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March 6, 2002

From Theater to Laboratory

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JAMA. 2002;287(9):1179. doi:10.1001/jama.287.9.1179-JMS0306-3-1

As a professor of comparative literature and a specialist in 18th-century literature and art, I was a freak when in the fall of 1995 I joined 3 first-year medical students—and a 50-year-old woman dead of heart disease—on a team in the Stanford Medical School's introductory anatomy course.

My purpose was not to lay the foundation for a career in medicine but to gain a richer understanding of early anatomical works and the old culture of dissection that I had been studying as part of a project on science, the novel, and the visual arts.

My research has explored the crossover between ways of visualizing the body in anatomical atlases and in pornography. Expensive books of both kinds were often shelved together in private libraries in the 18th century, the period when, according to today's experts, modern pornography was invented.1 The kind of strict, linear perspective associated with painting from the Renaissance onward fused in this period with new analytic ways of making mechanical and scientific diagrams. This fusion produced both a modern level of precision in works of anatomy and new erotic effects arising from close-up looks at the body that seem to come from secret, hidden vantage points. In fact, for me, the most chilling experience in the dissection room was not cutting open the penis and testicles of the male cadaver at the next table, although friends asked about this and fellow males in the class worried about it. Rather—and perhaps not surprisingly for a historian of art and vision—my crisis came when one of my partners dove into the globe of an eye, extracting the iris, lens, and retina.

From the rise of modern anatomical studies in universities and academies in Italy of the 16th century to the era of increasingly rigorous professional education and certification during the 19th century, the spectacle of dissection was quite available to members of the public. They might be patrons, artists, or even ticket-buying curiosity seekers who had paid a high price, but they certainly were not aspiring physicians.2,3 The title page of Andreas Vesalius' 1543 De Humani Corporis Fabrica shows a veritable mob straining to see the open female corpse in the foreground. Apart from its formal architecture, the scene is more like a booth at a fair than a contemporary laboratory where medical students learn anatomy. Much later, William Hunter, who published the first complete atlas of the pregnant uterus in 1774, gave demonstrations at the Royal Academy in London for painters, sculptors, and paying members of the public. This contrasts with today's experience, in which physicians walk through society with the aura of privileged initiates to a mysterious and frightening priesthood.

Compulsory study in gross anatomy works to initiate the newly arrived into the professional tribe of physicians. Medical students experience this aura in part through the placement of the gross anatomy course as a threshold experience at the beginning of their curriculum. The daily encounter with the cadaver throws a veil of mystery around them for family members and friends. Like them, I quickly noticed that it only took a few minutes before friends asked whether we were cutting up corpses.

The anatomy theater lies at the mysterious heart of medicine in the public fantasy and the professional imagination. To open a human body is to enter the realm where life and death cohabit, and the didactic dissection of corpses traffics in death and disrepute. (The corpses for anatomical demonstrations used to be stolen from graveyards or cut down from gallows.) In the past, however, transgression of the taboo did not coincide with professional initiation as it does now. In contemporary medicine, anatomy works as a threshold experience for medical professionals because they alone violate the taboo as part of their training. The content of the knowledge depends on the violation of the taboo (access to the interior of the body and to death); its professional efficacy, on the transformation of the anatomy theatre into a delimited professional space.

What did I learn in my anatomy course? I saw that the Latin terms used to identify structures remain identical to those of the 18th century, a time when atlases on the pregnant uterus and the larger structures of the brain essentially completed the subject. But I also saw that the sense 18th-century anatomists had of educating not only physicians but sculptors, painters, and a literate scientific public has disappeared as the first-hand experience of anatomical dissection has become a guarded professional ritual, a marker of special knowledge. Modern professional medicine has deprived the larger public of first-hand visual experience of the body's interior and its immense variability from person to person. In this sense medicine has become less tangible to patients. I count it a piece of great good fortune that my months of anatomical study allowed me to recover in a small way something of the 18th-century encounter with death and life.

Hunt  L The Invention of Pornography: Obscenity and the Origins of Modernity, 1500-1800.  New York, NY Zone Books1993;
Carlino  A Books of the Body: Anatomical Ritual and Renaissance Learning. Tedeschi  JTedeschi  ACtrans. Chicago, Ill University of Chicago Press1999;
Richardson  R Death, Dissection, and the Destitute.  Chicago, Ill University of Chicago Press2000;