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History of Studying Anatomy

• Respect Elders and past, present and emerging communities involved with the lands of University of Sydney's campuses.

Early Anatomy Scholars

• Claudius Galen (lived 129 to 216 CE):

  • Roman physician with extensive theoretical training.
  • Very widely read in philosophy, religion, mathematics, and grammar.
  • Extremely prolific writer, more than 130 medical works.
  • Formed the foundation of medical knowledge for over 1,000 years.
  • Dissected animals (often Barbary macaques) due to human dissection taboo.
  • Some anatomy inaccuracies due to animal dissections.
  • Accurate identification and description of about 300 muscles still used today.

• Andreas Vesalius (lived 1514 to 1564):

  • Believed knowledge from observation and experimentation more important than existing texts.
  • His great work, De Humani Corporis Fabrica (On the Fabric of the Human Body), was published in 1543.
  • Led to a blossoming of anatomy research and teaching in Europe.
  • Included 273 illustrations with text.

The First Anatomy Theatre

• University of Bologna officially approved human dissection in 1405 CE.
• Professors sat on elevated chairs; readers offered instructions (often from Galen); lecturers and demonstrators performed dissections.
• Influenced the design of university theaters everywhere.

A Move Towards More Hands-On Learning

• During the Renaissance period, the main teaching strategy was the observation of dissection.
• Students performed dissections individually or in small groups, which became the favoured learning style.
• Increased demand for bodies to be dissected.

The Demand for Bodies

• Bodies were sourced from a range of society, including:
  • Executed criminals.
  • Political prisoners.
  • Poor people who died in workhouses.
  • People who couldn't afford a funeral.
• Some anatomy schools, affiliated with hospitals, used their patients in exchange for treatment (while still living).
• Unethical behaviour and criminal activities encouraged by high demand.
  • Freshly buried bodies sold to medical schools.
  • An industry arose to protect graves of the recently deceased, such as cage and bar protection, and even security guards.
• William Burke and William Hare, in 1828 discovered a way to make money by murdering people and selling their bodies to a university medical school (16 times).
• Hare was convicted and Burke was tried and publicly dissected.
• Public disgust led to reforms (e.g., Anatomy Act of 1832 in the UK), making grave-robbing a greater crime.
• Modern educational practices altered to limit the use of bodies.
• Unethical uses of human bodies during the Nazi era, as political prisoners and in death camps, led to illustrations being used from these textbooks.

The Trade in Skeletons

• Until a few decades ago, medical students were expected to have their "half-skeleton" (sometimes full) to study from.
• India was a major source of teaching skeletons, with as many as 60,000 skeletons exported annually before 1985.
• Trade in human remains in Australia is illegal.

Studying Anatomy Now

• Current awareness of ethical responsibilities and respect when studying human bodies.
• Modern technologies and teaching methods introduce unique challenges.

Modern Representations of Human Body Donors

• Images are shared easily
• Consider if this is what body donors and their families would want

Body Donation in Australia & New Zealand

• A large number of body donor programs (17 in Australia, some central mortuaries).
• Most programs are oversubscribed.
• Body donation is well supported by the community in Australia & New Zealand.
• Donor and their families are recognised in ceremonies and memorials.
• Diverse origin points (e.g., Asia).
• Statutory retention periods vary by jurisdiction.

Unethical Use of Human Bodies During the Nazi Era

• Some Nazi crimes against humanity included abuses of human bodies of those killed due to politics.
• Illustrations from these practices (e.g. Wernkopf atlas, Sobotta atlas) still used today

Considerations for Other Countries

• Consenting donors are important
• Paid donations from educational/research institutions
• Purchased from third parties (body brokers)
• Unclaimed bodies
• Bodies of prisoners
• Imported from other countries

Reasons for Unethical Issues in Other Countries

• Lack of legal enabling legislation
• Religious or cultural beliefs
• Financial reasons
• Lack of appropriate infrastructure & expertise
• Absence of advocates driving change
• Insufficient number of bodies to meet the need

Why Does This Matter?

• Ethical concerns, such as lacking informed consent from vulnerable populations, regarding the use of unclaimed bodies.

Timeline

• A series of relevant anatomy acts and programs which were enacted over time

Anatomy Act 1881 (NSW)

• Modeled on British Anatomy Act 1832
• Enabled procurement of unclaimed bodies from public institutions, but excluding gaols.
• Limited anatomical examination by issuing licenses.
• Established framework for reporting and regulation.
• Included capacity for the first "decency" clause for consented donors.

Public Institutions

• Hospitals (e.g., Sydney Hospital, The Coast Hospital).
• Public Asylums (e.g., Rookwood & Liverpool Asylums).
• "Lunatic" Asylums (e.g, Callan Park & Gladesville Asylums)
• Morgues
• Waterfall Sanitorium

Public Asylums

• Early charitable institutions.
• Recognition of responsibility to infirm & ex-convicts.
• Demand exceeded capacity.
• Provided basic living essentials (e.g., housing, food, work)
• Focused on men.
• Improved medical care after 1903 Rookwood Royal Commission.

