From cradle to grave via the dissection room: the role of foetal and infant bodies in anatomical education from the late 1700s to early 1900s

Historical trends and current experiences of anatomical body donation in two Zimbabwean medical schools

BACKGROUND

Body donation is integral to anatomy education, but procurement can be ethically fraught. While voluntary donation is preferred, the use of unclaimed bodies, although considered unethical, is a primary means for body procurement in some countries. This mixed methods study examined historical trends and anatomy technical staff perspectives on body donation in two Zimbabwean medical schools.

METHODOLOGY AND MAIN FINDINGS

In Phase 1, 194 cadaver paper records from January 1984 to January 2021 were reviewed. Unclaimed bodies accounted for 67% while 33% (all white Zimbabweans) were voluntarily donated. Most cadavers were black Africans (62.4%) followed by white Zimbabweans (34.0%). Race was not indicated in seven (3.6%) records. In Phase 2, semi-structured interviews were conducted with seven technicians responsible for sourcing cadavers at the two institutions. Data were thematically analysed resulting in the development of eight themes, arranged into three domains. Cadaver procurement themes related to (1) cadaver source, (2) adherence to procurement guidelines, (3) screening for suitability, and (4) cultural and religious beliefs. Cadaver embalmment focused on (5) embalming practices, and (6) hospital mortuary-based embalming. Finally, (7) disposal processes and (8) resource constraints were found to influence cadaver disposal practices.

CONCLUSIONS

Contrary to best practice, there is continued reliance on the use of unclaimed bodies to support anatomy education in the two Zimbabwean medical schools. Improving the ethical sourcing of bodies requires increased efforts to educate all Zimbabweans, especially the black majority, about the role and importance of voluntary body donation in medical education. Additionally, well-structured, and well-resourced body donation programs could enhance ethical procurement.

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.

In jars: The integration of historical anatomical and pathological potted specimens in undergraduate education

INTRODUCTION

Across the UK, many anatomy departments possess historical potted wet cadaveric specimen collections, such as organs preserved in fluid-filled jars. Although considered obsolete by some for anatomical education, there is immense potential for their utilisation in teaching, particularly in institutes that have limited access to cadavers or have had body donation rates impacted by the Covid-19 pandemic. Another benefit of historical potted cadaveric specimens is that severe pathology, often not seen today, can be observed by the student.

MATERIAL AND METHODS

The aim of this study was to understand students' opinions and attitudes towards the use of historical anatomical and pathological potted wet specimen collections in undergraduate science teaching. Following their integration into the anatomy program of a Clinical Sciences degree, seventy-seven undergraduate students completed a five-point Likert questionnaire on their perspective for the integration of the historical potted specimens in anatomical education. This study was approved by the Research Ethics committee at the University of Bradford RESULTS: The study demonstrated that 90 % of students found the collection useful in teaching, 92 % would like to see the collection used more in teaching, and 76 % of students found that the collection encouraged them to consider medical ethics and the donor.

CONCLUSIONS

In conclusion, the survey findings suggest that further utilisation of historical potted wet specimen collections would be useful in the teaching of anatomy and that these collections could potentially encourage conversations on post-mortem bodily integrity, ethics, and organ donation.

Imaging fetal anatomy

Due to advancements in ultrasound techniques, the focus of antenatal ultrasound screening is moving towards the first trimester of pregnancy. The early first trimester however remains in part, a 'black box', due to the size of the developing embryo and the limitations of contemporary scanning techniques. Therefore there is a need for images of early anatomical developmental to improve our understanding of this area. By using new imaging techniques, we can not only obtain better images to further our knowledge of early embryonic development, but clear images of embryonic and fetal development can also be used in training for e.g. sonographers and fetal surgeons, or to educate parents expecting a child with a fetal anomaly. The aim of this review is to provide an overview of the past, present and future techniques used to capture images of the developing human embryo and fetus and provide the reader newest insights in upcoming and promising imaging techniques. The reader is taken from the earliest drawings of da Vinci, along the advancements in the fields of in utero ultrasound and MR imaging techniques towards high-resolution ex utero imaging using Micro-CT and ultra-high field MRI. Finally, a future perspective is given about the use of artificial intelligence in ultrasound and new potential imaging techniques such as synchrotron radiation-based CT to increase our knowledge regarding human development.

Ethical Rationales and Guidelines for the Continued Use of Archival Collections of Embryonic and Fetal Specimens

Benefits from the use of cadavers in anatomical education are well described. Historically, human embryos and fetal cadavers were used in anatomy education to understand development and congenital malformations. Recently, three-dimensional printed models produced from archival fetal specimens, and online repositories of images from archival collections of embryos and fetuses, have been used as an educational tool in human development courses. Given that the archival specimens were likely obtained prior to the era of informed consent, this raises questions about their appropriate and ethical use. Because some institutions in the United States retain archival collections of embryonic and fetal specimens that were once used as educational tools, their existence and utility require frequent reexamination against contemporary ethical frameworks to guide appropriate use or utilization. Four ethical rationales for uses of these collections are examined, including destruction, indefinite storage, use in research, and use in health professions education. Guidelines for the use of archival collections of human embryos and fetuses are presented. Indefinite storage and use in health professions education are supported, while use in research is also permitted, however, such use is limited and dependent on circumstance and purpose. The development of current digital repositories and three-dimensionally printed models based on archival collections that were collected without informed consent, or those promoting commercial opportunity, are not supported. New embryonic and fetal donations obtained with informed consent should include reference to potential uses with new technology and virtual, genetic, or imaging applications.

Three-Dimensional Printing of Archived Human Fetal Material for Teaching Purposes

The practical aspect of human developmental biology education is often limited to the observation and use of animal models to illustrate developmental anatomy. This is due in part to the difficulty of accessing human embryonic and fetal specimens, and the sensitivity inherent to presenting these specimens as teaching materials. This report presents a new approach using three-dimensional (3D) printed replicas of actual human materials in practical classes, thus allowing for the inclusion of accurate examples of human developmental anatomy in the educational context. A series of 3D prints have been produced from digital data collected by computed tomography (CT) imaging of an archived series of preserved human embryonic and fetal specimens. The final versions of 3D prints have been generated in a range of single or multiple materials to illustrate the progression of human development, including the development of internal anatomy. Furthermore, multiple copies of each replica have been printed for large group teaching. In addition to the educational benefit of examining accurate 3D replicas, this approach lessens the potential for adverse student reaction (due to cultural background or personal experience) to observing actual human embryonic/fetal anatomical specimens, and reduces the potential of damage or loss of original specimens. This approach, in combination with ongoing improvements in the management and analysis of digital data and advances in scanning technology, has enormous potential to allow embryology students access to both local and international collections of human gestational material. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.