly, practice of acknowledging the body donors may be nurtured and augmented to include the anonymised dead (human tissues from unclaimed bodies and unknown source) provided the research protocol received clearance from authorities concerned with ethical scrutiny. Moreover, adoption of the practice in review articles will enhance the boundaries of Responsible Research in anatomical science. Thus, few recommendations are proposed as epilogue for effectual implementation of the notion floated in present study.

Multiple stations in an integrated design of cardiovascular system morphology for medical undergraduate

The morphology knowledge is essential for clinical, diagnostic and surgical practice in medicine. However, it is a great challenge teaching this science in an integrated curriculum, since it has the need of active methods associated with technology, in a total impaired workload. Therefore, this work described an educational design of multiple practice stations in order to teach morphology of the cardiovascular system in the undergraduate medical education. This activity was conducted in the Multicampi School of Medical Sciences of Federal University of Rio Grande do Norte (UFRN) in Caicó/Brazil. Four anatomy stations and four embryology and histology stations of heart and blood vessels were drawn up. Anatomy stations approached cardiac cycle and cardiac valves (1 A); mediastinum and pericardium (2 A); internal morphology and heart conduction system (3 A) and external morphology of heart (4 A). Whereas embryology and histology stations approached embryogenesis of the heart (1B); cardiac microanatomy and fetal circulation (2B); and vascular microanatomy (3B;4B). All the stations emphasized cognitive and psychomotor fields associated with clinical correlations to active application of morphology knowledge. The multiple stations were considered as an organized, productive, enlightening and riveting alternative to medical students and teaching staff. This innovative experience integrated and energized the three areas of morphological sciences, resignifying the teaching and learning of cardiovascular system morphology.

First patient project: Engaging pathology through the donor dissection experience and its role in professionalism

The peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

Israeli medical faculties' response to the COVID-19 crisis vis-à-vis anatomical education: The cultivation of future academic leadership-A national mixed-methods study

The COVID-19 crisis created unprecedented conditions for the medical academic system that enable it to showcase the real value of learning approaches in anatomical education. In parallel, the ongoing reassessment of the role of dissection in medical training, given the huge advances in imaging technology and science education, continued. The present study investigates the response of the six Israeli medical faculties to the pandemic vis-à-vis anatomical education. We reached out to medical students studying anatomy at the time of the crisis (N = 311), advanced medical students working as anatomy instructors (N = 55), and deans and heads of anatomy departments (N = 6). Applying a mixed-method approach, we used Likert scale questionnaires and held in-depth interviews with faculty members. Our results indicate that Israeli medical faculties were committed to a dissection-based anatomy curriculum and made substantial efforts to maintain it in the face of health restrictions. Students appreciated these efforts as this was their preferred learning method. Through a phenomenological analysis of interviews, we demonstrate how the crisis opened up a unique prism through which new insights into the debated role of dissection may be gleaned. Our analysis also reveals that anatomy instructors played a pivotal role in the crisis, not only because they carried out faculty policy, but especially because it gave them the opportunity to determine policy and show leadership. The crisis additionally enabled faculties to cultivate their leadership skills. Our research confirms donor body dissection as a mainstay of anatomical education and emphasizes its immeasurable value to the curriculum and future physicians.

"Where is the spleen? Where are the lungs?"-An investigation of the level of anatomical knowledge of the Hong Kong public

This article investigates the level of anatomical knowledge of the Hong Kong public and uses the data to help suggest public engagement activities and health campaigns to raise health literacy in the general population. In the annual public engagement event organized by the University of Hong Kong, 250 attendees took a survey assessing basic anatomical knowledge by putting organs/structures in their correct positions. Description analysis, correlation analysis, independent sample t-test, and one-way ANOVA analysis were conducted by SPSS 27.0. Overall, a mean score of 6.5 out of 20 was achieved. Differences between various demographic parameters were analyzed, and the results showed that better performance on the survey was associated with younger age, higher educational levels, and having healthcare experience. There was also a statistically significant difference in correctly positioning the thyroid between males and females. Interestingly, some misconceptions were thought to arise from the bespoke use of the Chinese language in the survey. The data reflected room for improvement in the level of anatomical knowledge among the public, notably in the older age groups. This was attributed partially to a lack of public outreach initiatives and established anatomy-focused programs, which has restricted public exposure to anatomical knowledge and hindered the development of anatomical sciences in Hong Kong. In conclusion, the knowledge of the public on the human body needs to be improved and possible solutions to improve public awareness of health were raised.