Mental Asylums

• Established early (e.g., 1811 Liverpool Lunatic Asylum; closed 1839).
• First purpose-built asylum: Tarban Creek (Gladesville) in 1825.
• Earlier incarceration of mentally ill (e.g., Parramatta Criminal Asylum).
• Prejudice towards mentally ill.
• 1843 Dangerous Lunatics Act required certification by two medical experts.
• Insanity included circumstances like suicide or criminal intent.

"Lunacy" Act Definition

• Defines an insane person as "any person who shall for the time being be idiotic, lunatic, or of unsound mind and incapable of managing himself or his affairs, whether found insane by inquisition or otherwise."

Causes of Insanity

• Moral causes (e.g., domestic trouble, adverse circumstances, mental anxiety, religious excitement, love affairs, seduction, fright, nervous shock, isolation, nostalgia)
• Physical causes (e.g., intemperance in drink/sex, venereal disease, self-abuse, sunstroke, accident, pregnancy, privation/overwork, phthisis, epilepsy, disease of skull/brain, old age, other bodily disorders, chronic ill health, opium excess)

Why Might a Body Be Unclaimed?

• Lack of family (immigrants or ex-convicts).
• Communication barriers (time & distance, language).
• Poverty and/or illness.
• Financial costs (care & burial).
• Institutional discrimination.

Who Were They?

• Bodies received: 7609 (1883-1983)
• Many were ex-convicts or immigrants, assisted & free.
• Age range: 0–110 years
• Older death age compared to NSW population
• Seventy were aged 2 years old or younger when they died

The Skin

• Largest organ of the body (15–20% of total body mass)

  • Functions:
    • Physical barrier
    • Thermoregulation
    • Sense organ
    • Immunological
    • Vitamin D production
    • Excretion

• Basic structure:

  • Epidermis
  • Dermis
  • Hypodermis

• Accessory structures:

  • Hair
  • Hair follicles
  • Sweat glands
  • Sebaceous glands
  • Nails

Epidermis

• Most superficial layer (protective layer).
• Keratinocytes are the main cell type (~85% of cells).
• Cells differentiate as they move up epidermis layers.
• Exfoliated from top layer.

Thick and Thin Skin

• Thin skin has no hair follicles.
• Thickness varies throughout body; thicker in soles of feet and palms of hands.

Cells of the Epidermis

• Keratinocytes (85%) - barrier, external covering.
• Melanocytes (5%) - pigment-producing cells.
• Langerhans' cells (2-5%) - immune system cells.
• Merkel's cells (6-10%) - sensation cells.

Dermatomes

• Area of skin mainly supplied by a single spinal nerve.

Dermis

• The middle skin layer.
• Tensile strength & stretch.
• Contains collagen and elastin fibers.
• Other structures (hair follicles).
• Fingerprints (genetically unique). Undulations seen microscopically between epidermis & dermis.

Hypodermis

• Bottom skin layer - subcutaneous fat and superficial fascia (“band, door frame”).
• Loose connective tissue & adipose tissue.
• Anchors to underlying structures.
• Energy storage & insulation. Variable thickness.

Skin-Associated Structures

• Apocrine sweat glands empty into hair follicle; smelly sweat.
• Eccrine sweat glands control temperature regulation.
• Sebaceous glands secrete sebum into hair follicles.
• Arrector pili muscles cause goosebumps.
• Nails are keratinized cells.
• Nerve endings are for sensation purposes.

Nerve Endings in Skin

• Pacinian corpuscles (deeper dermis/hypodermis) - pressure changes, vibrations
• Meissner's corpuscles (top of dermis) - light touch, lips, palms

Sebaceous Glands

• Produce and secrete sebum.
• Sebum coats skin & hair surfaces.
• Cells produce sebum & die.
• Sebum is secreted into hair follicle.

Acne

• Affects 90% of Australian adolescents (aged 16-18).
• Has psychological impacts (self-esteem, mood).
• Moderate-to-severe acne can lead to permanent scarring.
• Causes: Excess sebum production, Plugged follicles, Bacterial proliferation, Inflammation.

How Does Acne Form?

• Accumulation of shed dead cells and keratin
• Excess sebum production
• Bacterial proliferation and inflammation
• Severe inflammation and scarring

Acne Treatment

• Vitamin A derivative (isotretinoin)
  • Shrinks sebaceous glands
  • Reduces sebum production
  • Reduces bacterial growth
  • Normalises follicle keratinisation
  • Anti-inflammatory.

Sunburn - Ultraviolet Radiation

• UV radiation's impact on skin.
• Types of skin cancer (basal cell, squamous cell, melanoma, Merkel cell).

Inbuilt Protection (Melanin)

• Absorbs UV and visible light.
• Transfers melanin to keratinocytes
• Scatter & absorb UV radiation
• Free radical quenchers in melanin
• Sunburn sensitivity varies depending on melanin (and skin thickness).

