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Moulage ( French for 'casting' / 'moulding') is the art of applying mock injuries for the purpose of training emergency response teams and other medical and military personnel. Moulage may be as simple as applying pre-made rubber or latex "wounds" to a healthy "patient's" limbs, chest, head, etc., or as complex as using makeup and theatre techniques to provide elements of realism (such as blood, vomitus, open fractures, etc. [1] ) to the training simulation. The practice dates to at least the Renaissance, when wax figures were used for this purpose. [2]
In Germany some universities and hospitals use their historical moulage collections for the training of students. The often very lifelike models are especially useful to show the students today the characteristics of rare diseases, such as skin tuberculosis or leprosy. [3]
Up until the 16th century, European scientists had little knowledge about human anatomy and anatomy of animals. Medical students of Bologna and Paris studied the books of Aristotle, Galen, and other Greek scholars. Four centuries after the invasion by the Arabs and the fall of Rome and Persia, many Greek books were translated into the Arabic language. European scientists then translated these Arabic books into the Latin and Greek languages. In the medical field, this led to a reliance on Galen as a medical authority in European countries. In European medical schools the professors of anatomy merely lectured from Galen, without any dissection of the human body, and Galen’s books were the only way to learn anatomy.
Andreas Vesalius (1514–1564), a Flemish anatomist, was at first a "Galenist" at the University of Paris. When he moved to Italy and entered the University of Padua, he began dissecting human bodies. He studied many details of human anatomy and found that Galen made some anatomical mistakes. For example, Galen wrote that the sternum has seven segments, but Vesalius found it has three segments. Galen wrote that the bone of the arm is the longest bone in the human body, but Vesalius found that the bone of the thigh is actually the longest bone in human body. At age 25 Vesalius realized that the anatomical knowledge of Galen was derived from animal anatomy and therefore Galen had never dissected a human body.
In 1543 Vesalius wrote an anatomical masterwork named in Latin De humani corporis fabrica libri septem ("On the fabric of the human body in seven books"), or in short De Fabrica. The book included drawings of human females and males with their skins dissected. [4] These pictures greatly influenced the creation of future anatomical wax models. The anatomical pictures of Vesalius were followed by those of Johann Vesling ("Veslingius") and Hieronymus Fabricius. By 1600 Fabricius had gathered 300 anatomical paintings and made an anatomical atlas named the Tabulae Pictae. Giulio Cesare Casseri ("Casserius"), Spighelius, and William Harvey are other followers of the pictures of Andreas Vesalius.
The Tabulae anatomicae of Bartolomeo Eustachi ("Eustachius") (1552), printed in 1714, had a major effect on the history of anatomical wax models. This work so affected Pope Benedict XIV that he ordered construction of a museum of anatomy in Bologna In 1742, named Ercole Lelli and featuring anatomical wax models. Felice Fontana made cadaveric specimens into wax models by the casting method for anatomical teaching. [5]
The history of wax models is ancient. Wax anatomical models were first made by Gaetano Giulio Zummo (1656–1701) who first worked in Naples, then Florence, and finally Paris, where he was granted monopoly right by Louis XIV. Later, Jules Baretta (1834–1923) made more than 2000 wax models in Hospital Saint-Louis, Paris, where more than 4000 wax models were collected. While wax models were being made, he made pleasant conversations with the patients, sang songs or at times played the piano. Moulages were made for the education of dermatologists around the world, but were eventually replaced by color slides.
The modeling of the soft parts of dissections, teaching illustrations of anatomy, was first practiced at Florence during the Renaissance. The practice of moulage, or the depiction of human anatomy and different diseases taken from directly casting from the body using (in the early period) gelatine moulds, later alginate or silicone moulds, used wax as its primary material (later to be replaced by latex and rubber). Some moulages were directly cast from the bodies of diseased subjects, others from healthy subjects to which disease features (blisters, sores, growths, rashes) were skilfully applied with wax and pigments. During the 19th century, moulage evolved into three-dimensional, realistic representations of diseased parts of the human body. These can be seen in many European medical museums, notably the Spitzner collection currently in Brussels, the Charite Hospital museum in Berlin and the Gordon Museum of Pathology at Guy's Hospital in London UK.