Focus on evidence-based anatomy in contemporary anatomy education: Arguments in favor of a pragmatic approach

The concept of evidence-based anatomy (EBA) emerged in 2014 and has become a significant element in contemporary anatomy education. The evolving fabric of the medical education curriculum has necessitated critical changes in practice. EBA enables these changes to be incorporated seamlessly and implemented congruently into anatomy education programs. However, in parallel, non-evidence-based (classical) knowledge that has been built up through centuries of anatomical practice continues to be the core element of anatomy education in some countries/regions. Its inherent limitations hinder integration with clinical practice, leading to a rise in misadventures in the clinical setting. This viewpoint commentary highlights the strengths of EBA vis-à-vis the related attributes of classical anatomy. Appropriate arguments show that EBA helps to reduce cognitive load and enables knowledge to be delivered through innovative education tools. EBA also helps to create an inclusive learning environment in a technology-driven era. Moreover, empowered by robust resources, it is driving the pertinent amalgamation of anatomy knowledge with clinical practice. This viewpoint article endorses the adoption of EBA in contemporary anatomy education on the basis of its potential for shaping future anatomical practice.

"A whole new perspective on how the body fits together"-An evaluation of a cadaver laboratory experience for high school students

The Center for Anatomy and Physiology Education has hosted interactive human cadaver laboratory tours for local high schools (ages 14-18) and undergraduate university students since 2014 to expose students to healthcare careers. Students receive information on the history of body donation and healthcare careers and observe human anatomy on prosections and with isolated organs. The goal of this study was to evaluate students' perceptions of the anatomy laboratory tours and their impact on students' interests in healthcare careers. Students completed pre- and post-tour questionnaires. Responses were analyzed using thematic analysis and linguistic inquiry. Of the 261 students who completed pre-tour questionnaires, 204 (78%) completed the post-tour questionnaire. Before the tour, students anticipated learning about human anatomy and expected to only see but not touch a cadaver. Most students expressed excitement and/or nervousness. A few students viewed the laboratory tour as an opportunity to test if they could see themselves in a healthcare career. After the tour, most students indicated that the tour either met or exceeded their expectations. Students found the laboratory tour to be educational and interesting and were surprised by the opportunity to interact with the donor. Numerous students expressed an increased interest in healthcare careers after the tour. Overall, students perceived the tour as an engaging experience that improved their anatomical knowledge and reinforced/increased their interest in healthcare careers. Academic institutions can positively impact local students by implementing an anatomy tour, sharing access to their in-house human cadaver laboratory, and recruiting instructors to share their anatomy expertise.

New virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system

With the limitations imposed by the COVID-19 pandemic, new technologies were used as methods to continue teaching and learning activities. This scenario brought forth the need to develop online tools for teaching. Therefore, this research aimed to develop a digital platform linking the knowledge about the central nervous system (CNS) anatomy from feline, equine, and sheep models. The platform was produced from the analysis of a collection of mesoscopic slides made from the sequenced cross-section of the CNS of a feline, an equine, and a sheep. All sections were analysed and stained using the Paul-Wiegert modified technique. The platform was organized in four modules: (1) Neuroanatomy of the Central Nervous System; (2) Neuroanatomy of Feline; (3) Neuroanatomy of Equine; and (4) Neuroanatomy of sheep. For each module, an explanatory document in PDF was developed, as well as video lectures and a descriptive atlas identifying the structures present in the encephalon and in the cervical part of the spinal cord. Even though there are numerous online platforms that allow the study of veterinary anatomy of different species and organs, the veterinary neuroanatomy platform presented here is the first platform that conjointly addresses the CNS anatomy of felines, equines, and sheep. Future research applying this platform as an aid to the study of neuroanatomy by students, teachers, and veterinary professionals should validate its use as a complementary tool for teaching and learning animal neuroanatomy.

Practical anatomy classes: An alternative to improve the learning of middle school students

Anatomy is the branch discipline focused on studying organisms' physical structures and parts. Although technological advances are broadening the anatomy study, the practices of prosection and dissection of human cadavers and animals remain a primary teaching method. Despite the large body of research supporting its benefits, in some countries, cadaveric prosection and dissection of vertebrate animals in secondary education have been banned. In the current study, to prevent a lack of access to anatomical sciences education, the use of plastinated biological specimens was proposed for teaching practical biology in middle and high schools. The study was conducted in the 2014 academic year. Eighty-seven middle school students participated in the experiment. Groups consisted of: (i) theoretical classes only; (ii) theoretical class plus prosection with fresh specimens class; (iii) theoretical class plus expository with plastinated specimens classes. A post-test grade method was used to assess the impact of such tasks on the learning experience of each group. An ANOVA test and multiple regression model were used to analyze the effects of the variables of interest. Our study highlighted that students who underwent the plastination practical class had higher overall performance and a higher mean post-test grade than those in the pure theoretical group. A favorable effect of a positive self-knowledge assessment on the students' performance was found, supporting the self-efficacy model of human behavior. Thus, the current study provides further evidence to support the use of plastinated specimens as an effective teaching method in countries where dissection is not feasible.