Fitzpatrick Skin Types

• Classifies skin tones based on reaction to sun
• I - VI (varying levels/amount of pigmentation, reaction).

Burns

• Different degrees of burns (superficial, partial/intermediate, full thickness, fourth degree).
• Skin damage varies at each degree.
• Deep burns require surgery and can cause scarring and infection.

Botox and Injections

• Botulinum toxin blocks nerve signals that cause muscles to contract .
• Relaxes wrinkles and can treat hyperhidrosis.

Fascia

• Latin word meaning “band” or “frame”.
• Layer of strong, flexible connective tissue.
• Covers, separates, or holds together organs, muscles, vessels, and nerves.

Deep Fascia

• Different classifications of deep fascia by location:
  • Epimysial: surrounds muscles.
  • Intermuscular septa: divides & creates compartments; prevents spread of infections.
  • Aponeuroses: sheet-like connective tissue; wide attachment area.
  • Retinacula: surrounds joints, neurovascular bundles & tendons
  • Investing: surrounds neurovascular bundles.
  • Visceral fascia surrounds the organs in the thorax, abdomen, and pelvic areas.
  • Parietal fascia lines the body cavities
  • Fascia of the abdomen: wall of the abdominal wall; surgeons use it to close sutures.

Aponeuroses

• Sheet of connective tissue that attaches muscles
• Often papery & peels off easily
• Found in abdominal, dorsal lumbar, palmar, & plantar regions.

Diastasis Recti

• Linea alba aponeurosis stretches during pregnancy; separation of abdominal muscles.

Visceral & Parietal Fascia

• Visceral fascia surrounds organs (thorax, abdomen, pelvis).
• Parietal fascia lines the body cavities.
• Fluid in space between visceral & parietal layers reduces friction as organs move.
• Examples: pleura, pericardium, peritoneum.

Why Do We Need Fascia? (Superficial Fascia)

• Protection & cushioning of underlying tissues from impact
• Fat storage
• Anchors skin to underlying tissues
• Allows movement & flexibility
• Nerves & vessels can travel through this layer
• Contains immune cells (respond to infection).

Why Do We Need Fascia? (Deep Fascia)

• Supports & structural integrity of muscles.
• Force transmission via tendons, ligaments & aponeuroses.
• Compartmentalization (prevents spread of infections).
• Reduces friction.
• Vessels & nerves support (ensures they are not compressed).
• Resistance to tearing & trauma
• Proprioception (sense of body position)

Relationship of Spinal Cord and Spinal Nerves

• Spinal cord is protected by the spine.
• Spinal nerves branch from the cord, carrying sensory and motor neurons.
• Spinal nerves branch from the spinal nerve roots; examples = spinal cord + spinal nerves relationship.

Neurons

• Transmit electrical signals.
• Myelinated vs. unmyelinated axons.

Actions of the Joints

• Remember: Muscle contracts; the points connecting the muscle move closer together.
• Joints are where two (or more) bones meet.
• Joint movements have special names; we do not say "flexing your muscles".

Examples of Muscle Actions

• Flexion: bending (decreasing angle at a joint).
• Extension: straightening (increasing angle at a joint).
• Abduction: moving away from the body midline, in coronal plane.
• Adduction: moving towards the body midline, in coronal plane.

How to Work Out a Muscle Action

• Where the muscle attaches.
• What joint the muscle crosses.
• Relative location of the muscle to the joint: posterior, anterior, lateral.
• Direction of the muscle fibres.

Motor Units

• Motor neuron and muscle fibers.
• Numbers vary depending on muscle function.
• Nerves activate muscles usually on the deeper side of muscle.
• Nerves can individually stimulate parts of muscles (e.g., deltoid).

Pennation

• Muscle fibers insert at an angle to one tendon side:
  • Unipennate (one side).
  • Bipennate (two sides).
  • Multipennate (multiple sides).

Mechanical Advantages at Joints

• Muscle effectiveness for joint action varies.
• Muscle angle crossing a joint affects strength of muscle contraction.
• The tendon length affecting the joint position for maximum contraction effects specific muscle fibers (e.g., wrist, fingers).

Types of Muscle Contraction

• Isotonic: Muscle changes length (movement produced).
  • Concentric (muscle shortens).
  • Eccentric (muscle lengthens).
• Isometric: Muscle length remains constant (no movement).

Muscle Functions

• Prime mover (agonist): produces specific movement (concentric contraction).
• Synergist: helps prime mover, does similar actions or steadies a joint.
• Fixator: steadies proximal limb segments; isometric contraction.
• Antagonist: opposes action of prime mover (eccentric contraction).

Muscle Tone

• Muscles are slightly contracted even when relaxed.
• Maintains posture and stability
• Absent during anesthesia or nerve lesions.

How Muscles are Fed (Blood Supply)

• Supplied by arteries.
• Often multiple arteries contact the muscles.
• Tendons have their blood supply.
• Endurance training increases blood vessels
• Strength training increases muscle fiber mass