Bernard M. Jaffe, MD, Editor-in-Chief
Bernard M. Jaffe, MD
Professor of Surgery
Department of Surgery
School of Medicine
New Orleans, LA
My, how times have changed! If you need proof of that statement, I recommend that you visit the Teatro Anatomico, an anatomy lecture/demonstration hall in the Palazzo dell'Archiginnasio in Bologna, Italy. This lecture hall exists as a testament to the study of anatomy, a subject that has seen its importance in medical school education progressively fade as first-year teaching time is reallocated to glitzier, more touchy-feely subjects.
The Archiginnasio Palace was the first permanent home of the University of Bologna, which claims to be the oldest university in the world. The famous sixteenth century architect Antonio Morandi planned the structure to unite the components of the university under one roof; previously, they had been spread throughout Bologna. Specifically, he envisioned a single site for both the legisti (students of civil and canon law) and the artisti (students interested in philosophy, mathematics, natural sciences, and medicine). Note the division between law and medicine even 500 years ago. The second floor of the palace served as the major educational area. It housed ten classrooms and two large halls, one each for the legisti and artisti.
The Teatro Anatomico is only one component of the palace. Let me try to describe this anatomy theatre for you. I say try, because its majesty is simply overpowering and its beauty surpasses verbal description. The Teatro Anatomico stands as it was built in 1637, designed and implemented by Antonio Levanti. The large amphitheater is rectangular with tiered seats to accommodate students along all four sides. The central dissecting table commands attention from the entire perimeter. For educational purposes, cadavers were dissected in full view of the students, and critical anatomic features were examined.
In contrast to today's university environment, the lecturer/professor had a lofty position, perched in an ornate chair overlooking the students and the dissecting table. The chair remains today as it was then, with two well-known skinless statues (muscles totally exposed) supporting an elegant canopy overhead. The grand design and raised position of this chair generated well-deserved respect for the professor, a posture that is far from automatic in today's medical schools. Lectures were dispensed without the benefit of notes or books, because provisions were made for neither. You can bet that students in the seventeenth century, when the Teatro Anatomico was built, never skipped lectures or chatted with friends in full view of their instructors.
The study of anatomy was demanding in those days. Demonstrations lasted from 4:30 AM until 4:30 PM, with no breaks, because there was no way to preserve the cadaver once dissection had begun. To minimize spoilage of the carrion, anatomy was taught only in the winter.
The wood-paneled architecture of the amphitheater is gorgeous. Twelve statues of famous Bolognese and international anatomists are suspended around the walls. A beautifully carved statue of Hermes, surrounded by symbols of the heavenly constellations, adorns the exquisite ceiling. It was an honor for Marlene and me to visit this great and famous room, and it was evident that it must have been quite a privilege to study there. The luster of the setting paralleled anatomy's importance to medical education in those bygone days.
Bologna has always been regarded as a liberal city, with active trade unions, permissive judges (and complete tolerance of graffiti), long vacations, short work weeks, and left-leaning politics. This liberalism accounted for the early availability of public education. Public education had nothing to do with governmental support, and there really was not what you and I would consider a government in Bologna in the seventeenth century, anyway. Public education meant that anyone who could afford to pay could study at the university. Admission was not restricted by gender, religion, class, or race (or even grades), and in that regard, Bologna was well ahead of other European universities. Even in the 1600s, the medical school divided students into citomontari (Italians) and transalpines (foreigners); the Bolognesi are responsible for the concept of the foreign medical graduate.
Times have changed considerably since then. Professors are no longer placed on pedestals. Attendance at even 1-hour lectures is limited, with many students preferring to study using transcribed lecture tapes.
Anatomy seems to have become an obstacle, rather than a valued course. I have asked many students simple anatomy questions during their junior clerkships (on the wards, in the operating room, and during oral exams), and few have known the answers. Most admitted having forgotten them because they had completed their anatomy course 2 long years earlier. Unfortunately, these students never really learned their anatomy.
Most medical school departments of anatomy struggle to find gross anatomists to teach the first-year course. Cell and molecular biologists fill in, reluctantly, as a requirement of employment (and hindrance for tenure). Their hearts are not really into gross anatomy, and the students recognize this in a heartbeat. No wonder our future doctors do not love this discipline. Believe it or not, anatomy has actually become an elective in some medical schools.
Finally, amphitheaters are disappearing or have disappeared. Since the closing of New Orleans' Charity Hospital, Tulanians mourn the loss of the Matas amphitheater, where generations were educated. On the other hand, the electronic age has made learning in situ obsolete. It is much more comfortable, and likely far more effective, to learn at home from images on the Internet.
In the twenty-first century, even the Teatro Anatomico has been relegated to the status of a museum, a piece of history to be admired and forgotten. This gorgeous room, unused for decades as an educational venue, now stands as a tribute to the past, when anatomy was important and learning was not made easy.
Surgical Rounds has long recognized the importance of anatomy in medical teaching and in the armamentarium of surgeons, which is why we have continued to publish the Anatomical Charts each month. This feature has consistently been one of our readers' favorites, and Anatomical Charts are among the most favored handouts at the annual Congress of the American College of Surgeons. The publishers and I are delighted that we have been able to resume publishing the Anatomical Charts on glossy, heavier paper and in the easy-to-pull-out style. They are nowhere near as venerable as the Teatro Anatomico, but we hope they provide a substantial service to you, our readers.