Prose by Abraham Nussbaum

Welcome to Carolina, and thank you for the opportunity to speak with you about the anatomy lab you will begin next Tuesday. Before enrolling, you all knew that anatomy is both the foundation of medical practice and a formative experience in the life of a physician. But why begin with anatomy, and why study anatomy by dissecting a human body? My sister Elisabeth trained as a nurse, and in her first week of school, she learned to make a hospital bed. We do not begin our own training with that humble but eminently practical skill. Perhaps we ought to. Instead, we take science courses, studying basic science before learning medical science—it is years before we are responsible for so much as bed.

Science courses are taught through generalized accounts. So in histology, you will use atlases, microscopes and computer images to study cells and tissues. Similar resources are available to study anatomy, and I encourage you to avail yourself of these materials, but you will primarily learn anatomy by studying a particular body rather than a generalized account. Why?

You will ask this question often, because of the twelve courses you will take this year, none will require the same commitment as anatomy. What you have heard is true; anatomy will keep you up late at night. But you can certainly master the material, just as you will in other courses. The other courses resemble your undergraduate courses; only anatomy will form you as a physician, someone who is intimate with the bodies of strangers. You will never know another body as well as the embalmed human body that will serve as your text in anatomy lab, but knowing this body will inaugurate you into a lifetime of caring for the bodies of strangers.

This is a remarkable gift, an exquisite text from which to learn. Women and men gave you this gift, in the hope that you will learn well from their flesh so that you can care well for the living. You are responsible to these women and men, who gave you all that remained at their life’s end. Be grateful to them, for they gave you a gift that historically most physicians have not had. Aristotle dissected monkeys, not humans. The Greek anatomist Galen likewise dissected animals rather than humans, and it was not until the fourteen century that physicians regularly conducted dissections. Only in the late eighteen century was anatomy fully incorporated into medical practice. And even then, cadavers were often obtained from unwilling donors. As recently as the 1890’s, half of the cadavers used at Johns Hopkins were obtained illegally, and through the 1920’s, some of the cadavers studied by Tennessee medical students were obtained by grave robbing.

What this curious history should teach you is that dissecting a human body violates an ancient taboo, the sensible prohibition that we ought not disturb the flesh of the dead. Taboos are like the skin of a culture, an outer surface that protects and orders it vital innards. When you violate a taboo knowingly, willfully, consciously, you ought to do so only when absolutely necessary.

Dissecting a body is necessary. The historian Michel Foucault describes the “great break in the history of Western medicine” as the precise moment two hundred years ago when clinical experience was united to an anatomical gaze, an intimate sense of how bodies are ordered and disordered beneath their skins. Foucault quotes Marie-Francois-Xavier Bichat, a physician reared in a previous form of medicine, a medicine not united to anatomy, who wrote in 1801 that“for twenty years, from morning to night, you have taken notes at patients’ bedsides on affections of the heart, the lungs, and the gastric viscera, and all is confusion for you in the symptoms which, refusing to yield up their meaning, offer you a succession of incoherent phenomena. Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate.”

Two hundred years later, dissecting a body is necessary, because it will transform the way you see the world, give you the gaze of a physician. I knew this last fall when I met a patient who could not move his deltoid muscle, and I could suspect the axillary nerve as the damaged nerve. I knew this last fall when I was watching a movie and as a beautiful actress walked across the screen I thought to myself that she had the most remarkable clavicle. In ways small and large, the practice of dissecting a body to know its muscles, organs, vessels and nerves, will form you as a physician. Like the lyrics to a banal pop song, you will literally hold someone’s heart in your hands. So. Open up a few corpses, scalpel away flesh and taboos, but be amazed, be grateful, and bear out the gift in your life as a physician.