Anatomical Theaters

Since ancient times, the primary way to teach and learn anatomy have been to dissect human cadavers. Generations of surgeons have learned and mastered the craft, first by watching live surgeries, and then practicing specific skills such as suturing on animals. The standard practice in medical schools is to stand some feet away from the operating table, while making sure not to get in the way of the surgeons, the assistants and the instruments. Some colleges and institutions have special observation decks, but with the advent of cameras it's not needed to be present inside the operating theater anymore. Students can watch a surgery on a screen from the classroom.

The Agnew Clinic by American artist Thomas Eakins, 1889.

Many Renaissance-era universities had specially built operating rooms with galleries for the students to watch the action from. These were called anatomical theaters. At the center of the theater stood the operating table, where the surgeons performed. Surrounding this table were several tiers of seating like in a Roman amphitheater. From these advantageous positions, observers could get a good view of the proceedings.

Indeed, some surgeons seemed to revel in the showmanship aspect of their work. Scottish surgeon Robert Liston (1794–1847) would often clench the bloody knife with his teeth to free his hands. Ironically, Liston was among the first to push for cleanliness and hygiene in the operating room, and would always wash his hands prior to an operation.

The first anatomical theaters arose in Italy in the 15th century to meet the growing demands of teaching medicine and the increasing number of medical students. Alexander Benedetti describes an anatomical theater for the first time in print in 1493:

A temporary theatre should be established in a sizeable and well-ventilated place with seats around it, and of such a size as to hold a number of spectators so that the dissectors may not be disturbed by the crowd. These should be skilled men who have conducted several dissections. Seating must be allotted in order of rank. There must then be one Praefectus to keep an eye on everything and to put people in their places. There must be guards to restrain the eager public as it enters. Two reliable stewards should be chosen to make the necessary payments from the money that is collected.

In those days dissections were few and far between. The practice was thoroughly regulated by the church with only a handful of dissections allowed to be conducted each year. Frederick II (1194–1250), the Holy Roman emperor, ruled that anyone studying to be a physician or a surgeon must attend a human dissection, which would be held no less than every five years. There was also a shortage of cadavers, so many anatomists had to resort to illegal means such as grave robbing, body snatching, and even murder.

The oldest permanent anatomical theater in Padua, Italy. Photo: Kalibos/Wikimedia Commons

Early anatomical theaters were thus temporary structures often erected outside the grounds of the university, because it was imprudent to suggest permanent accommodation for public dissections. The first permanent anatomical theater was built at the University of Padua, in Northern Italy, in 1594. Its establishment was one of the most important achievements in medical science during the 16th century, for it placed anatomy at the foundation of medical studies.

The anatomical theater of Padua held about 250 spectators in six concentric galleries. The first row was reserved for Professors of Anatomy, the Rectors of the City and of the University, the Councilors and members of the Medical College and representatives of the Venetian nobility. The second and third rows were reserved for students. The fourth, fifth and sixth rows were for other spectators. There was no seating, so observers had to stand to watch the dissection of human cadavers—mostly executed criminals or deceased hospital patients.

The anatomical theater in Padua. Photo: Lanoyta/Wikimedia Commons

A full dissection sometimes stretched to two weeks. To entertain visitors during breaks between sessions, musicians were brought in and scented candles were lighted to suppress the stench. Dissections were also carried out in the colder months to delay putrefaction.

The theater was in use until 1872, when the medical school was transferred to St. Mattia's former convent. The theater remains a matter of pride for the University and is still preserved.

Only three years after the construction of the anatomical theater in Padua, the second permanent theatre was built in Leiden in Holland in 1597, on the initiative of Pieter Pauw, professor of anatomy at Leiden University. Like the one in Padua, the Leyden theater had six galleries, but wider, flatter and more spacious than the theater in Padua. Public dissections took place in winter for students and surgeons, as well as for curious members of the public for a fee. In summer, the theater was used to display various curiosities including human and animal skeletons, ancient Egyptian mummies and Roman antiquities, and many other unusual objects from different parts of the world. Because of these exhibitions, the theater became a significant tourist attraction. The theatre finally closed in 1821 when the department of anatomy was transferred to a new building.

The anatomical theater in Leiden. Photo: Wikimedia Commons

Another important anatomical theater of the time was built in London in 1636 at the Barber Surgeons' Hall. It was similar in size and shape to the theater in Padua, but had four rows of seats instead of six. The seats were carved and the walls were adorned with the signs of the Zodiac. There were niches and brackets for skeletons and other anatomical preparations including the skeleton of an ostrich, and a bust of King Charles I. Public dissections were like grand shows, lasting three days and ending with a feast.

One of the finest anatomical theaters was in Bologna, Italy. It was constructed over a period of 12 years completing in 1637, and was located in the Palace of the Archiginnasio, the first unified seat of the University of Bologna. It had walls of exquisitely carved fir wood, a richly carved ceiling of cedar wood and an imposing professorial chair, set ten feet above the floor level. This was surmounted by-a canopy bearing the seated figure of a woman representing Anatomy and a small cupid standing nearby holding a femur in his hand. For three hundred years the theater was an object of reverence and admiration among visitors. It was completely destroyed during the Second World War. After the war, the theater was rebuilt with exemplary philological rigor, using all of the original pieces recovered among the rubble of the building.

The anatomical theater in Bologna. Photo: Fotokon | Dreamstime.com

The anatomical theater in Bologna. Photo: Joaquin Ossorio Castillo | Dreamstime.com

The anatomical theater in Bologna. Photo: Joaquin Ossorio Castillo | Dreamstime.com

By the early 20th century, anatomical theaters had become obsolete. With the use of anesthetics, it was no longer necessary to conduct surgeries in the fastest possible time, and surgeons realized that slower, meticulous incisions produced more successful results. But it was the germ theory that brought death to the anatomical theater. The idea that spectators and doctors themselves might carry germs into the surgical space led to tighter control on the operating space, eventually causing the transformation of the old-fashioned operating theater into the sterile environment that modern operating rooms are.

References:
# William Brockbank, Old Anatomical Theatres And What Took Place Therein, National Institutes of Health
# Rebecca Rego Barry, Inside the Operating Theater: Early Surgery as Spectacle, Jstor 
# Alison Abbott, Hidden treasures: Padua's anatomy theatre, Nature