Book Review: The Courtiers’ Anatomists

BookReviewLogoReview by Elisabeth Brander

In the history of anatomy, certain people and places have proved to be a popular topic. Andrea Carlino, Sachiko Kusukawa, and many others have considered the significance of 16th century anatomists, often emphasizing the work of Andreas Vesalius, while Andrew Cunningham has taken a broad look at Enlightenment-era anatomy with a particular focus on Italy and England. In The Courtiers’ Anatomists: Animals and Humans in Louis XIV’s Paris (University of Chicago Press, 2015), Anita Guerrini, professor of history at Oregon State University, examines a place and time that has not been the focus of as much academic interest. Her latest monograph describes the activities of a group of anatomists working at the Paris Academy of Sciences during the 17th and 18th centuries.

23130498Guerrini’s narrative is rich and complex. By using a broad framework that discusses the importance of animal dissection for the development of early modern experimental science, she deftly touches on several key components of anatomical practice during the French Enlightenment. The stage is set with an overview of the Parisian anatomical scene during the 17th century: the rivalry between the physicians of the Paris Faculty of Medicine and the surgeons at Saint-Côme for access to dissection material, the question of whether reading texts or performing dissections was more beneficial for the study of anatomy, and the impact of William Harvey’s discovery of the circulation of the blood. The physiological discussions precipitated by Harvey, and the mechanistic theories of René Descartes, became central to the work of a number of French anatomists including Jean Pecquet and Louis Gayant, who embraced animal dissection as a means of investigating structure and function. These men carried out much of their work at the Paris Academy of Sciences, an intellectual organization founded in 1666 whose members had a broad interest in scientific inquiry and were active in fields including mathematics, astronomy and, of course, anatomy. Continue reading “Book Review: The Courtiers’ Anatomists”

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

MedHum Mondays Presents: Rhetoric in the Flesh

DailyDose_Poster

Welcome back to the Daily Dose! Today’s MedHum Monday series will be a cross-post from the Dittrick Museum (also managed by Brandy Schillace). Graduate student and guest blogger Julia Balacko will present a review and summary of the Dittrick’s recent medical humanities book launch event for T. Kenny Fountain’s newest work–a rhetorical exploration of anatomy, meaning making, and trained vision. As with so many  intersections between medicine and humanities, there is much more here than meets the eye!

Contributor: Julia Balacko

EVENT: Book Launch for T. Kenny Fountain’s Rhetoric in the Flesh

hRecently, I had the pleasure of attending the book launch for T. Kenny Fountain’s Rhetoric in the Flesh: Trained Vision, Technical Expertise, and the Gross Anatomy Lab at the Dittrick Museum. At the event, Fountain discussed some of the key arguments from the book, and shared anecdotes from his participant observation in the human gross anatomy lab.

Fountain’s text is an ethnographic account penned from the perspective of a rhetorician of science communication. His focus on language offers a lens into anatomical learning and clinical training that is at once pointed and engrossing. Through his account, Fountain reveals the underlying relationships and tensions between students of anatomy and the bodies they dissect.

As I learned from the book launch talk and from an initial reading of the text, one term that Fountain’s participants in the laboratory often returned to was “making.” This word appears counterintuitive, given that dissection entails acts that are more closely associated with destruction than creation: scraping fat from tissues, disarticulating bones, removing organs to see structures beneath of them. However, “making” had a particular cadence in the interviews and interactions that Fountain had with students and faculty in the lab.

Students, instructors, and teaching assistants in the cadaver laboratories employed “making” to describe cutting and preparing the corpse in ways that would mimic the beautifully colored, flawlessly sketched anatomical drawings in their medical atlases. To dissect a body in a careful fashion that would reveal biological structures as cleanly and as clearly as the textbooks was to “make” the body, both into a mimicry of the visuals in the textbooks, and into a body that was representative of what the books deemed anatomical truth. Some students alternatively deemed this process “Netterizing,” or rendering their cadaver’s anatomy to appear as manifestly as the eminent anatomical artist and physician Frank Netter did in his illustrations.

Students in the past have also “made” cadavers into new visual things, as the Dittrick Museum’s collection of rare photographs from 19th century medical schools reveal. Medical students in that era would commonly photograph themselves and their classmates standing over the body they were dissecting. These photographs were frequently sent as postcards to family members as a sign of pride, demonstrating the students’ hard work in medical school and their experience in the anatomical laboratory. In these images, the cadaver represented how they were becoming professionally distinct as physicians: they could learn by dismembering real human bodies, a privilege not extended to other professions and certainly not to a scientifically-minded lay person.

The Dittrick Museum Chief Curator, James M. Edmonson, published these photographs along with historical commentary in the book Dissection: Photographs of a Rite of Passage in American Medicine 1880-1930. Yale professor John Harley Warner, also a historian of medicine, coauthors the book.

As we see, the students dissecting bodies can transform these cadavers into something else. Yet bodies can be “made” by more than the students and faculty alone. Fountain’s text argues that bodies can make themselves. In one case in his book, a woman who donated her body to science accompanied her anatomical gift with a letter. The letter contained details of the domestic abuse she suffered, as she explained the scars medical students would discover on her skin when they began to dissect her. The woman cast her body in a context that the students who received her body, and read her correspondence, could not ignore when considering the conditions under which that body lived and died. This woman “made” her body a representation of its life, its embodied struggles, and its significance as a precious gift to the students who received it.

Cadavers can also “make” themselves in death. One cadaver in the laboratory Fountain observed at had late-stage cancer that had not been reported on her medical records before she was embalmed for dissection. The cancerous tissue was stiff and impossible to cut through. It obscured structures, encased organs, and halted the dissection. In this instance, the cadaver makes itself both anomalous– by not representing “true” anatomical structures like the textbooks– and simultaneously representative of the reality of disease, which medical students will confront as future physicians.

In the past and today, cadaver dissection stands an important source of experiential and visual knowledge of the material human body for medical professionals. Like the 19th century medical students who posed proudly next to their cadavers, medical students today are equally as privileged to gain firsthand knowledge from the human body. Although students’ relationships to their cadavers have no doubt changed, as Fountain’s book suggests, the study of anatomy remains an exceptional experience in the education of future physicians.

You can learn more about and purchase Rhetoric in the Flesh here: http://www.attw.org/publications/book-series/rhetoric-in-the-flesh

To learn more about the Dittrick Museum’s photographs, get Dissection: Photographs of a Rite of Passage in American Medicine here: http://www.amazon.com/Dissection-Photographs-American-Medicine-1880-1930/dp/0922233349

ABOUT THE AUTHOR:

Julia Balacko is a second-year PhD student in medical anthropology at Case Western Reserve University. Her research explores the history, development, and cultural meaning of cadaver dissection in American medical education.