Source: the Metropolitan Museum of Art. https://www.metmuseum.org/art/collection/search/358129
It’s late on the eve of our MSK exam, and my classmates and I are quizzing each other on muscle groups. As we create mental images of the diagrams in the Netter Atlas, my eyes drift towards the illustrations of muscles and sinews decorating the walls. In the remodelled reading room of Penn’s Biomedical Library, we are surrounded by prints from Vesalius’ De humani corporis fabrica (1543). The figures strike contemplative Classical poses, their surfaces peeled away to reveal what lay underneath.
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A few weeks beforehand, a classmate expressed their surprise that the format of our anatomy exams had remained essentially the same for decades – after all, we still used practice exams from the late 90s and early 2000s. “Well, what do you expect-” someone else remarked, “-human beings to sprout another arm?” The comment made me laugh — but it was also memorable for another reason.
It is impossible to imagine the medical students of Vesalius’ 16th century Italy taking notes on antibiotics, CAR T therapy, or Manhattan plots. Yet, one could easily imagine the students of past ages taking their first foray into a real human body. As they unravelled the mysteries of our internal workings, they might have begun to see the world a little differently. A breath no longer was just an inhalation, but a mingling of air with the branching patterns of our respiratory tract. A handshake was no longer just a clasping of hands, but an intricate meeting of lumbricals and interossei. Their experience of the world would increasingly be filtered through a “medical gaze” – a common topic in medical sociology, yet an ever difficult one to define.
Amongst the various upheavals to medical education over the subsequent centuries, anatomy lab has remained remarkably stable. The dissection hall was where nearly all of us were supposed to first see the insides of the body, where the donor became our first “patient,” and where we came face-to-face with our own mortality. As my classmates and I gripped the tarp and prepared to uncover our donor, an unfamiliar scent filling our nostrils, we embarked on a process of change. When we made that first incision into bare skin, we re-enacted the same motion that had been a rite of passage at the heart of the medical student experience for hundreds of years.
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Not everything about anatomy lab was so exalted, however, and the lofty ideals I’ve presented so far sometimes crashed into reality. The minute of silence that preceded the first cut — a small gesture of respect for the “ultimate sacrifice” our donors made — contrasted so starkly with the flurry of cutting. No one warned us that adipose tissue would melt underneath the warm glow of the lights, that we’d need to use a bucket and turkey baster to drain the pink fluid that had collected in the chest cavity. Our task often felt messy and violent, with a savageness that seemed incompatible with the idea of honoring the dead.
I had a visceral feeling that bodies should be kept whole, that there is a certain sanctity that must be respected even after death. Even for those who believe otherwise, it is difficult not to feel anything as a small mole interrupts your incision or as the remains of a tattoo lingers on the skin you touch – stark reminders of a life once lived. It was an unspoken identity that always hung thickly in the air, at times suffocating if you tried too hard to look for it.
During this time, rumors floated around that we would be the last class to experience cadaver dissection at Penn. Apparently the administration was embroiled in debates about the utility of the in-person component of anatomy, a reflection of the same protracted debates taking place in medical education more broadly. With the release of Complete Anatomy almost a decade ago and the steady march of novel interactive technologies, educators began asking whether the traditional dissection hall was still the best place for students to learn. After many schools successfully adopted entirely virtual approaches to anatomy during the COVID-19 pandemic, it seemed like the reign of cadaveric dissection may finally be coming to an end. And despite a general allegiance to tradition, I found myself supporting the reformers. If virtual simulations were advancing by the day, why not get rid of flesh-and-blood dissections? Wouldn’t that avoid the ethical and emotional issues that plagued the act of naïve medical students dissecting a corpse?
