Education or Entertainment?

With the return to campus, it is now possible to have conversations with colleagues who you bump into during the course of the day.

I had one such interaction last week. I was greeted with the exclamation,

‘Oh, I have a question for you!  Which Anatomy Act brought in the ability to donate your body?’

Bit of a strange opener but I confirmed it was the first act in 1832.  

You had actually always been able to donate your body if you wanted to but after the Anatomy Act came in in 1832, Jeremy Bentham famously left his body to anatomists and an auto icon was created which is still on display in London.

Second question, how long is a body left embalming before it is dissected?

 At this point I thought this was a bit strange.  I was fairly sure this person knew the answer to this so I took a punt.

‘Did you watch silent witness this week?’

What followed was a 20 minute conversation about all the things that we didn’t thing had been portrayed quite accurately in the television series. This included the rather alarming fact that a donor body had been dissected when the family had objected.

Which brings me back to the title.  Are these programs to educate or entertain?

I know a couple of people who have had short careers in forensics.  They went into the role not realising that there is a lot of sticking to the rules, ensuring everything is done the same, every single time.  They maybe thought they were going to undertake post mortems, do all the lab analysis, interview witnesses and even track down killers, all the things we see a single character doing in many tv series.  That is what makes the program entertaining.

Is there an onus to make sure our entertainment is educational or at least not factually incorrect?

I have been watching the Dexter box sets. The picture on the right here was described as a clean cut between the tarsal bones.

I think we all know it is nothing of the sort. If you want more examples you only have to google Dexter anatomical mistakes to be shown a selection of poorly described injuries.

Does it matter – does it detract from the entertainment of the show? I’m not sure it does, but we need to be sure that people are not accepting fictional TV shows as a source of knowledge.

I have not watched any of Gray’s Anatomy but I have been advised never to watch it in the company of anyone medically qualified. A google search for their mistakes produces a long list.

I’m maybe showing my age but I did watch Top Gun with two RAF pilots. I am assured that apparently the missiles fire as soon as they lock on to the target in that model of plane.

I remember them correcting the error in that film decades later. Maybe we should be looking at these errors as opportunities to engage in a bit of SciComm and ensure that people remember the correct information rather than complaining that they should employ more qualified researchers, although if Hollywood wants an anatomical fact checker, I am open to offers.


Sent from my iPad

Felt it?

I’ve recently been experimenting with the anatomy felts.

Having produced a spinal cord section, I wondered if that could be miniaturised such that it could be produced in a workshop. I appreciate a felting workshop to produce a miniature spinal cord section is a niche market but…why not.

The first thing is colour choice. With 6 ascending tracts and 7 descending tracts there is a lot of wool to sort out. I wanted to keep some sort of colour themes so went with purple for ascending and oranges for descending.

Just over an hour later and 1 have a section of a spinal cord safety encased in a deep frame from ikea and ready to find a home with a friendly neuroanatomist across the pond.

Now all I need to find is a bunch of neuro nerds who might want to join in the fun.

A Helping Hand

There are some great medical illustrators and artists out there who produce some fantastic works of art.

Inspired by some of Sarai Llamas work, I turned to Netter to see if it would be possible to convert some of his epic dissection illustrations into felts.

The making of the neck felt is already covered in this blog on another post.

My second project would be a hand.

I started by drawing around my hand and then felting in a base of core wool to create the bones

At this point I made the first mistake. I had drawn around my own hand and so I was felting a left hand whereas all of the illustrations were of a right hand.

The transition of deep to superficial is important in anatomy. It’s equally important in art. When painting you start with the sky and the background and then work forward. When felting you need to start with any structures that are going to be deep in the final felt.

The first thing to place was the radial artery.

This artery sits in what is called the ‘anatomical snuff box’ and disappears below the dorsal interosseous (between the bones) that lie between the finger and thumb.

Once this was in place the other interosseous muscles had to be placed. Each muscle runs from the length of the metacarpel (bones of the hand) towards the knuckle joint. The fibres of the wool were placed in the same direction to give the impression of the muscle fibres.

The final muscle by the little finger of the hand is the abductor digiti minimi muscle and its fibres run in the opposite direction, down towards the wrist.

At this point someone contacted me via twitter and enquired about purchasing it. I suggested they might want to wait until it was finished – it could all go wrong.

The next stage was to add in all of the tendons that connect the muscles of the forearm to the fingers. These were fine wires that were covered in wool and then felted into place.

Some of these tendons in the hand are connected and so these bridges between them had to felted into place before the tendons were fixed to the hand.

It is these bridges that give the hand some of its quirky properties.

