Are we running out of Bodies? Dissection, Cadavers, and Medical Practice

DailyDose_PosterI’ve spent a surprising number of hours unearthing the unusual history of anatomy, dissection, and yes–body snatching. That story links early anatomists like Vesalius (Fabric of the Human Body) to murderers Burke and Hare, to the grave-robbery that supplied bodies to a growing medical community. Here at the Dittrick Museum, we have a comprehensive collection of dissection photography as a rite of passage in American medicine 1880-1930, and curator James Edmonson and John Harley Warner put together an entire pictorial book of them. Between my work on the history of medicine and my research for Death’s Summer Coat (US in 2015), I’ve become very aware of the progress–and problems–of cadaver use, storage, and procurement. So, when the Economist ran a story last year about cadaver shortages, I took notice.

Male figure, anterior view showing blood vessels, liver heart and bloodletting points.  Woodcut circa 1530 - 1545
Male figure, anterior view showing blood vessels, liver heart and bloodletting points.
Woodcut circa 1530 – 1545

“THEY are inert, smelly and upsetting to look at—it’s a wonder that dead bodies are in such high demand. But for medical students they are an indispensable learning tool,” says the author. But are they? Even now with so much modern technology? Many say yes. Some, however, aren’t so certain. In 2013, the Case Western Reserve University School of Medicine and the Cleveland Clinic Lerner College of Medicine, both located in Cleveland, Ohio, announced plans to build a joint medical education building. The historic partnership will result in a state-of-the-art facility to the tune of more than eighty million US dollars. The plan is to be at the forefront of technology, a forward-thinking institution of the medical future. There is one thing that this new building will probably not have, however. There will be no cadaver lab for the purpose of human dissection.

51O9RjsA1UL._SY344_BO1,204,203,200_As I say in chapter 5 of DSC, the decision by CWRU and CCLCM wasn’t made in a vacuum. A brief search of medical journals reveals a sizzling debate. To quote the title of a 2004 debate forum in The Anatomy Record, ‘To What Extent Is Cadaver Dissection Necessary to Learn Medical Gross Anatomy?’[i] That is, do we need a dead body to prepare medical students for practice? The forum was collegial, but not all discussions and rebuttals have been so friendly. Among medical faculty, the argument is not merely philosophical – and sometimes it simmers with bitter rancour. Human dissection has not, however, always been an element of medical training. In fact, the practice has been fraught almost since the first: a battleground over bodies, from the religious prohibition of the pre-modern period to a ‘gory’ New York City riot in the eighteenth century, when an enraged public rose up against body-snatching anatomists. What do these tensions mean? How does the cadaver relate to conceptions of death, then and now? These questions have to do with more than medicine; they get at the heart of how we deal with death as an event (with a body) and dying as a process (with an overseeing physician) today.

dissectionIn the first of a series of blog posts for Dittrick Museum, I explained the tension in social terms. The 1832 Anatomy Act in England intended to provide greater access to cadavers for medical science, but it was viewed with enormous suspicion and public outcry. Called the ‘Dead Body Bill’, the ‘Dissecting Bill’ and the ‘Blood-stained Anatomy Act,’ it allowed the unclaimed bodies of paupers to be given to the anatomy schools. The bodies consisted of poor, indigent, trod-upon groups. The 1834 Poor Law that followed added to the unease for the laboring poor in Britain; Peter Bussey, a 19th century Bradford Chartist, who claimed in 1838 that “If they were poor they imprisoned them, then starved them to death, and after they were dead they butchered them.”[ii] Our other posts covered the supposed “positive benefit” such actions were to have, Grave Robbing for the Benefit of the Living, and a bit more about some of the doctors in Buried History (including the infamous Ohioan, Horace Ackley). But in all of these, we see a graduated tension: not whether doctors should dissect, but the ethics of procuring the body. No one wanted to see the remains of a loved one strung up in a student lab (and this, in fact, did happen–one of the driving forces behind changes to the laws). And yet, other attitudes were changing too, and people began to donate their bodies to science at an increasing rate. Surely, between donation and modern means of preservation, we have no need to go hunting grave yards… can there really be a shortage of cadavers to go around?

The funny thing about history is how often it repeats itself. According to the Economist article, growing numbers of medical students has, in fact, off-set the balance. We have a tendency, at times, to consider things only from a Western perspective; when we look globally, we see that more and more people are choosing medical careers worldwide–sometimes in cultures where body donation sits in opposition to religious practice. The solution is not to malign the spiritual or ritual treatment of bodies; it is an important part of cultural and individual processing of death. But of course, this is only one small part of the larger issues surrounding body donation and cadaver availability–some others mentioned by the article include: better identification and so fewer unclaimed bodies, fewer bodies “fit” for dissection (that is, fewer young and healthy persons dying ‘before their time’).[iii]

fig26So where does that leave us? Perhaps the most interesting–and alarming–statistic comes from the body retrieval sector, what Michel Anteby, professor at Harvard Business School, calls “a market for human cadavers in all but name”. [iii] Does that mean we are returning to the practice of paying for cadavers (which is, after all, what supplied the murder trade of Burke and Hare)? Not necessarily. In May 2014, Canada’s Globe and Mail reported that approximately half of Canadian medical schools have cut back on using cadavers, opting for pre-cut body parts and high-tech imaging technology [iv]. And this new technology also has its antecedents. I spoke about SynDaverTM Labs in DSC; the company constructs simulated tissue, organs, or whole bodies for dissection. Their ‘Synthetic Human’ includes skin with fat and fascia, bones, muscles, tendons, and ligaments, articulating joints, a functioning respiratory system, a complete digestive system, visceral and reproductive organs, and a circulatory system. And yet, simulated cadavers appeared far, far earlier–from the Wax Venus to the papier mache models build by Auzoux in the 19th century [for more, see Paper Woman or my upcoming chapter in Steampunk Guide to Death]. The Independent‘s claim that a “lack of anatomy training could lead to a shortage of surgeons” –or the worry that such shortages might lead to nefarious activity–is probably overstatement. It may be true, indeed, that dissecting models isn’t like the real thing (though Auzoux claimed it was precisely the same). On the other hand, medical schools have adjusted already, along with changing ideas about who dissects and who doesn’t (notably, still a must for surgeons!) And, as the debate surrounding cost of new facilities in medical schools continue, no doubt the profession will continue to be as creative as ever in their solutions.

But not too creative. A body is more than muscle and tissue, meat and bone. As any student of anatomy (or forensic anthropologist) will tell you: this is (or was) a person. The respect given to the cadaver in the years after those “rite of passage” photographs has, at least seemingly, deepened. This is your teacher, your instrument, your body. Protect it, guard it, learn from it. True for all of us, who get but one body–doubly true of the medical doctor in training, who–if he or she is very lucky–will have two.

[i] G. D. Guttmann, R. L. Drake, and R. B. Trelease, ‘To what extent is cadaver dissection necessary to learn medical gross anatomy? A debate forum’, Anatomical Record 281(1): 2–3.

[ii] Knott, John. “Popular Attitudes to Death and Dissection in Early Nineteenth Century Britain: The Anatomy

[iii] R. MCS. “Why there is a shortage of cadavers” The Economist. Jan 19, 2014. http://www.economist.com/blogs/economist-explains/2014/01/economist-explains-10

[iv] Harrah, Scott. “Global Cadaver Shortage & Why Almost Half of Canadian Medical Schools are Cutting Back” The UMHS Endeavor. May 12, 2014. https://www.umhs-sk.org/blog/the-global-cadaver-shortage-why-canadian-med-schools-are-cutting-back/Caribbean-Medical-Schools

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