MILITARY PHARMACY AND MEDICINE

More documents

Recommendations

Info

© Military Pharmacy and Medicine • 2012 • 4 • 84 – 86supraorbital arches. Bones were not broken off inthis case [18].Three skeletons found in a cemetery in Sandomierzdated to the end of 18 th and mid-19 th centuryalso wore the signs of post-mortem examinations,as indicated by the marks found on skulls– cut-off cranial vaults as well as rib cuts (thoraciccavity was opened in this fashion). Thepoor and the homeless who died in the hospitalor in prison were buried in this cemetery [19]. Insuch cases autopsy could be performed in orderto identify the cause of death (when it was difficultto determine it otherwise – such autopsieswere judicial) or to train future doctors.These autopsies could be related to the activityof the provincial physician in Sandomierz or theJagiellonian University.Three skulls with removed calvarias were foundduring rescue works conducted in the cemeteryin Wroclaw, which was used from the 2 nd half tothe end of 19 th century. Due to poorly preservedmaterial, it is difficult to draw more precise conclusionswith regard to these remains [20]. Hospitalcare has been developing in Wroclaw sincemedieval times. In the 19 th century, some of Wroclawhospitals contained autopsy rooms [21, 22].Anatomopathological studies developed particularlyrapidly during this period. History of Facultyof Medicine in Wroclaw reaches the beginningsof 19 th century; therefore these autopsiescould be didactic in character.Openings in the skulls collected in Torun,Brzesc Kujawski and Dabrowna are similar inshapes; similar autopsy techniques were usedhere with cranial vaults likely removed using asaw. Skulls found at the two latter sites have calvariasremoved above the supraorbital arches. Incase of the skull found in Opole, this procedurewas conducted carelessly and the orifice is asymmetric.Skulls found in Torun and Dabrownabear cutting marks at the bone edges, indicatinglittle experience of the operator. Skulls fromOpole and Torun bear signs of broken off bonefragments. Since there were hospitals in BrzescKujawski and Dabrowna, they could constitutesources of anatomical knowledge but it is alsopossible that these autopsies were judicial.In the surgical school in Boulogne post-mortemexaminations were conducted as early as in 13 thReview articlecentury. Anatomy handbook by professor ofmedicine, Mondina de Luizzi (1270-1326) fromBoulogne, became the fundamental literatureused for teaching anatomy and autopsies wereperformed based on it. Mondina de Luizzi conductedthe first autopsy in the presence of studentsin 1315 on the corpse of a woman condemned todeath. His publication does not resemble modernanatomy handbooks, which describe specificorgans. It is rather a guide to performing a postmortemexamination and gaining access to theorgans of the abdomen, thoracic cavity and head[23]. One of the illustrations from a book “Anathomia”by Guido da Vigevano (1280-1349) from1345 depicts a doctor performing an autopsy andopening the skull. He removes the skull vault bymaking an incision above supraorbital arches,through parietal bones and occipital bone. Heuses a knife (perhaps a kind of chisel) and a hammer.He hits the end of the knife with a hammerin order to remove the superior portion of theskull [24]. Interestingly, the corpse is depictedin a vertical, not horizontal position (as in thelater work by Vesalius). Six of eighteen illustrationsfrom this handbook concern neuroanatomy.Frontal and sagittal sutures are shown onthe skull; dura mater and brain are also revealed.Guido da Vigevano probably did not distinguishthe arachnoid in his studies [23].Such autopsy technique described in this handbookhad to be widespread. Skulls from Torun,Dabrowno and Brzesc Kujawski bear signs ofautopsies conducted in such manner, althoughthe last incision ran throughout the entire had,from supraorbital arches, through parietal bonesto the occiput. On the skulls from Opole andTorun, incisions were made along coronal sutureor by the posterior part of frontal bone laminaand do not pass through occipital bone. Thistechnique was also used in the skull from Opole,but symmetry was not preserved while cuttingoff the cranial vault.It is worth noting that anthropological materialbearing signs of autopsy was also found duringexcavations in other European countries. Materialfrom England is most often dated to 18 th and19 th century and comes from cemeteries locatedby shelters and hospitals for the poor as well ascemeteries located near medical schools. Bodiesof criminals were often subjected to post-mortemexaminations. Signs of autopsies were noted on84 http://military.isl-journals.com
