Speaking for the Dead

Cadavers in Biology and Medicine

D. Gareth Jones

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138634459
• eBook ISBN:
  9781351793704
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This was first published in 2000: This text explores issues surrounding the use of human cadavers and human tissues in science and medicine. This is an area of increasing significance in contemporary society, as more and more techniques become available for manipulating human genes and human material (including embryos, body organs and brain tissue). These issues are explored through case studies from contemporary society. Some of the most topical issues examined include plastination of human bodies as an art form, the use of biopsies from surgical operations, the ethics of using human DNA and stem cells in research, and the debate surrounding the transplantation of animal tissue and organs into humans.

1 Cadavers as Images of Ourselves

Introduction

In the eyes of most people anatomy and cadavers are inseparable. Talk to practising doctors about their experiences as medical students in anatomy, and their thoughts will drift instinctively to the dissecting room and the dead bodies, the cadavers, they encountered there. One of the most vivid accounts of a first acquaintance with a dissecting room is provided by the composer, Hector Berlioz. In his Memoirs (1969 as translated by Cairns, 1969, p.46), he writes:

...I gave myself up wholly to studying for the career which had been thrust upon me. It was soon put to a somewhat severe test when Robert, having announced one morning that he had bought a "subject" (a corpse), took me for the first time to the dissecting room...at the sight of that terrible charnel-house– fragments of limbs, the grinning heads and gaping skulls, the bloody quagmire underfoot and the atrocious smell it gave off, the swarms of sparrows wrangling over scraps of lung, the rats in their comer gnawing the bleeding vertebrae–such a feeling of revulsion possessed me that I leapt through the window of the dissecting-room and fled for home as though Death and all his hideous train were at my heels. The shock of that first impression lasted for twenty-four hours. I did not want to hear another word about anatomy, dissection or medicine, and I meditated a hundred mad schemes of escape from the future that hung over me.

It is not clear how accurate was this description of the dissecting room Berlioz encountered in the Paris of 1822. Regardless of the excessive repulsive feelings that may have coloured his account, and of the rebellion against his father that was so much a part of his unhappy encounter with the world of medicine, it is a highly evocative picture that lingers in the memory. This is not all there is to know about anatomy, but it is a facet of the anatomist's world that cannot be entirely dismissed.

Almost invariably the dissecting room is seen as the place where anatomy begins and ends, a perception that so clearly comes to the fore with the almost inevitable follow-up comment cum question: can there possibly be any research left to do in anatomy? The implication here is that all that could be known about dead bodies is already known; the world of research has come to an end.

This is a travesty, as unhelpful as it is misleading. The suggestion that the world of the anatomist is nothing more than that of dead bodies lying on slabs in the dissecting room, is a caricature, missing as it does anything that can be seen and understood using microscopes. The other world of cells, let alone everything that can be studied at the subcellular or molecular levels, is tragically lost. While this misapprehension is of greater interest to anatomists than to anyone else, it needs to be borne in mind throughout this book as we move seamlessly from the macroscopic to the microscopic and back again. A second unfortunate implication is the impression that dead bodies are of little concern to anyone other than anatomists (and in a parallel clinical context, pathologists). From the perspective of this book this is an even more serious misconception than the first, since anatomy has a great deal to contribute to the world of clinical medicine, providing as it does entry to an appreciation of the significance of the dead body. This, in turn, has another consequence, namely, that the dead body cannot be approached in an ethical vacuum, whether it is within the context of anatomy or of clinical medicine. One point that I hope will emerge is that the ethical context developed to understand the uses and abuses of the dead body in the dissecting room is relevant to the development of appropriate ethical contexts within clinical medicine. The reason for this is that, since the dead body was once a living human body, there is a strand between the two, with mutual connections leading in both directions.

