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The Anatomy Laboratory: A Concept Ahead of Its Time

2003; Elsevier BV; Volume: 78; Issue: 2 Linguagem: Inglês

10.4065/78.2.250

1942-5546

Terry A. Ellis, Douglas R. Bacon,

History of Medicine Studies

John S. Lundy, MD, the first chair of the Section on Anesthesia at the Mayo Clinic, had an idea that profoundly affected not only the field of anesthesia but also the rest of medical training at the Mayo Clinic. In 1925, Lundy proposed establishing an institution-sponsored anatomy laboratory. At that time, the Section on Anesthesia was still in its infancy, with anesthesia services split between Worral, Saint Marys, Kahler, and Colonial hospitals.1Lundy JS The 1925 Report of the Section on Anesthesia, Mayo Clinic.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1926Google Scholar These hospitals combined had 20 operating rooms and 1 obstetrical suite. Two physician anesthesia providers, 21 anesthetists, and 3 assistants1Lundy JS The 1925 Report of the Section on Anesthesia, Mayo Clinic.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1926Google Scholar, 2Lundy JS The First Annual Report of the Section on Anesthesia from January 1st, 1927 to January 1st, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar provided anesthesia for more than 20,000 patients who underwent surgery at the Mayo Clinic in 1925.1Lundy JS The 1925 Report of the Section on Anesthesia, Mayo Clinic.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1926Google Scholar Besides managing these responsibilities, Lundy trained several surgical fellows each year in the art of regional anesthesia.2Lundy JS The First Annual Report of the Section on Anesthesia from January 1st, 1927 to January 1st, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar, 3Carbon copy of a letter from John S. Lundy to William Mayo, June 18, 1925.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1925Google Scholar Lundy noticed that the surgical fellows’ interests did not lie in learning anesthetic techniques, but he believed that anesthesia should be delivered only by those trained in the specialty. Lundy, searching for a way to interest surgical fellows in the emerging field of anesthesiology, to entice more physicians into becoming dedicated anesthesia providers, and to develop a resource for anesthesia education, approached Mayo Foundation for authorization to establish an anatomy laboratory.4Lundy JS The Third Annual Report of the Section on Anesthesia for the Year 1929.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1930Google Scholar He predicted that the laboratory would be a great success and would serve as one of his most valuable assets for training anesthesia fellows. William J. Mayo gave his approval (Figure 1), and Lundy began work on the anatomy laboratory in 1925; however, no meaningful work occurred for almost 13 months.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar, 6Letter from William Mayo to John S. Lundy, June 23, 1925.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1925Google Scholar During this intervening period, Lundy solved several logistical problems. First he had to procure and furnish a room that would serve as the laboratory.6Letter from William Mayo to John S. Lundy, June 23, 1925.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1925Google Scholar, 7Lundy JS Anatomy Service Report, February 14, 1929.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1929Google Scholar He accomplished this with Mayo Foundation assistance and with tools and instruments sometimes borrowed from operating rooms.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar, 7Lundy JS Anatomy Service Report, February 14, 1929.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1929Google Scholar His next dilemma was how to prepare, store, and lay to rest the cadavers. He contacted the University of Minnesota and Stanford University anatomy departments and obtained from them techniques for embalming, storage, and preservation.8Carbon copy of a letter from John S. Lundy to C. M. Jackson, August 4, 1925.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1925Google Scholar, 9Carbon copy of a letter from John S. Lundy to C. M. Jackson, September 20, 1927.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1927Google Scholar, 10Letter from C. M. Jackson to John S. Lundy, September 21, 1927.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1927Google Scholar, 11Letter from Head of Anatomy Department, Stanford University, to John S. Lundy, September 6, 1927.In the Collected Papers of John S. Lundy. Rochester, Minn, Mayo Foundation Archive1927Google Scholar The anatomy laboratory was established in the basement of the Palen and Lohse funeral home; the cadavers were obtained mainly from the state hospital; and the initial dissections finally began in 1927.10Letter from C. M. Jackson to John S. Lundy, September 21, 1927.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1927Google Scholar, 12Lundy JS. Report of the Section on Anesthesia for the Year 1930, Fourth Annual Report. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1930.Google Scholar, 13Lundy JS. Twenty-one Months' Experience in Operating a Dissecting Room Under the Mayo Foundation. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; July 12, 1927.Google Scholar The anatomy laboratory started as a single room without adequate lighting, no real ventilation, and borrowed equipment. With funding from the Section on Anesthesia, Lundy procured the rudimentary facilities to run a successful anatomy laboratory, the first to be associated with a private medical clinic. In the first 7 months of 1927, 66 fellows and 10 staff members spent more than 3300 hours in the laboratory.