© Military Pharmacy and Medicine • 2012 • 4 • 85 – 86Magdalena Cybulska at al.: Autopsy marks on anthropological material …the skulls (removed calvaria), ribs, clavicles andvertebral bodies.Bone marks indicate that autopsies were performedin order to establish the cause of death,but also served the purpose of educating futuredoctors. For example, limb amputations werepracticed on cadavers. Autopsies were conductedon female, male cadavers, but also onbodies of children and fetuses. There is a lot ofanthropological material from 18 th and 19 th centuryLondon showing that autopsies were frequentatthat time [25].Italian anatomist, Giovanni Battista Morgagni(1682-1771) thought that it is a duty of a doctorto perform post-mortem examinations of hispatients. He supposed that disease is localized ina particular organ [4].Great development of anatomical studiesoccurred from the second half of 20 th century,as indicated by anthropological excavation dataas well as written sources. This fact is related toprogress in the field of surgery and anatomopathologyitself. General anesthesia and introductionof antiseptics and aseptics to operatingrooms, improved hemostasis led the surgeons tobroaden the range of procedures and advancedeeper into human tissues. The significance ofanatomopathological studies in clinical medicinewas also emphasized. Doctors linked diseasesymptoms they saw in their patients withanatomopathological picture seen on an autopsytable. Therefore, post-mortem examinationswere supposed to be a way to explain pathologicalchanges. Karl von Rokitansky (1804-1878), aCzech who co-created the new Viennese schoolalso known as anatomopathology school in thehistory of medicine, had great contributions topathological anatomy [4, 26].Modern medical textbooks pertaining to theissue of post-mortem examinations also describecranial opening. Soft tissues should be first separated:skin, dense connective tissue layer, tendinouscap of the epicranial muscle, loose connectivetissue layer and periosteum of calvaria.Incision runs about 2.5 cm above the superiormargin of the orbit and posteriorly about 1 cmabove the external occipital tuberosity. Externallamina is cut with a saw and separated fromthe diploe using a chisel. External and internalhttp://military.isl-journals.comlamina can be also simultaneously cut with anoscillation saw [27]. Therefore, in the medievaltimes soft tissues also had to be removed beforeuncovering the bone. Saws and chisels were usedfor cutting bones.Autopsy techniques evolved together with theprogress of medical sciences. Particularly the 19 thcentury is related to development of post-mortemexaminations. During that time, Rudolf Virchow(1821-1902) — the creator of cellular pathology— and previously mentioned Karl Rokitansky(1804-1878) exerted great influence on theexamination technique [28].Medical historians also use art for their studies.In the 17 th century, many painters depicteddoctors performing autopsies. The painting byRembrandt “The Anatomy Lesson of Dr JoanDeyman” (1656) depicts a medic performingan autopsy of human brain using a scalpel. Anassistant standing to the right of doctor JoanDeyman holds calvaria, removed (sawn-off) inorder to uncover the brain. We find signs of suchprocedures in anthropological material. Unfortunately,only the middle portion of the paintingremained, while three quarters of it was burnt inthe anatomical theater fire [29, 30].Osteologic data suggest that autopsies were commencedin Poland during late Middle Ages. Theywere not public. Material acquired from historicalcemeteries indicates (we analyzed six archeologicalsites for the purpose of this publication)that sections were carried out earlier than suggestedby written sources. However, developmentof anatomical studies in Poland as well asin other European countries falls on 18 th and 19 thcentury. Possibly, cadavers for the autopsy camefrom cemeteries by the hospitals and churches.First autopsies resulted from scientists’ curiosity,need to search for the cause of the disease anddeath. Didactics played a smaller role.At the turn of Middle Ages and renaissance aswell as in renaissance, people began to realizethe necessity of performing anatomical studiesfor educational purposes. Until 18 th century,public autopsies excited emotions from bothmunicipal and church officials and they usuallyinvolved convicts’ bodies. Cadavers for anatomopathologicautopsies could come from warfare,they could belong to the homeless, prisoners85
Page 6 and 7:
MILITARY PHARMACYAND MEDICINESCIENT
Page 8 and 9:
MILITARY PHARMACYAND MEDICINEEDITOR
Page 10 and 11:
© Military Pharmacy and Medicine
Page 12 and 13:
Page 14 and 15:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 27 and 28:
Page 29:
Page 32 and 33:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44: © Military Pharmacy and Medicine
Page 59: © Military Pharmacy and Medicine
Page 143 and 144: © Military Pharmacy and Medicine E
Page 145 and 146:
© Military Pharmacy and Medicine E
Page 147:
Trzecia strona okładki
show all

MILITARY PHARMACY AND MEDICINE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?