Anatomy and the Culture of Dissection

"Anatomy" is generally defined as: 'the science of the structure of the bodies of humans, animals and plants; a treatise in this field; the artificial separation of the parts of a human, animal or vegetable body, in order to discover their position, structure and relations; dissection' (New Shorter Oxford Dictionary, 1993). Anatomy can also refer to a detailed analysis of a particular topic (for instance, 'the anatomy of a crime') and, in a non-technical sense, the human body (Collins Dictionary of the English Language, 1986). Quite clearly, "anatomy" in the sense in which it is used in anatomy departments is far more specific than many of these definitions.

Anatomy departments as discussed here limit their attention to human anatomy. They are Departments of Human Anatomy, even though much research within them concentrates more on rats than on humans. Central to their raison d'être is the structure of the human body. This is particularly the case for teaching, with the dissection of the human body constituting a central activity. For medical students in particular, anatomy is largely defined as what can be learned from dissection of the human body. Gross anatomy, with its dissection and macroscopic study of the regions and systems of the human body, is the closest we come to a public image of anatomy, regardless of how members of an anatomy department may view the scope of their discipline. Anatomy, in this sense, is replete with nineteenth century connotations, that sit uneasily alongside the activities of many contemporary anatomy departments.

It is impossible to move beyond this elementary point without enquiring into the culture of dissection, with its roots in the sixteenth and seventeenth centuries. No matter how anatomy is defined at the start of the twenty first century, there is no debate as to its position within the intellectual spectrum: it is a biological science. What debate there is concerns whether it belongs mainly within the domain of medicine, as a science serving medical education, or as one of the biomedical sciences.

In other words, were we to use the verb "anatomize" or the noun "anatomization" today, we would use it in a scientific sense. When a body is anatomized, or dissected, a complete body is reduced to its component parts in an attempt to build up a new body of knowledge. More specifically, the body of one individual is dissected so that a profession's understanding of the morphology and function of bodies in general can be increased. In the light of that which is learned about specific bodies, the intention is to strengthen and broaden the science of anatomy in general.

But what do we mean by such an obvious term as the "body"? According to Kass (1985), the term in old English referred to the living body, and only later in Middle English was the same term used for the dead body or corpse. Later, it was used to refer to the person or individual being. In the sixteenth century the term came to refer not only to the material part of human beings, but to material things in general.

Kass argues that, although the term "body", in its primary usage, refers to the body of human beings or of animals, it is an abstraction. The body is always some body, it is somebody's body. This, in turn, raises questions such as: is my body mine or is it me? Can it be alienated from me, like other property of mine, such as my car or my dog? On what basis do I claim property rights in my body? Do I hold my body as a gift? If so, is it mine to dispose of as I wish? However we wish to answer questions such as these, we find we are moving continually between a particular body, somebody's body, and the body in general. Whether or not Kass is correct, we have to agree with him that we cannot limit our horizons and interests to a generalized body. Cadavers, body parts, tissues and bony remains have always come from particular individuals, and even when these individuals lived in the distant past, they can never be completely dehumanized. They still remind us that they were once one of us.

However, the scientific ethos within which anatomy has functioned for two hundred years (see Chapter Two) arose out of a bewildering array of competing cultural forces. These provide a much broader appreciation of anatomy than that obtained by viewing it solely as the science of dissection.

Developing a Vision of the Interior of the Body

Prior to our modern detached, scientific approach to the human body, anatomy was part of a popular culture enamoured with the interior of the body but experiencing great difficulty in coming to terms with this largely hidden domain. In the early-modern period in Europe, particularly the sixteenth and seventeenth centuries, there existed a fascination with the body that led inevitably to a morbid curiosity with dissection–the only known way of exploring this tantalizing and exotic territory. Dissection was not carried out in a sanitized environment such as the modern dissecting room, but in anatomy theatres and with bodies straight from the gallows. It was carried out under the guise of a prescientific understanding of the body and in close association with playwrights and poets, a world far removed from modern conceptions. Jonathan Sawday in his elegant book, The Body Emblazoned (1995), brings to light the culture of dissection in the early-modern period, with the morbid eroticism of some Renaissance poetry and theatre, the longing of writers to explore the unknown mysteries of the body's interior, and the surprisingly close connection between the respective theatres of playwrights and anatomists.