If you place you hand on a table and curl your second finger under the palm, as shown in the picture, then it’s impossible to left your ring finger up from the surface. This is due to the connections that exist between the second and third finger tendons. If the model didn’t have these connections in it then it wouldn’t depict a human hand. Ive never tried the finger trick with any other mammal so I am not sure if it’s a common feature.

Once the tendons were in place it was a case of adding the coverings of the different compartments that group the tendons together as they pass underneath the extensor retinaculum.

The fingers were then covered in white fibres laying across the finger to represent the transverse fibres of the extensor expansions. Towards the finger tip the two lateral bands of the extensor tendon came together towards the insertion point at the base of the distal phalanx – visible in final picture.

The whole outline then had to have a layer of subcutaneous fat added in a pleasing shade of yellow before adding a layer of skin, choosing a tone that resembled my own skin as I had drawn around my hand at the start of the process.

The resulting hand was framed and packaged off to the scientist who first expressed an interest in it.

I shall return to Netter for more inspiration.

Neuro

Last weekend saw the first National Undergraduate Neuroanatomy Competition that took place on line.

The NUNC team were absolutely on fire and produced a fantastic competition with a professionally delivered MCQ and spotter.

At the closing remarks I spotted this little felt on their desk.

It is a cross section of a spinal cord showing the ascending and descending paths along with the nerve rootlets leaving the spine and the spinal canal in the centre. I produced it a few months before the competition and had sent it down to Dr Scott Border because he is a neuro guy (and my house is getting a bit full of felts).

There is such a thing as neurophobia; the fear of learning neuroanatomy because it is so complicated. Each of the coloured sections above carries neurons either towards the brain – green, the sensory pathways, or away from the brain – red, the motor pathways. When an injury occurs to the spine someone who understands this can work out where the damage is based on the symptoms that are displayed. It’s mind blowing.

When I learnt my neuroanatomy I studied these cross sections for ages. The information went in well enough to pass the exams.

Having spent a few hours felting the various tracts, their positions and relations to each other, it is now firmly cemented in there.

The act of doing enhances the retention of the information. Maybe learning can be combined with a craft project that helps us destress. Maybe there is more of a role for art in learning. Could be an interesting little research project.

Standing on your own two feet

Art meets Anatomy

I have been experimenting with various felting techniques building towards a bigger project. Last month it was smaller faces and so I made a model of a small girl. Usually when making felt models a wire armature is used. This gives a frame to build around and enables the structure to stand easily when finished.

The other option is to make it anatomically correct.

When humans became bipedal it had an effect on the spine, causing it to become a series of gentle curves. If you image an foetus curled into a ball then all of the spine curves towards the back – this is the shape of the primary curves, described as kyphotic. The curves that can be seen at the back and the neck, where the curve is towards the front of the body are described as secondary curves or lordotic. Between them they document your development.

As a foetus you have just the one kyphotic curve. Once born you spend most of your time lying on your back. Around 3 months you develop the ability to lift your head. The head is a large weight balanced on top of a narrow support structure called the neck. To be able to balance it the neck arches forward so that the mass of the head can be centred over the support. This gives you the first secondary curve at the neck. Imagine how big your neck muscles would have to be if you didn’t have this curve and you relied on the muscles to hold your head up!

At this point you have a child who can sit up with a beautiful straight back. Despite what you might have heard in exercise classes that this is the posture you should be aiming for – it is unobtainable as a bipedal human.

The next stage of development requires you to balance the weight of your body over two small feet. This is not possible unless your body arches forward to recentralise the centre of mass of the torso. This gives you the secondary curve in your lower back. Only with these curves in place can a human body be easily balanced over two feet. Apes lack these curves and so they can only walk a short distance on two feet and it looks ungainly. Despite what people say about the drawings of Di Vinci showing a J shaped spine – they don’t – he drew bipedal people – they would have had the same curves as you and I.

To get a felt model to balance these same curves had to be in place. It’s only when you are trying to shape a small body that you appreciate how pronounced these curves can be. The bottom has to stick out quite a way and you need to make sure the shoulders are pulled back. Placing one foot in front of the other made it easier to ensure the balance was obtained.

The feet and ankle joint also had to be correct. When you look at the ankle from behind it is trapezoid shaped and behind the lower leg. This structure needs to be the same to offer a counter to the balance of the body; an ankle that sits behind the leg and a forefoot that spreads out.

Once you have all these in place, it will stand.

What has this taught me?

To balance not only do I need the curves in my back, I also need my head to be on top of my neck and my shoulders back. No more head forward posture or slouching shoulders because these are postures that are causing muscles all over my body to work more.

I balance best when my feet are flat and my forefoot spread – remember that when you are wearing shoes that alter the shape of your foot.

Only when all of those things are in alignment will I be able to balance without extra muscular effort.

It amazing what you can learn from felt.

p.s. – I managed the small face

Neuroscience?