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A few weeks later, we had a session in our medical humanities seminar (simply called “Doctoring” at Penn) that was aimed at helping us better process our experiences in lab. We were assigned a chapter from Foucault’s Birth of the Clinic (“Open Up A Few Bodies”) describing the development of pathological anatomy. In it, Foucault uses a beautiful metaphor to explain how it is only with death that we can obtain the full truth within the body: “the living night is dissipated in the brightness of death (p. 146).” Instead of seeing bodies as inert objects to incorporate into our regime of knowledge, Foucault encourages us to respect the abiding interplay between light and discovery, between life and death.
Foucault’s ideas were also reflected in the other reading for the session, which described how medical students oscillate between two opposing views of the cadaver: the cadaver as a person, or the cadaver as a specimen (Goss et al., 2019). Reading the article, I thought it was a good representation of how my classmates and I felt – whereas the “person view” compelled us to connect to our donors emotionally, the “specimen view” gradually dominated as we gained more comfort and technical skill. Our strokes grew swifter; less hesitation held us back as we peered ever deeper. As my classmates and I pointed out networks of nerves and anatomical variations unique to our donors, we became self-assured cartographers of sorts, pleased with our newfound ability to navigate the body.
I realized that seeing the donor as a specimen did not mean losing my empathy – rather, it was a protective mechanism for those in danger of feeling the most. The innocuous Latin terminology and Netter’s diagrams masked how deeply unnatural it really was for a human being to flay another’s skin and to split another’s skull. Because we were spending hours each week in the lab, we began to forget how firmly the activities we regularly engaged in were placed outside the domain of “normal.” And paradoxically, it was Foucault’s perspective that helped me see the humanity in this outwardly inhuman experience – it was a privilege to hold a lantern to the darkness, to appreciate a beauty that only a few will get to behold.
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One weekend, as rivulets of rain pooled on the sidewalk, I felt like the downpour still failed to wash away a feeling of unease. Something was still missing – knowledge, even broadly defined, was not justification enough for asking donors to give up their bodies. Looking at the overcast sky, I suddenly recalled a book I had read and rushed home to find it.
In The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine, the historian of medicine Shigehisa Kuriyama charts the emergence of the body in both ancient Greek and Chinese medical tradition. In doing so, he challenges several prevailing presumptions. One is the cultural universality of the body itself. Far from being a basic and shared reality, conceptions of the body grew to differ so greatly as to describe “mutually alien, almost unrelated worlds (p. 8).” The way a culture conceives of the body, he argues, is reflective of that culture’s conception of the self. He cites the French philosopher Paul Valéry: “Each of us calls this object My Body; but we give it no name in ourselves, that is to say, in it. We speak of it to others as of a thing that belongs to us; but for us it is not entirely a thing; and it belongs to us a little less than we belong to it… (p. 14).”
The dichotomous organization of “cadaver as person” and “cadaver as specimen” tends to miss out on the essential idea implied by Valéry. That there is a third, equally — if not more — important perspective. I did not gaze upon the cadaver only as the body of another, but as an analogue for myself. Part of my discomfort perhaps stemmed from the fact that as I peeled successive sheets of adipose off the surface of the abdomen, the pit of my own stomach tensed ever so slightly; as I broke the clavicle with my mallet, my imagination shuddered at the thought of my own collarbone fracturing. The face was the most intense – as I peered directly into another’s eyes, it was my own that stared back.
In my youth and seeming invincibility, anatomy lab forced me to confront the inevitable. Atrophy engendered by prolonged disease, pacemakers to correct for arrythmias of the heart, artificial joints to replace those eroded by inflammation. These were reminders of my vulnerability, and glimpses into the future. They were a powerful message that I did not possess my body, rather, it possessed me.
Yes, anatomy lab reminded me of my mortality, but it was also the sincerest reminder that each of us was beholden to our physicality during life. Heartbreak literally causes a wrenching of our hearts; excitement brings on the flapping of nameless wings in our guts. Our personhood is not limited to the rational recesses of our minds, it is also, and perhaps more essentially, “embodied.” We are each tied to the body through which we experience an intricate and imperfect world. It holds us tightly in its grasp, subjecting us to feelings like ambition and love, confusion and hurt. Although a cadaver has lost the ability to feel, we, who continue living, have not. As we stripped away successive layers from the donor in front of us, little did we know that we were also stripping away layers from ourselves.