In sixteenth and seventeenth century Europe, the body was considered taboo, was viewed as capricious, and was talked of in the language of treason, treachery, duplicity and secrecy (as in the writings of John Donne). According to Sawday (1995), this was 'an...intangible world of imaginative and symbolic desire, where ritual, intellectual curiosity, and the sovereign rites of justice and punishment, merge into a fascination with the human interior'.

Contributing to the flourishing of anatomy during this period was a fascination for matters of sexuality and pain, which in turn were closely associated with dissection. Of considerable surprise is the conjunction between the anatomy lecture theatre cum dissecting room, and the playhouse. In analyzing the play The Anatomist, by the seventeenth century writer, Edward Ravenscroft, Sawday (1995) finds that 'the role of the corpse...conceals criminality, duplicity, and licence'. In the play, the corpse serves as a focus of attention, a place for demonstrating technical skill and a refuge from the outraged guardians of sexual morality. Sawday further argues that in order to obtain the delights of the flesh, the play suggests that we first have to be willing to become flesh. 'And once we are flesh, what happens when the anatomist catches our eye?' (Sawday, 1995).

Earlier than this, in 1594, Thomas Nashe writes in The Unfortunate Traveller, of his narrator being examined and then locked up to await dissection. At this point, the character meditates:

Oh, the cold sweating cares which I conceived after I knew I should be cut like a French summer doublet! Methought already the blood began to gush out at my nose. If a flea on the arm had bit me, I deemed the instrument had pricked me. Well, well, I may scoff at a shrewd turn, but there's no such ready way to make a man a true Christian as to persuade himself he is taken up for an anatomy...Not a drop of sweat trickled down my breast and my sides, but I dreamt it was a smooth-edged razor tenderly slicing down my breast and my sides. If any knocked at the door, I supposed it was the beadle of Surgeon's Hall come for me (quoted in Sawday, 1995, p.49).

Even stranger to us are the accounts of poets and writers outlining their dreams of dissection, feeling the hand of the dissector with its associated shiver of erotic anticipation. Such erotic dreams of partition were present in poetic texts until well into the seventeenth century. Being dissected was seen as the most complete form of physical surrender. An illustration of this is a poem dating from 1659 by Richard Lovelace, who, addressing his mistress, makes his poetic persona surrender to her:

Ah my fair Murdresse! Dost thou cruelly heal,
With Various pains to make me well?
Then let me be
Thy cut Anatomie,
And in each mangled part my heart you'l see (quoted in Sawday, 1995, p.51).

Sawday argues that, by accepting the most complete form of physical surrender, namely dissection, the poem is able to express the extent of the poet's desire for his beloved.

The fascination and horror of dissection stemmed, in part, from its close liaison with public executions. In the sixteenth and seventeenth centuries, the felon, executioner, anatomist, plus various advisers and assistants each played a carefully orchestrated part in the spectacle that made up the culture of dissection: these were two acts in a single drama. It was not until the eighteenth century that clinical detachment emerged. Prior to Harvey's time (1578-1657):

...anatomies were performed in public...as ritualistic expressions of often contradictory layers of meaning, rather than as scientific investigations in any modern sense...In the age of Vesalius...the centrality of the public anatomical demonstration rested as much on the dignity invested in the anatomist, as on its utility as a branch of natural science (quoted in Sawday, 1995, p.63).

The Renaissance anatomy theatre contained outlines of judicial court, dramatic stage, basilica-style church or temple. It was a place of symbolic confrontation: between the naked cadaver and the anatomist; between the old text-based and the new observational approach to knowledge. Anatomy represented the symbolic power of knowledge over the body of the individual criminal, the anatomist gradually emerging as the living embodiment of a progressive technological regime. Anatomists were active participants in the execution process, thereby demonstrating the conjunction between science and the executioner's skills (see also Richardson, 1988). The result was that, if anatomists were to be able to continue their investigations on the human body, they had to be seen to be more than the executioners' accomplices. Their activities had to assume some divine significance, but this could only be accomplished if the remains of the dissected body were to provide a medium with which to understand the creative intent of God. As anatomists peered into the interior of the body, they were peering into a sacred temple. In the early-modern period it was these overtones that legitimized anatomy, a situation that remained unchanged until Descartes and Rembrandt, when the body became no more than an abandoned ruin.

