Saturday, 29 September 2012

They gave their bodies as a book for us to read

Those who've donated their bodies to medical science
have been commemorated at Cardiff University.
(Pic : BBC Wales)
Yesterday, a memorial artwork was unveiled at Cardiff School of Biosciences, to honour those individuals who've donated their bodies to medical science. A public fund raising effort was led by anatomy professor and Head of Teaching, Prof. Bernard Moxham, and the memorial itself was created by Royal Society artist, Tom Phillips.

Anatomy has always seemed to balance art with science. Studying anatomy felt like you were serving some sort of renaissance-era apprenticeship. I doubt teaching gross anatomy has changed that dramatically through Galen,William Harvey and Henry Gray - apart from our understanding of what the various bits and pieces do and the methodology itself.

At the same time, anatomists are leading cutting-edge research in areas like dentistry (there's a possibility in the future we'll be able to "grow" natural dentures in a laboratory), stem cells (one of the "holy grails" of modern medicine), sports science & physiotherapy (biomechanics and treatment of injuries) and connective tissue diseases like osteoarthritis (artificial joints and cartilage repair).

The latter would be of particular interest in Wales, where our economy has more jobs with repetitive movements, we have a heavy industry legacy and an ageing population. According to Bevan Foundation statistics, in February 2012 (p6), around 18% Welsh disability benefit claimants at the time had musculoskeletal or connective tissue diseases – the largest single category after mental health.

More recently, anatomy has been popularised, and continues to balance art with science, through the likes of Gunther von Hagens' Body Worlds exhibits, where he famously – and somewhat controversially - plastinates cadavers/ anatomical specimens and arranges them in poses.

It even has its influences on music and literature. Anatomical terms are sometimes used to great effect to provoke disgust and fear. Extreme metal bands like Cannibal Corpse or Newport's Desecration often use more gutteral anatomical terms or concepts in their music that could've been cherry-picked from any medical textbook.

Anatomical terms/images are often used in extreme forms
of music to create a sense of dread or horror.
(Pic : Wikipedia)

It isn't a forbidden knowledge, but there's a natural "morbid" curiosity about internal workings. I don't think people like to be confronted with the fact that despite the higher levels of reasoning, humans, as a species, aren't dramatically different to most other animals and (with rare exceptions) no different to each other under the skin.

When you consider the whole host of things that can go wrong at all stages of development, it all suggests that human bodies are nothing more than beautiful accidents. That can be comforting, or if you hold certain beliefs, quite disturbing too.

For blindingly obvious reasons, having an expertise in human anatomy is essential for anyone wanting to practice medicine, dentistry and allied professions. Most medical schools in the UK still use donated bodies to teach anatomy – around 40-50 bodies are donated to Cardiff University annually – and this is (usually) still taught through full cadaveric dissection.

Anatomy has been heavily restricted since the 1830's with the original Anatomy Act, which outlawed the illegal trade in cadavers (aka "grave robbing"/"bodysnatching") and provided legal means for anatomists to obtain cadavers. This was because until the Anatomy Act, only the bodies of executed murderers were allowed to be used for dissection. Dissection was a "fate worse than death", perhaps in part due to Christian beliefs about resurrection. Or, it was considered a form of posthumous execution/punishment, evoking the "hung, drawn and quartered" method of execution.

Following the Alder Hey organ retention scandal, the original Anatomy Acts (1832 and 1984) were supplanted by the Human Tissues Act of 2004, which created a quango (Human Tissues Authority) to oversee and licence the use and storage of human tissues for research, teaching or display. It also outlaws selling organs. Scotland has a separate, but similar, law.

Some newer medical schools now use prosections (preserved or plastinated specimens that have been pre-dissected). Swansea's graduate-entry medical school, I understand, uses a mix of prosthetics, detailed models and things like x-rays. Having said that, as its a 4-year course, they have contact with patients very early on, which means gaining an understanding of practical anatomy is more urgent than those on a traditional 5 year medical/dentistry course.

There are still ongoing arguments over whether prosections or full dissection is the best way to teach anatomy.

It's not nice to look at, but could plastinated models/copies
of human organs be used for teaching at school level?
(Pic : Bodyworlds.com)

What I would like to see though, is moulds of real human organs, plastinated and copied for science teaching in schools – in particular GCSE and A-Level courses. I think "real" organs/systems would be better, in some cases, than dissecting animal organs or hard plastic models.

Having plastinated models of diseased organs - for example, a smoker's lung or a cirrhosis liver - might also be of more use in PSE lessons compared to a video or overhead slide.

But none of this would happen, and all our lives will be much, much worse right now, without someone deciding that when they die, they wanted people to learn from their body.

There's strong debate in Wales about the issue of organ donation and presumed consent. Organ doners are, quite rightly, said to be making a selfless gift in death.

It's time we remembered those other selfless individuals too. Those who wanted their whole body to be used to hone the skills of those who were practicing medicine, dentistry and related disciplines. The donors who continue to help those undertaking life-changing scientific research, or simply to provide all of us with an opportunity to understand what's within ourselves a little bit better.

That's important. There's nothing more humbling in the face of a increasingly changing and sometimes scary world, and no greater driving force to try and improve it, than being confronted by your own mortality and natural vulnerability.

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