There was a tacit acknowledgement we all grew to recognize by the end of our anatomy course — that upon peeling back the layers of the body, connective tissue and viscera would not be all that we would find. There would also be the intangible things often buried deep inside of us. Within the body, we would have to come to grips with the themes that operate wordlessly in our daily lives, the experiences we inherit, and this strange existence we share.
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Anatomy is often called one of the most transformative experiences a medical student will have, and it was only after the fact that I finally understood what this transformation entailed.
To bring this story back to its beginning, let’s talk about the over two hundred woodcuts that grace the pages of Vesalius’ Fabrica. The product of an expert group of illustrators, they are the most detailed anatomical drawings that existed during the time and hold up well even in comparison to our own textbooks. However, there is one major difference. The flayed figures, instead of being presented to us as static diagrams, instead strike poses reminiscent of great works of Classical sculpture.
The depiction of the figures this way is no accident. The reason why Ancient Greek statuary was so celebrated during Vesalius’ day and continues to be so is not solely its naturalism, but also its ability to portray an inner life beyond external appearances. Unlike Archaic figures which are almost always smiling (“the Archaic smile”), many Early Classical figures seem to have a touch of melancholy to them. With heavy eyelids and pursed lips, many appear like they are lost in thought. In Art and Experience in Classical Greece, art historian J. J. Pollitt describes the fundamental way Early Classical sculpture diverged from its Archaic predecessors. The Archaic kouros was a stout four-square figure – “its traditional… stance and impassive face seem to ignore the ordinary human condition. As you look at it… it will seem to look past you (p. 15).” In contrast, a Classical figure captures a moment in a narrative. It is animated by a subtle yet unifying force; it is able to live and think.
Like many others during the Renaissance, illustrators of the Fabrica were co-opting the same ancient vocabulary. They attempted not only to capture the forefront of anatomical knowledge but something deeper and more elusive — the contribution of that knowledge to making sense of our condition. The very idea that the immobile figures could be made to echo expressions of the body in living people, of contentment, of suffering, of contemplation, is what transports us from the act of seeing to the act of being. It is what drives home Valéry’s idea that the body is not just something that each of us have, but what each of us inhabit.
In the end, a full anatomical education is not about being able to name the function of every single muscle or trace the embryological origins of the digestive pathway, goals just as easily serviced by virtual curriculum. Even the more practical argument that cutting into a human body should be done first on a cadaver before a living patient, although not without currency, is not the most crucial defense of anatomy.
Instead, anatomical dissection deserves its place in the curriculum because learning the axioms and syntax of the body under death is among the best ways to gain an appreciation for its language in life. Unlike the model of the body provided in virtual programs, each donor is unique, reflecting the singularity of each of our narratives. An understanding of the circuitry of the pulse, of inspiration, that people once used as evidence for the stirrings of the soul, is the true fruit of our study. It is what compels us to resist the urge to see bodies solely as interchangeable specimens. It is what binds us to the people we will one day treat and to each other.
References:
Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. 1963. Routledge, 2003.
Goss, Adeline L., et al. “Not Just a Specimen: A Qualitative Study of Emotion, Morality, and Professionalism in One Medical School Gross Anatomy Laboratory.” Anatomical Sciences Education, vol. 12, no. 4, July 2019, pp. 349–59. DOI.org (Crossref), https://doi.org/10.1002/ase.1868.
Kuriyama, Shigehisa. The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. Zone Books, 1999.
Pollitt, J. J. Art and Experience in Classical Greece. Revised edition, Cambridge University Press, 2009.
Millie Huang is an MS1 at the Perelman School of Medicine.