A quality improvement apprenticeship: Gross anatomy in the time of Covid-19

The study of anatomy is a team-driven field in which anatomy instruction occurs in small groups in the laboratory with one faculty member guiding students through each anatomical region. One laboratory experience may include several small group instructors in one simultaneous learning session. In comparison, the education of future gross anatomists often happens in an apprenticeship model, where the optimal learning outcomes are met through training with an experienced mentor. It was the vision of the authors to further their education through initiating an inter-institutional exchange to apprentice with innovative mentors in order to bring new ideas back to their own gross anatomy courses. The Southeastern Conference, a consortium of the Universities in the Southern region of the United States often associated with intercollegiate sports, has a host of academic initiatives in addition to the athletic emphasis. The Southeastern Conference Faculty Travel Program is one mechanism by which the organization promotes scholarly excellence. In this case, the Faculty Travel Program provided a way for authors from the University of Kentucky to visit a nearby institution, Vanderbilt University, and learn from like-minded anatomy educators, with the goal of incorporating changes in their courses geared toward quality improvement. After this implementation, positive themes emerged in the student feedback on course evaluations. However, the collaboration was interrupted by the onset of the Covid-19 pandemic. This article examines the strengths of interinstitutional apprenticeship and the benefits of such practices in a time of accelerated change in anatomical instruction.

The Core Concepts, Competencies and Grand Challenges of Comparative Vertebrate Anatomy and Morphology

Core concepts offer coherence to the discourse of a scientific discipline and facilitate teaching by identifying large unifying themes that can be tailored to the level of the class and expertise of the instructor. This approach to teaching has been shown to encourage deeper learning that can be integrated across subdisciplines of biology and has been adopted by several other biology subdisciplines. However, Comparative Vertebrate Anatomy, although one of the oldest biological areas of study, has not had its core concepts identified. Here, we present five core concepts and seven competencies (skills) for Comparative Vertebrate Anatomy that came out of an iterative process of engagement with the broader community of vertebrate morphologists over a 3-year period. The core concepts are (A) evolution, (B) structure and function, (C) morphological development, (D) integration, and (E) human anatomy is the result of vertebrate evolution. The core competencies students should gain from the study of comparative vertebrate anatomy are (F) tree thinking, (G) observation, (H) dissection of specimens, (I) depiction of anatomy, (J) appreciation of the importance of natural history collections, (K) science communication, and (L) data integration. We offer a succinct description of each core concept and competency, examples of learning outcomes that could be used to assess teaching effectiveness, and examples of relevant resources for both instructors and students. Additionally, we pose a grand challenge to the community, arguing that the field of Comparative Vertebrate Anatomy needs to acknowledge racism, androcentrism, homophobia, genocide, slavery, and other influences in its history and address their lingering effects in order to move forward as a thriving discipline that is inclusive of all students and scientists and continues to generate unbiased knowledge for the betterment of humanity. Despite the rigorous process used to compile these core concepts and competencies, we anticipate that they will serve as a framework for an ongoing conversation that ensures Comparative Vertebrate Anatomy remains a relevant field in discovery, innovation, and training of future generations of scientists.

Evolution of a discipline-The changing face of anatomy

This special issue is unlike any other special issue published in this journal's history. You will not find the types of original research in anatomy and evolutionary biology that you are accustomed to seeing adorning the pages of The Anatomical Record. Instead, the articles included cover the past and future of the discipline of anatomy broadly and of the American Association for Anatomy (AAA) more narrowly, and through two specific rhetorical frames: ethics; and diversity, equity, and inclusion. The articles in this issue are divided into two sections. The first section traces the history of anatomy and addresses many of the ethical dilemmas we face as a result of that history. The second section sets the stage for how the discipline and the AAA move forward to create a more diverse, equitable, and inclusive future for students, teachers, colleagues, and everyone else we touch through our work as anatomists. While this is only the beginning of our reconciliation with our past, the future certainly looks bright.