Books of the Body: Anatomic Ritual and Renaissance Learning (review)

Books of the Body: Anatomic Ritual and Renaissance Learning. By Andrea Carlino, translated by John and Anne Tedeschi. Chicago: Univ. of Chicago Press, 1999. Pp. 272. $29.95.

This book delineates the development of human dissection from ancient times up through the Renaissance, the problems such activity generated for society, and how the information gained was used to better train physicians to learn further about human disease. Plato and Aristotle delineated the methodology of animal dissection as a way of disclosing the secrets of nature. Aristotle recognized that similar-appearing structures had similar functions in different animal species. According to Galen and Celsus, the first human dissections were performed in Alexandria about 200 BC. Alexandria became one of the main centers for anatomic studies, with Herophilus, Erasistratus, and Celsus writing about how anatomic knowledge of internal organs was necessary to understanding how disease developed and progressed. They even described human vivisection of people given to them by the king; they said that with death everything changes, so study of dead bodies was less useful. Classical Hippocratic medicine believed humoral balance led to health, while imbalance of humors caused by climactic variations or dietary excesses led to disease. Many procedures, such as bleeding, purging, vomiting, blistering, and cupping, were developed on the rationale that correcting the humoral imbalance would help the patient regain health. These procedures were still being enthusiastically employed up to the 18th century, although the "humoral" concept of disease was changing to a "chemical" one.

In classical Rome, Galen, who had studied in Alexandria, emphasized the central place of anatomic study in understanding pathologic phenomena. He believed that persistent study of anatomy and logical interpretation of findings led to a better understanding of disease. Basically, he promoted the idea that form follows function. Unfortunately, however, Galen with this potentially productive mental attitude did most of his anatomical studies on animals. Carlino points out that Galen could have dissected gladiators killed in the coliseum or German barbarians killed in battle, but he did not. Monkeys were his favorite subjects, and he made mistakes by depending too greatly upon analogies between primates and humans. Through the rest of the Roman period and the Dark Ages, Galen's writings were more and more deified as the only truth in medicine, and all new practitioners were expected to follow them to the letter.

Cutting up dead people has always been considered a disagreeable task, and it certainly goes against society's rules for handling fellow humans. Such cultural restrictions blocked future physicians from learning human anatomy from dissection. In Italy in the 15th century, society's concerns were met by a very formalized process. Only criminals who were sentenced to death could be used. Before hanging, they were given a chance for full confession so that they might achieve Purgatory or Heaven instead of Hell, and they were promised a proper burial with a mass. What they were not told was that a few hanged individuals would be used for anatomic dissection before a belated burial. Since both dismembering the body and late burial would be considered strong acts of desecration by society, family, and the criminal him- or herself, the religious order working with the condemned criminals were not told which bodies were to be turned over to the medical school until after they were hung. Thus neither the religious order nor the criminal knew of this horrible fate. In a university town only one or two dissections took place each year, and a government official identified which bodies were to be turned over to the medical school. Perhaps as a result, popes often wrote directives requiring rapid burial of the dead. After late burial of a dissected criminal, multiple masses were to be said to right the wrong done to the individual. All these societal constraints severely limited the human bodies available for dissection, thus slowing the learning and teaching of human...