from sacrilege to privilege_ the tale of body procurement for anatomical dissection in the united...

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The Einstein Journal of Biology and Medicine 23

4HISTORICAL PERSPECTIVE

From Sacrilege to Privilege: The Tale of Body Procurementfor Anatomical Dissection in the United States

Raphael HulkowerAlbert Einstein College of MedicineBronx, NY

ABSTRACT

Anatomical dissection remains an integral part of most medical schools curricula, and in order to meet their educa-tional needs, schools turn to a mixture of donated and unclaimed bodies. However, the procurement of bodies foranatomical dissection has not always been a simple task. The history of the cadaver supply in the United States, asin many other countries, is a story of crime, punishment, and legal dilemmas. The method by which medical schoolsobtain cadavers has affected not only anatomists and medical students, but all members of society. Methods of pro-curement through the centuries have been able to change only along with concurrent changes in societal percep-tions of death and dissection. An appreciation of this history and these societal changes may benefit students in theirstruggles to come to terms with how their cadavers were obtained and how society has granted them the privilegeto dissect a fellow humans body.

INTRODUCTION

The study of anatomy has traditionally beenviewed purely as a rigorous learning experience,a rite of passage that strengthened the mindand determined who was rightfully a medical

student. In the twentieth 20th century, however, manyeducators began to view human dissection as an emo-tional learning experience in addition to being a prac-tical tool. Students were encouraged to think not onlyintellectually, but emotionally. This was particularly truein the last three decades of the 20th century. Memorialservices at the end of anatomy courses began in the

United Kingdom in 1965 and in the United States in the1970s, with the goal of heightening students sensitiv-ity toward their cadavers (Warner and Rizzolo 2006).Cadavers were occasionally referred to by their names,and student inquiry into the lives of their cadavers wasencouraged as appropriate and healthy.

In this setting, it is natural for students to wonder notonly about how their cadavers died, but also about howthey were procured after death. Did these people chooseto donate their bodies to science? Or were they poor orneglected, and had no one to claim them and provideburials? Such natural curiosity has only been intensi-fied in recent years with the scandals that surrounded

the Body World exhibit and similar productions. Whilefew students ever find out a full account of how theirindividual cadavers were procured, the history of bodyprocurement for medical dissection is a story that hasgrabbed the attention of historians, physicians, and stu-dents alike.

DISSECTIONTHE ULTIMATE CAPITAL PUNISHMENT

Societys perception of death and dissection has changeddramatically since the first recorded dissections of humanbodies by Herophilus around 300 B.C.E. These early dis-sections were carried out publicly, as were the limiteddissections carried out during the Middle Ages. In the17th and 18th centuries, anatomical theaters were setup in many European cities in order to educate doctorsand students, but they were public spectacles with littleeducational value (Korf and Wicht 2004). Because ana-tomical dissection was associated with great dishonor,the only legal source of cadavers at the time was the

corpses of the executed. Legislators took advantage ofthis public perception by using the threat of dissectionas a deterrent to committing serious crimes. High-levelcrimes became punishable by dissection when ana-tomical dissection became a part of the sentence of cap-ital punishment, as in the Murder Act of 1752 England(Hildebrandt 2008). To this day in the United States,the only federal law relating to the cadaver supply waspassed in 1790; it permitted federal judges to add dissec-tion to a death sentence for murder. At times, the threatof dissection was also used to discourage less heinous,but equally disruptive, crimes such as dueling. A 1784Massachusetts law stated that a slain duelist would eitherbe buried in a public place without a coffin or given to

a surgeon for dissection (Tward and Patterson 2002).

Many offenders and their families considered anatomi-cal dissection to be more frightening and undignifiedthan the capital punishment itself. People viewed dis-section as a desecration of the corpse and believed thatit would impede resurrection and deny the survivalof identity after death. While execution was a threatto ones life, dissection was an assault on ones soul.Being doubly sentenced (to execution and to dissec-tion) was a punishment far worse than execution alone


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(Halperin 2007). In this way, anatomical dissection waspracticed for a mixture of medical and punitive purposes(Hildebrandt 2008).

NIGHT DOCTORSTHE GRAVE-ROBBING ERA

Until the 18th century in Europe and the United States,the use of executed criminals bodies for dissection ful-filled the needs of both the court system and the anat-omists. Not only was there a legal method to acquirecadavers, but this method may have assisted in prevent-ing crimes. However, as the study of anatomy grew inpopularity, the number of executed criminals was notnearly enough to meet the needs of medical schools andsurgeons. In the United States, the pressing demand islikely to have begun around 1745, when the first for-mal course in anatomy was taught at the University ofPennsylvania (Tward and Patterson 2002).