When did neuroscience get so trendy?

I have been attending a leadership course recently that claims it looks at the neuroscience of leadership. I think they mean psychology, but it seems neuroscience is the new buzz word.

I lost a section of the presentation this week when comments they made sent me off at a tangent.

We were presented with an MRI of a brain.

A section of the image was alight. This, we were told is the area of the brain which lights up if you are physically hurt. It is apparently the same area that lights up if you feel excluded. Therefore (and this is where is started to fall apart) if you exclude someone, the brain sees it the same as physical pain.

Pain and the brain is fascinating and I would encourage anyone interested in this to look at the work of Lorimer Moseley. His TED talk about the snake bite makes you rethink pain)

It was indisputable. Science said so.

My mind went to how on earth they had done that experiment. Had they put someone into an MRI and then physically hurt them to see what happened? How did that pass ethical approval? Even more intriguing, had they put someone into an MRI and then told them they were excluded from something. How did they know that what had caused the physical pain wasn’t a by product of some exclusion.

Even more challenging, in another seminar I was told that it was scientifically proven that if you placed your hand over your heart and told yourself you were loved, it caused your vagus nerve to fire. Does it not work if I put my hand over my elbow? I hope it’s not location dependant because the presenter was American and had their hand way too far to the left to be over their heart. Maybe it calms you down which may affect your nervous system but surely you can’t say its scientifically proven to cause nerves to fire.

Of course, what is and isn’t science is a massively grey area.

Doing a PhD between a medical school and humanities has unveiled a whole new aspect of this debate. The seminal work by Gieryn demonstrates that the boundaries between science and non science are mobile and people redefine them to suit their purposes.

The leadership company wants to present its theories as being valid. They are correct because their theories are backed up with science and this in some way is better than someone who has experience.

A year spent in the quagmire of disputed science has caused me to be a bit less trusting of what is being held up as scientifically proven and on the look out for when science is used to bolster up claims that may be a little dubious.

Mind – does it matter?

Any study that involves Humans has trouble accounting for the mystery that is the human mind. That is why clinical trials are so in favour of the double blind trial; neither the test subject or the person applying the test know whether the person is getting the treatment being tested or the placebo. It should eliminate the role played by the human mind. It is that powerful and yet we often dismiss it with – it’s all in your head.

There is the famous scene at the end of the Harry Potter books where Harry asks if something is real or whether it is all in his head and Dumbledore answers with some snapping rhetoric that the two are not mutually exclusive – just because it’s in your head doesn’t mean it’s not real.

Scientists don’t like the dubious nature of the mind. This drug works so well because it does A, B and C, not because you believe it is going to work. The craze of drinking a tablespoon of cider vinegar doesn’t re acidify your body’s systems because we have a whole physiology that works to stabilise your internal environment. So why do people feel better if they do it? Because they believe it is making an effect. Does it matter that their belief is based on something that some people, think is wrong? That’s the situation with a lot of things in the world and so long as nobody is exploiting their beliefs does it really matter?

Why this reflection this week?

I am studying fascia in the human body as part of my PhD studies. There are a number of different beliefs about what this structure does, connected to established science by varying degrees.

I had a friend who recently broke her wrist and although she has been going through physio she had reached 50 degrees of movement and hadn’t seen any improvement for a few weeks.

Do you want to try something? The science behind it is a little … It certainly won’t do any harm. That was the conversation over a zoom meeting. One week later and she visits the physio again. She is now at 70 degrees of movement. Did the fascial treatment do that? Was it her belief that it was going to make a difference that actually made the difference? It’s not a controlled study. You can’t do double blind trials on treatments where both the person applying it and the person it is applied to will know what has been done. Does it matter?

It’s a challenge to doing the PhD I wasn’t really expecting

Production of a Netter Felt

I recently constructed a felt inspired by a Netter illustration for a friend. The construction was posted on social media with the final piece receiving quite a few comments and likes.

I thought I would break down the process so that you could see how it was done.

Needle felting is an ancient craft that matts together wool fibres by repeatedly stabbing them with a very sharp barbed needle. It can be very therapeutic at the end of a day.

The Netter image started with some wool and a piece of fabric.

The footprint of the image was shaped out using this core wool and felted to the fabric to create a layer of wool fibres on top of the fabric that other structures could be felted onto.

The structures of the collar bone and mandible were built up to mark out the area into which everything else had to fit.

The idea was to make all of the structures within the neck and to build it up like a reverse dissection.

This meant the blood vessels had to be made. I started out making these on pencils but as I progressed with the construction most things had to be trimmed down to size.

Muscles are not a solid block of colour and so three variations of ‘fleshy’ tones had to be mixed up to gives the muscles their colour.