Of particular fascination was the genre of self-dissection, in which the body is depicted as an accomplice to the dissection process. An example of this is found in Vesalius, where anatomy appears to animate the body and endow it with a life of its own, enabling it, in effect, to assist in its own dissection. This genre gave the impression that knowledge of the (dead) body was actually knowledge of the living, thereby stressing the naturalness of dissection. The rationale for this may have been the ambivalent and emotionally charged spectacle of public dissection. Nevertheless, this failed to completely rehabilitate dissection, since dissected cadavers existed on the edge of living society, constituting as it were an uneasy community of the dead. In depicting cadavers in this manner, anatomists like Vesalius and their illustrators provided a commentary on human destiny, just as much as on human anatomy. They appear to be saying that the anatomist was not disrupting the body, as much as the body was willingly allowing the anatomist to assist the general process of decay and dissolution. What this did was to provide a context for dissection, which prior to the sixteenth century, was far from self-justifying.

However much our contemporary cultures appear radically different from these early European ones, it would be foolhardy to overlook this important message: anatomy, and especially gross anatomy, is not a self-justifying regime. It is not carried out in a cultural and philosophical vacuum, but neither is any procedure that invades the human body, living or dead. This social, cultural and philosophical dimension impinges on many of the ventures in contemporary medicine, let alone across the whole gamut of human anatomy.

The World of the Dead Body

Even in the modern world, the process of dissection requires justification. Those societies that allow dissection still protect the dead human body from the forays of clinical teachers, adventurers, and entertainers. Although examples of some of these will be thoroughly assessed later (see Chapters Two and Three), it is useful at this juncture to illustrate the range of possibilities. These represent the outer limits of anatomy, even though most of them would be shunned by the vast majority of anatomists. Before tackling these, however, consider the following relatively innocuous incident, which sets useful boundaries for further discussion of treatment of the dead body.

In Wales, a newborn baby's body was sent more than 320 kilometres in a cardboard box from one hospital to another. A shocked stores worker discovered the body in the parcel delivered by a courier when the bottom of the small box broke open. The baby should have been transported either by ambulance or by funeral director, for a special postmortem examination. Health chiefs have launched an inquiry into the blunder, and the baby's parents are receiving counselling. Although the body was still inside a plastic box, a member of parliament described the incident as 'disgraceful'.

In this case, nothing amiss was done to the body, nor was its transportation a distance of 320 kilometres the issue. It was simply that the container was inadequate, thereby jeopardizing the dignity of the dead body, and the sensitivities of the family and the worker who discovered it. This provides a signal to all who would transgress the limits presumed to govern society's approach to the corpse that powerful regulatory forces are at work. An understanding of these is urgently required if the body's potential in therapy and research is to be utilized to the full.

Many societies allow dead bodies to be used in anatomy departments and medical schools for purposes of teaching and research. However unusual by normally accepted social standards, this use of corpses is deemed to fit within the constraints of moral and civil behaviour. In general, the public is allowed to view such human material only under severely circumscribed conditions, to ensure that it is not treated merely as a means of gratuitous satisfaction. Despite this, there are exceptions. Consider the following illustrations taken from actual news reports (identifying information has been removed).

For more than a decade, cadavers have been exhibited in macabre public peep shows at a Department of Forensic Medicine. It has been discovered that a hitherto t...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• List of Abbreviations
• 1 Cadavers as Images of Ourselves
• 2 History and Contemporary Ethos of Dissection
• 3 Acceptable and Unacceptable Uses of Cadavers and Tissues
• 4 Human Skeletal Remains: When Indigenous Concerns Conflict with Scientific Aspirations
• 5 Organ and Tissue Transplantation: Further Uses of Cadavers
• 6 Cadavers that May Not be Cadavers
• 7 Uses of Human Embryos and Fetuses
• Bibliography
• Index