The dying art of anatomical dissection

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WHEN the infamous body-snatcher William Burke was hanged in 1823 for murdering 16 people and selling their bodies to Edinburgh's dissecting theatres, his skin was tanned and sold in strips, and some 20,000 people turned up to see his corpse publicly dissected.

Since then, dissection has become an integral part of the medical school curriculum. But as new methods of teaching anatomy gain popularity, the days when students learned about the human body by sawing through bone, peeling back layers of muscle and plucking out the internal organs for themselves could be numbered.

This month, Birmingham University joined Newcastle on the list of medical schools which now rely on prepared specimens of human tissue and video images to teach anatomy.

But medical experts fear that doctors who do not learn anatomy by traditional means will lack a three-dimensional understanding of the human body.

At Cambridge, Nottingham and Liverpool, too, the emphasis is shifting from dissection to prosection, where the bodies and organs are pre-prepared for students by laboratory technicians or lecturers.

Frank Albrighton, spokesman for Birmingham University, defended the decision, saying that 'doctors do not, after all, cut people in half or saw off the top of their heads'.

Dr Reg Jordan, academic sub dean at Newcastle University, believes its medical school is moving with the times by dropping dissection.

'Anatomy teaching is applied now,' he says. 'It is about scans, radiographs and computers. At medical school we are not intending to produce a complete doctor. GPs don't need to know how to patch up bodies. It is the right time to do that when they specialise later.'

Students at Cambridge no longer dissect the whole body but are given a quick overview of anatomy and then told to concentrate on select areas. Professor Ray Lund, head of anatomy, tells students to spend less time memorising and more time thinking about the material they see.

He calls this approach the 'American system of problem-based learning'. Students are asked to find solutions to problems that could arise in day-to-day practice, such as: if someone gets shot in the abdomen, which organs is the bullet likely to go through and what likely scientific problems should you be looking out for? Since lecturing in the United States, however, Professor Lund says he has reservations about this teaching method. 'Students have said to me that when they look at a person front on, they have no idea where the organs are.'

There are other dissenters. Sheffield University had to reinstate its dissection course last year after two years of prosection as a result of protests by students. Carl Pearson, professor of neuroscience, who was instrumental in reintroducing the course, believes cost is the underlying reason for the growing interest in prosection.

'It is much less staff-intensive and a lot cheaper,' he says. 'From the time a body is donated, it becomes our financial responsibility - the university has to bear the cost of the burial and the funeral. With prosection, fewer bodies are needed.'

At Sheffield, 170 students are sharing 24 bodies this term. Half this number would be needed for prosection classes.

Sir Robert Shields, professor of surgery at Liverpool Hospital, is concerned about the lack of hands-on experience. 'No amount of plastic models, prosections, computers or diagrams can give students that unique sensation of handling tissue and seeing the body in three dimensions.' he says.

Dr Lionel Kopelowitz, of the General Medical Council, could not agree more. 'You have to get your hands soaked in the fat and get your dissecting manual covered,' he says. 'Then you begin to have a good working knowledge of medicine. Anatomy is to medicine what learning the alphabet is to English literature: it is the foundation of all branches of medicine.'

But this year's intake of medical undergraduates at Birmingham University will never know the thrill of fingering the sciatic nerve or discovering the juxtaposition of the gall-bladder relative to the liver. One, Hilary Bleach, said that she chose Birmingham specifically for its well-equipped dissection theatre and did not know about the change in curriculum until the day she started.

Professor Pearson has another reason for favouring a traditional approach to dissection: 'It is the fastest and most effective way of curing students with a weak stomach,' he said.

'Once they have seen a circumcision and a big toe nail being removed, their squeamishness is gone forever.'

(Photograph omitted)