A comprehensive book monograph on moulages is "Diseases in Wax: the History of Medical Moulage" by Thomas Schnalke (Author) the director of the Charite Museum and Kathy Spatschek (Translator). In the 19th century moulage was taken of medical patients for educational purposes. The prepared model was painted to mimic the original disease. Nowadays anatomicals model are an important instrument of education of human anatomy in department of anatomy and biological sciences in medical schools. [6]
Moulage has evolved dramatically since its original intent. In modern terms, the word moulage refers to the use of "special effects makeup (SPFX) and casting or moulding techniques that replicate illnesses or wounds" [7] in simulation based techniques. Common examples include designing diabetic wounds, creating burns or other illness effects, like dermatological rashes [8] [9] and gunshot wounds. [10]
These illness and injury effects are applied to training manikins or simulated or standardized patients for training or other purposes. Simulation staff attend training to learn these techniques. It is argued that the use of moulage in simulation improves realism or participant buy-in. [8] Moulage is an emerging field of research for paramedicine, radiography and medical education, [11] [12] [13] with researchers exploring how moulage contributes to learning in training. Military training utilises highly-authentic moulage techniques to desensitise to graphic wounds, prepare for battle, and treat injuries. [14] New advancements in the field include using tattooed injuries and moulage through augmented reality. [15] The level of authenticity required for moulage remains unclear. [7]
Anatomy is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its beginnings in prehistoric times. Anatomy is inherently tied to developmental biology, embryology, comparative anatomy, evolutionary biology, and phylogeny, as these are the processes by which anatomy is generated, both over immediate and long-term timescales. Anatomy and physiology, which study the structure and function of organisms and their parts respectively, make a natural pair of related disciplines, and are often studied together. Human anatomy is one of the essential basic sciences that are applied in medicine, and is often studied alongside physiology.
Aelius Galenus or Claudius Galenus, often anglicized as Galen or Galen of Pergamon, was a Roman and Greek physician, surgeon, and philosopher. Considered to be one of the most accomplished of all medical researchers of antiquity, Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, pharmacology, and neurology, as well as philosophy and logic.
Andries van Wezel, latinised as Andreas Vesalius, was an anatomist and physician who wrote De Humani Corporis Fabrica Libri Septem, which is considered one of the most influential books on human anatomy and a major advance over the long-dominant work of Galen. Vesalius is often referred to as the founder of modern human anatomy. He was born in Brussels, which was then part of the Habsburg Netherlands. He was a professor at the University of Padua (1537–1542) and later became Imperial physician at the court of Emperor Charles V.
The history of anatomy extends from the earliest examinations of sacrificial victims to the sophisticated analyses of the body performed by modern anatomists and scientists. Written descriptions of human organs and parts can be traced back thousands of years to ancient Egyptian papyri, where attention to the body was necessitated by their highly elaborate burial practices.
The human body is the entire structure of a human being. It is composed of many different types of cells that together create tissues and subsequently organs and then organ systems.
Herophilos, sometimes Latinised Herophilus, was a Greek physician regarded as one of the earliest anatomists. Born in Chalcedon, he spent the majority of his life in Alexandria. He was the first scientist to systematically perform scientific dissections of human cadavers. He recorded his findings in over nine works, which are now all lost. The early Christian author Tertullian states that Herophilos vivisected at least 600 live prisoners; however, this account has been disputed by many historians. He is often seen as the father of anatomy.
Bartolomeo Eustachi, also known as Eustachio or by his Latin name of Bartholomaeus Eustachius, was an Italian anatomist and one of the founders of the science of human anatomy.
Comparative anatomy is the study of similarities and differences in the anatomy of different species. It is closely related to evolutionary biology and phylogeny.
Matteo Realdo Colombo was an Italian professor of anatomy and a surgeon at the University of Padua between 1544 and 1559.
