Samuel Carter
Cincinnati, Ohio, United States

The poet William Blake opens his poem “Auguries of Innocence” with the lines:

To see a World in a Grain of Sand
And a Heaven in a Wild Flower 
Hold Infinity in the palm of your hand 
And Eternity in an hour.¹

An early part of the English Romantic movement, Blake explored how humans experienced and came to know a greater truth through Nature. Medical students enter the anatomy lab also seeking truth from nature to become better physicians—to understand anatomy, the hard, concrete locations of things necessary to know when caring for the human body. However, students also take from this experience a more transcendent truth by engaging with Nature (in the uppercase, by which I will differentiate this more Transcendentalist concept of it for the remainder of the essay) as understood by Romantics like Blake and related Transcendentalists like Ralph Waldo Emerson, the latter of whom wrote that Nature causes “all mean egotism” to vanish.² In medical education, the cadaveric experience serves a paramount role in teaching future physicians the human, not just the human body. Aristotle’s Four Causes, as introduced in Physics and later expanded on in Metaphysics, allow for a rewarding thought experiment that demonstrates how cadaveric dissection makes the transcendental move from the material of the body to the higher causes of the human.

The gross anatomy experience makes the movement across Aristotle’s Four Causes, which he first summarizes in Physics as falling into “four familiar divisions”: “the material… the parts of the whole,” “the whole and the combination and the form,” the “sources whence [something] originates,” and “the end or the good… ‘that for the sake of which.’”³ In sum, he views the world so that any aspect of creation relies on four components: matter (the thing that makes it up, the pieces), form (the shape that matter takes), the efficient cause (what initiated the steps to bring it all about), and the final cause (the purpose). The cadaveric educational experience captures all four of these causes in a manner that other ways of studying anatomy cannot. In doing so, it prepares students of the body to be true caregivers of the human.

An anatomy student holds at his or her fingertips every necessary resource to learn where structures are located in the body. Lecture slides and flashcards teach the matter, and most medical students will attest that they spend extensive time using these resources. However, when viewing Aristotle’s Four Causes as a progression and applying them to the subject of anatomy, these methods begin falling short at the formal cause and struggle to reach the efficient or final causes. While ever-improving illustrations and models show the way that matter comes together in a rational and mechanical sense, they fall short in making the movement beyond the rational, which is necessary for a profession that cares not only for the body but the human. These methods, though helpful adjuncts, never replicate the human—infinity—in the palm of your hand: they capture nature but not Nature. They do not inspire the awe of examining the physical depths of a human such as oneself, nor do they instill the same sense of responsibility to others. As a result, they leave us blind to the efficient and final causes of the human.

The cadaver reveals the efficient and final causes by presenting the form still known and loved by others. The truth of a single human’s existence does not cease at death but continues in the knowledge and emotions held by that person’s remaining loved ones. When the priest and poet George Herbert describes human creation in his poem “The Pulley,” he writes, “So strength first made a way; Then beauty flowed, then wisdom, honour, pleasure. … ”⁴ These features flow into the form of the individual and are known by that form. By engaging only with the material of anatomy, a student misses that formal element suggestive of a creative force and the individual mark of personality and purpose. Of course, these features are known best by those holding the donor in their memory, who remember these attributes in their vision of the donor’s form, as we do for ourselves and our loved ones. They hold in their vision of that form the knowledge of the donor’s hopes, fears, loves, hates, pains, goals, and pleasures: all the causes of their loved one contained in that one cohesive composition of material. Therefore, without engaging with this formal composition, the anatomy student misses the suggestion of the efficient and final causes as associated with the form and, perhaps even more importantly, does not take on the responsibility of respecting these causes as a body donor’s loved ones still know them—the latter demonstrating why dissection offers an early example of the physician’s responsibility to patients’ families.

Body donors’ loved ones have given the form away, and, in doing so, they have placed the personhood of their loved one into the trust and care of those who will be given the honor to dissect. The world and heaven, infinity and eternity now all lie under blue nitrile exam gloves and a silver-glinting scalpel. Schools, including my own, often refer to a preclinical student’s cadaver as the “first patient.” By extension, the donor’s loved ones are the first families and friends of the patient: the ones who know and love that person by all held in his or her form in the present and past, who have glimpsed and loved the efficient and final causes. To know the weight of this duty is the first step to knowing the weight of the profession. It takes the student from mere goals of remembering structures, developing manual dexterity, becoming comfortable with viscera, and performing well. It combats tendencies towards “mean egotism” and directs the future physician’s eyes to the honor and scope of the profession’s duty.

References

1. Blake W. Auguries of innocence. In: Bentley GE Jr, ed. Selected Poems. Penguin Classics; 2003:139-143.
2. Emerson RW. Nature. In: Levine RS, ed. The Norton Anthology of American Literature. 8th ed. Vol B. WsW Norton & Co; 2012:214-243.
3. Aristotle. Physics: A Revised Text with Introduction and Commentary. W. D. Ross, ed. and trans. Oxford: Clarendon Press; 1936.
4. Herbert G. The Pulley. In: Burrow C, ed. Metaphysical Poetry. Penguin Classics; 2006:79.