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar Besides being extremely popular, the laboratory was also a cost-effective training tool. Lundy determined that in the first 7 months, the average cost per student-hour in the laboratory was $0.60.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar The anatomy laboratory grew at a pace that far exceeded the facilities and the staff. Within 1 year of the laboratory opening, Lundy procured funds to expand and remodel, adding more dissection tables and equipment and obtaining a full-time anatomy teacher, Wilmot C. Foster, MD.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar, 12Lundy JS. Report of the Section on Anesthesia for the Year 1930, Fourth Annual Report. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1930.Google Scholar What occurred next was a masterstroke by Lundy. He observed that surgical fellows who performed dissections before assisting with patients in the operating room fared better than those who did not. He encouraged surgical fellows to perform dissections and procedures on the cadavers to better understand the anatomy and technique involved in performing the procedure on living people. He then expanded this idea on two fronts. First, Lundy established a lecture series that covered purely anatomical dissections; he also initiated a series of lectures and dissections that covered the most frequently performed procedures at the Clinic.7Lundy JS Anatomy Service Report, February 14, 1929.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1929Google Scholar, 14Lundy JS. Carbon copy of the schedule of Anatomy Service, quarter beginning January 2, 1928. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1927.Google Scholar Second, Lundy developed a simulation program. Lundy's idea was to re-create the operating-room environment in the anatomy laboratory and to have surgical fellows perform procedures under conditions similar to those in the operating room. This enabled the surgical fellows to practice procedures, learn anatomy, and get valuable feedback, advantages often not possible in the operating room.5Lundy JS Annual Report of Anatomy Service, January 1, 1927 to January 1, 1928.In the Collected Papers of John S. Lundy. Mayo Foundation Archive, Rochester, Minn1928Google Scholar, 14Lundy JS. Carbon copy of the schedule of Anatomy Service, quarter beginning January 2, 1928. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1927.Google Scholar Thus, Lundy established a simulation program for surgical fellows at the Mayo Clinic in 1927. Another feature of Lundy's plan was to have a fulltime anatomist, Dr Foster, teach and guide the fellows in their dissections, lectures, and simulations; this gave Lundy the time to explore other possible uses for the anatomy laboratory. Lundy believed that the laboratory would be one of his greatest anesthesia training assets because most physicians who chose to specialize in anesthesia would be leaving general practice to do so and would benefit from further studies in anatomy.12Lundy JS. Report of the Section on Anesthesia for the Year 1930, Fourth Annual Report. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1930.Google Scholar Thus, in less than 2 years, the anatomy laboratory was transformed from a simple room in which dissections were carried out into a multifunctional educational tool that was used across medical specialties and was an invaluable asset to the Clinic.12Lundy JS. Report of the Section on Anesthesia for the Year 1930, Fourth Annual Report. In the Collected Papers of John S. Lundy, Mayo Foundation Archive, Rochester, Minn; 1930.Google Scholar In conclusion, John S. Lundy made a special contribution to the Mayo Clinic by establishing an anatomy laboratory; the repercussions of this contribution are still felt today. Lundy hoped to accomplish many things with the laboratory, and the success he enjoyed went far beyond anything he could have expected. Initially, he set out to learn more about nervous system anatomy to foster regional anesthesia techniques. He also sought more appropriate training for surgical fellows and ultimately hoped to establish a training program for physicians interested in anesthesiology. In creating the anatomy laboratory, he provided surgical fellows with an invaluable learning tool; he also developed a surgical simulation program while expanding his understanding of anesthetic techniques. Lundy supervised the anatomy laboratory for more than 30 years, from 1927 to 1959. Direction of the anatomy laboratory was eventually transferred to the Mayo Medical School. The first director of the medical school anatomy laboratory was Duane K. Rorie, MD, an anesthesiologist with a doctorate degree in anatomy who ran the laboratory from 1972 to 1980. The anatomy laboratory continues to thrive under the direction of the Mayo Medical School while remaining true to its roots. Today, the successful Procedural Skills Laboratory, the most recent iteration of which was begun in the Stabile Building in 2000, is philosophically a descendant of Lundy's original surgical simulation program but much expanded. Of note, the leadership of the Procedural Skills Laboratory has once again crossed paths with the Department of Anesthesiology, with Dr Rorie, now Emeritus Chair of the Department of Anesthesiology, serving as Director of the Laboratory.