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COLUMN ONE

Cutting Out the Cadaver

Dissecting human bodies in medical school anatomy labs, long a gruesome rite of passage for doctors, is going the way of house calls.

February 28, 2004|Alan Zarembo | Times Staff Writer

SAN FRANCISCO — The anatomy teacher propped up half a human pelvis on the lab bench and swiveled it to give the seven medical students a different view. The chemically preserved specimen, expertly dissected, was fitted with color-coded wire tabs that identified the neatly displayed parts.

The students at UC San Francisco stood a respectful distance away. They took notes. They wore street clothes. And, unlike past generations of medical students who spent months dissecting cadavers, they did not touch the pelvis.

It's a lot more efficient than "bushwhacking your way through the body," said one student, 29-year-old Sydney Sawyer.

For nearly a century, the dissection of human cadavers has been a dreaded and honored rite of passage for budding doctors.

But over the last two decades, the field has lost prominence at medical schools -- the victim of overly packed curriculums, a shortage of teachers and a general sense that dissection is an antiquated chore in a high-tech world.

For The Record
Los Angeles Times Tuesday March 02, 2004 Home Edition Main News Part A Page 2 National Desk 1 inches; 53 words Type of Material: Correction
Anatomy -- An article in Saturday's Section A about the teaching of anatomy in medical schools incorrectly stated that the Burke and Hare scandal, in which a boardinghouse owner conspired to kill several guests and sell the bodies, occurred in England in the early 1800s. In fact, the boardinghouse was in Edinburgh, Scotland.

Most medical schools have scaled back the time students spend in the anatomy lab to give them more time to study molecular biology or genetics. A few have eliminated dissection as a requirement for being a doctor. When UCSF, one of the top medical schools in the nation, did away with the requirement two years ago, it sent shudders through the field of anatomy.

The future is moving toward ready-to-view, professionally dissected specimens (known as "prosections") that allow students to scoot in and out of class with a minimum of mess, and computer simulations that do away with cadavers entirely.

"There's a lot of problems with cadavers," said Vic Spitzer, director of the Center for Human Simulation at the University of Colorado Health Sciences Center. "They are like leather. They smell. They're oily. They're hard to work with."

But for many anatomists who learned the human body the old-fashioned way -- sawing, slicing and snipping away limb by limb, organ by organ -- the changes are a sad sign of medicine's transformation from an ancient craft of hands and eyes to a sanitized science ruled by technology.

They lament that future generations will bypass a lifelong lesson of medicine: Putting a scalpel to a dead body confers a sense of higher purpose -- it is the gruesome price to pay for the privilege of someday working on a live one.

"The part that is so awful about it makes it so effective," said Dr. Bert Thomas, an orthopedic surgeon at UCLA who graduated from medical school 25 years ago.

In Thomas' time, anatomy was the most important course of the first year of medical school.

He had never seen a dead body before. The closest he had ever come to internal organs were a photographs in a college biology textbook.

"We called him Oscar," Thomas said of the cadaver he studied. Oscar had suffered severe hardening of the arteries and died in his 70s. Thomas and his dissecting partners at the University of Pennsylvania kept the face covered as they proceeded over the months.

"I was one of the more distressed people," Thomas recalled.

One day, after midnight, he returned to the basement lab alone to review the anatomy of the forearm. Dead bodies were spread across the tables. As he tugged on some tendons, Oscar's hand curled behind Thomas' arm and grabbed his elbow.

"I remember pulling on those tendons many years ago very vividly," he said. "I remember the valves of the heart."

Dr. Paul Schmit, another UCLA surgeon, can still remember the smell of the embalming fluid that seemed impossible to wash from his hands.

"Madame Ovary," he said, reciting the name that a medical school classmate picked for their cadaver 23 years ago.

"Sasha," said Dr. William Dignam, an 83-year-old retired obstetrician/gynecologist who could still recite the Latin names of all the hand bones even though he hadn't studied them since medical school 60 years ago.

Human dissection has been a staple of medical education for decades, and a cornerstone of science for millenniums. The first recorded dissection was around 300 BC by the Egyptians, who were already well-versed in the craft of mummification.

But it was a 16th century Belgian anatomist, Andreas Vesalius, who transformed the discipline into a modern science.

He systematically dissected the human body, publishing his detailed account in the now classic seven-volume text De Humani Corporis Fabrica (On the Fabric of the Human Body).

He had to dissect covertly, because outsiders would certainly see his work as grotesque and unholy. But some scientifically minded Italian priests let him work in the backroom of a church. Later at the University of Padua, where he was a professor, he constructed a table that could be quickly flipped over, dumping the body underneath and revealing a splayed-open dog in case of any unexpected visitors.

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