Plastination is a technique or process used in anatomy to preserve bodies or body parts, first developed by Gunther von Hagens in 1977. The water and fat are replaced by certain plastics, yielding specimens that can be touched, do not smell or decay, and even retain most properties of the original sample.
Neurophysiology is a branch of physiology and neuroscience that studies nervous system function rather than nervous system architecture. This area aids in the diagnosis and monitoring of neurological diseases. Historically, it has been dominated by electrophysiology—the electrical recording of neural activity ranging from the molar to the cellular, such as patch clamp, voltage clamp, extracellular single-unit recording and recording of local field potentials. However, since the neuron is an electrochemical machine, it is difficult to isolate electrical events from the metabolic and molecular processes that cause them. Thus, neurophysiologists currently utilise tools from chemistry, physics, and molecular biology to examine brain activity.
Dissection is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause of death in humans. Less extensive dissection of plants and smaller animals preserved in a formaldehyde solution is typically carried out or demonstrated in biology and natural science classes in middle school and high school, while extensive dissections of cadavers of adults and children, both fresh and preserved are carried out by medical students in medical schools as a part of the teaching in subjects such as anatomy, pathology and forensic medicine. Consequently, dissection is typically conducted in a morgue or in an anatomy lab.
De Humani Corporis Fabrica Libri Septem is a set of books on human anatomy written by Andreas Vesalius (1514–1564) and published in 1543. It was a major advance in the history of anatomy over the long-dominant work of Galen, and presented itself as such.
A wax sculpture is a depiction made using a waxy substance. Often these are effigies, usually of a notable individual, but there are also death masks and scenes with many figures, mostly in relief.
From the ancient Egyptian mummifications to 18th-century scientific research on "globules" and neurons, there is evidence of neuroscience practice throughout the early periods of history. The early civilizations lacked adequate means to obtain knowledge about the human brain. Their assumptions about the inner workings of the mind, therefore, were not accurate. Early views on the function of the brain regarded it to be a form of "cranial stuffing" of sorts. In ancient Egypt, from the late Middle Kingdom onwards, in preparation for mummification, the brain was regularly removed, for it was the heart that was assumed to be the seat of intelligence. According to Herodotus, during the first step of mummification: "The most perfect practice is to extract as much of the brain as possible with an iron hook, and what the hook cannot reach is mixed with drugs." Over the next five thousand years, this view came to be reversed; the brain is now known to be the seat of intelligence, although colloquial variations of the former remain as in "memorizing something by heart".
Ancient Greek medicine was a compilation of theories and practices that were constantly expanding through new ideologies and trials. The Greek term for medicine was iatrikē. Many components were considered in ancient Greek medicine, intertwining the spiritual with the physical. Specifically, the ancient Greeks believed health was affected by the humors, geographic location, social class, diet, trauma, beliefs, and mindset. Early on the ancient Greeks believed that illnesses were "divine punishments" and that healing was a "gift from the Gods". As trials continued wherein theories were tested against symptoms and results, the pure spiritual beliefs regarding "punishments" and "gifts" were replaced with a foundation based in the physical, i.e., cause and effect.
An écorché is a figure drawn, painted, or sculpted showing the muscles of the body without skin, normally as a figure study for another work or as an exercise for a student artist. The architect and Renaissance man Leon Battista Alberti recommended that when painters intend to depict a nude, they should first arrange the muscles and bones, then depict the overlying skin.
A cadaver, often known as a corpse, is a dead human body. Cadavers are used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Students in medical school study and dissect cadavers as a part of their education. Others who study cadavers include archaeologists and arts students. In addition, a cadaver may be used in the development and evaluation of surgical instruments.
The Medical Renaissance, from around 1400 to 1700 CE, was a period of progress in European medical knowledge, with renewed interest in the ideas of the ancient Greek, Roman civilizations and Islamic medicine, following the translation into Medieval Latin of many works from these societies. Medical discoveries during the Medical Renaissance are credited with paving the way for modern medicine.
The history of dermatology concerns the development of the practice of researching, defining and treating skin diseases, from ancient times to the present. The field has its origin in the earliest forms of medicine, later becoming a distinct field with its own specialised practitioners and researchers.