The major blood vessels of the neck acted as landmarks for the other structures, so these were inserted first with a darker background to ensure no white would show through in the final image.

All of the muscles were constructed and then laid out to ensure everything would be close to the correct places before fixing.

Each muscles was then coloured with a selection of the three fleshy tones to give them extra shape and shading. Working from the deepest structure, the muscles were added onto the fabric.

The finer blood vessels and nerves were small strands of coloured topps wool that were anchored in place and then twisted to produce a fine fibre before tacking into position along the course with a fine felting needle.

The adding of the hyoid bones with the digastric attachments and the trapezius framed the rest of the dissection.

Wool can be felted into any shape. The direction of the needle stabs dictates which dimension will reduce in size. Utilising this it was possible to felt the reflected cut end of the sternocleidomastoid muscle and the innervation and blood supply on its deeper surface.

The collar bone and deltoid area was built up to finish the bottom of the picture and the submandibular gland, adipose layer and flesh finished the image at the top edge, before it was sprayed with hairspray, framed and sent off to its new home.

Crucifixion

There is one week of the year where it is fitting to talk about crucifixion and so as we enter Holy Week, I want to talk about the weirdest anatomical argument ever.

The year is 1801 and three member of the Royal Academy in London are arguing about the anatomical correctness of works of art. In particular the sculptor Thomas Banks and painters Benjamin West and Richard Cosway think that such greats as Michaelangelo had not accurately depicted the body of Christ on the cross.

There seemed only one way to settle this argument – they planned to crucify someone and see what it looked like! The three of them approached the surgeon Joseph Constantine Carpue to see about obtaining a body. This was in 1801 and the regulations about the use of human remains came into being in 1832. It was quite common to get casts made of human bodies that had been flayed to expose the first layer of muscles. These écorchés were considered important for artistic education. People look on these models now and wonder at the detailed work of the sculptors, not realising it is the cast of a dead person.

As it transpired, Carpue had a suitable subject.

In October, Carpue had been called to the Chelsea Hospital where an old Irish captain called James Legg had argued with another pensioner called Lamb. Legg had subsequently burst into Lamb’s room and challenged him to a duel. Lamb had thrown down the gun refusing to fight and Legg had shot him in the chest. Legg was clearly suffering from what we would now class as dementia but an insanity plea was not successful and he was to be executed for murder in November.

A building was erected close to the place of execution and as soon as the execution had taken place the still warm body was nailed to a cross and a cast made. It was important to the artists that the body was still warm and would sag as they felt some of Michaelangelo’s inaccuracies had come in from recreating crucifixions with stiff corpses.

Banks, Thomas; Anatomical Crucifixion (James Legg); https://www.royalacademy.org.uk/art-artists/work-of-art/O1350 Credit line: (c) (c) Royal Academy of Arts /

Once cool the body was removed to the surgeon’s rooms where the body was flayed and another cast made so that the positions of the muscles were visible.

The two casts were displayed in Thomas Bank’s studio before moving to the Royal Academy. In 1822 they were moved to Carpue’s anatomical museum and then to another sculptors studio. By 1917 the écorché cast had been returned to the Royal Academy. The location of the first cast is unknown.

I’m not sure what comments to make about this story other than to wonder that that was ever considered a suitable way to settle that argument. Does it matter if art is anatomically correct? I don’t recall anyone picking holes in a Picasso because it didn’t look like a face, or Dali because watches don’t actually melt.

Is it because some art is close enough to reality that the assumption is the artist was trying to be accurate and failed.

Does it matter? Does it matter enough to start crucifying people?

Reflection and Focus

It’s been a year today since the UK went into lock down for the COVID pandemic. There is a nation wide minute silence at midday.

It’s a time to reflect on things that have occurred over the past year. The changes we have had to made, the concept of having to do things before we are completely ready. We have made some changes which we will continue to adopt.

I’ve taken 2021 as a year to concentrate on growth, reflection and focus.

      When I started on my anatomical journey several years ago the plan was always to try and take anatomical knowledge back to the fitness industry and help improve knowledge of the human body.  It hasn’t been a straight journey.  Along the way I have moved into massage therapy, I’ve had some fantastic educational opportunities and I have met some fantastic people.  I would now describe myself as an atomists – I’m not sure that was ever the plan.

I’m now starting on a PhD project looking at why we have different understandings of the human body.  I’m going down rabbit holes I never knew existed.

For years I have only fed back to the fitness industry in odd articles, presentations, one or two workshops.  I couldn’t produce any more because I wasn’t ready.  I needed more time to get all my ducks in a row.

Not any more – lets start now.  Start small, its not great but if I wait until I’m completely ready I am never going to do anything.

Here it is – the first You Tube video looking at how some people are taught about the pelvis and why it might even be making it harder.

Bony Pelvis Video