Sunday, 1 June 2008

23.Anatomy

Last week Daphne, Jane and I Visited the Wellcome exhibition 'Medicine Man', with its model of a lesson in anatomy. It reminded me of my study of this subject in Jerusalem.

In the early 1950s, before I began my studies, students had to go abroad for their pre-clinical studies - and for anatomy in particular. Similar to the 18th - 19th centuries in Europe, corpses were scarce in Israel. There were no executed criminals, or abandoned vagabonds; and the orthodox Jewish institutions insisted on the Biblical commandment of burial before sunset, and of the complete body - to ensure its resurrection intact, when the Messiah comes.
If the law demanded a coroner's autopsy, a trained rabbinical expert had to be present, to ensure that every organ was replaced in the body, possibly excepting some tiny fragments for essential microscopy.

After Israel's independence in 1948 a new source of corpses became available: Arab terrorists who had been killed
by the army in ambushes. In the 1950s they were still called infiltrators. Their existence was denied by the Arabs who had sent them; and their bodies were not reclaimed. So now anatomy could be studied at the medical school in Jerusalem. The city was divided, of course, without access to the university departments on mount Scopus. We were scattered in various buildings around western Jerusalem, and the anatomy department was in an old Arab house behind the municipal 'garden' - an oval area with flowers and trees, not far from the demarcation wall with the Old City beyond.

On the first day we all assembled in the large room, sitting silently around the dissecting tables. The bodies were covered with red rubber tarpaulins. There was a strong smell of formaldehyde. Professor Itzkovitch and Dr Gershon Gitlin introduced us to the subject - I remember it very well. First and foremost, they emphasized, these were human beings. They were dead, but they had to be treated with respect. No smoking was allowed in the room, and no eating. Second, we were reminded that there was some opposition to human dissection among the population. We were forbidden to talk about the activity there. No photographs, or visitors, were allowed.

It took me a while to realize, that there was another reason for the secrecy. All the bodies were middle aged men, with a swarthy appearance, and all were circumcised. Some had puncture wounds, or evidence of internal bleeding. Clearly, only more or less intact Arab bodies were chosen, and all bullets had been carefully removed. The delivery of bodies, and their embalming with formaldehyde, obviously took place at night. Soon, we had named out corpse Ahmed.

The course was intensive - we spent very many hours dissecting, for a whole term. Our textbook was Cunningham's manual and we followed its instructions to the letter. Each table of 5 or 6 student worked on one body. We began by laboriously teasing out the nerve strands under the skin of the scalp and face. Then we removed and dissected the brain. Then we turned to the chest, the abdomen and the limbs. We also received lectures about osteology, as well as embryology - it was Dr Gitlin's favorite research subject. The female reproductive organs were brought in on separate trays - presumably they were from patients who had undergone the relevant surgical removal, or perhaps 'unofficial' post-mortem dissections of non-orthodox women. We never asked.

With hindsight, anatomy was grossly overrated and over-taught in 1954. This imbalance was later recognized, and the topic of anatomy in the curriculum was gradually modified and shortened. Different specialists obviously required different aspects of anatomy - and psychiatrists needed none. So why burden their limited brain capacity?

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