To meet the growing demand, the practice of robbingthe graves of freshly buried persons became rampantin the 18th and 19th centuries. If the soil was soft andthe grave shallow, a thief with a partner could exhumea body in less than an hour. Most bodies were stolenbetween November and March, when medical schoolswere in session and the cold helped preserve the corpses.The corpses were transported, often by wagon, for saleto local anatomy professors. As professors would acceptonly bodies that had not badly decomposed, ten dayswas usually the limit between death and burial (Halperin2007). As grave-robbing provided a fairly easy way tomake money, the perpetrators ranged from professionalthieves to tavern owners to employees at the medical

schools themselves. At times, even medical students ordoctors themselves robbed graves (Garment et al. 2007;Halperin 2007).

The public was well aware of the practice of grave-rob-bing. They often referred to the perpetrators as nightdoctors, sack-um-up men, or body snatchers,while the anatomy professors called them by the moredignified term resurrectionists. British and AmericanVictorian literature even makes reference to grave-rob-bing for dissection, for example in Charles Dickenss Taleof Two Cities in 1859 and Mark Twains Adventures ofTom Sawyerin 1876 (Halperin 2007).

On some occasions, the temptation to make a quick buckby selling cadavers to anatomy labs was so great thatgrave-robbers even resorted to murder. In 1827, WilliamBurke and William Hare were so impressed by the profitthey made from selling a body to the local laboratorythat they conspired and murdered 16 other people attheir lodge, until they were caught. Ironically, Burke wasexecuted, dissected, and put on public display (Twardand Patterson 2002).

Several methods were used to guard against grave-rob-

bing. Some cemeteries placed iron cages, called mort-safes, around fresh graves, while others stored corpsesin vaults until the bodies decomposed to the point thatthey were safe from robbers. More commonly, a guardwas hired, or family members took turns, to watch overthe graves for the first few nights after burial. The graves

most likely to be robbed were those of the poor or unpro-tected members of society, such as African Americans.Such graves often had worse security and were buriedwith less care. For the most part, society looked the otherway with regard to grave-robbing, provided that thebodies continued to be procured mostly from the poorand marginalized segments of society (Halperin 2007).

Public outcry was much greater when the corpse of awhite or prominent member of society was stolen. Onone occasion at the Ohio Medical College, visitors to theanatomy lab discovered the body of U.S. Senator JohnScott Harrison, son of President William Henry Harrison.The visitors were Senator Harrisons son and nephew.

The most famous of such events was the New YorkResurrection Riot in 1788 (also known as the DoctorsRiot). Supposedly, a doctor working in the anatomylab at New York Hospital waved the arm of a cadaverat a young boy looking in the window. The boy wenthome and told his father, who went to the graveyardof New Yorks Trinity Church to visit the grave of theboys recently buried mother, only to find that the gravehad been robbed. This report spread and people startedto accuse the local physicians and anatomists. The out-cry was so great that a mob sacked New York Hospitalon April 13, 1788. Medical students were grabbed andbeaten, and the mob took four students captive untilthey were rescued by the local sheriff. The following

day, the riots continued as the mob searched the city fordoctors, medical students, and cadavers. Three to fourhundred men stormed down Broadway toward the city

jail, intent on capturing the medical students who werebeing held there for the students own protection. Whenthe mob grew to 5,000 people, Governor George Clintoncalled in the militia. By the time the mob was stopped,three rioters and three militiamen had been killed, andmany others wounded. In response to the riot, New Yorkpassed its first law against grave-robbing in 1789 and atthe same time allowed judges to sentence dissection tothose being hanged for arson and burglary in additionto murder. Nevertheless, as the law did not provide a suf-ficient legal method for medical schools to obtain their

cadavers, schools continued acquiring bodies illegallyand grave-robbers continued their trade (Halperin 2007;Tward and Patterson 2002).

LEGAL ADJUSTMENTS: THE ANATOMY ACTS

By the end of the 18th century, U.S. state governmentsbegan to realize that a dramatic legal change would benecessary to effectively end the practice of grave-rob-bing. Until medical schools had a good alternative source


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of cadavers, there would always be a market for illegallyobtained bodies. Massachusetts was the first state toenact laws, in 1830 and 1833, allowing unclaimed bod-ies to be used for dissection. Over the course of the nextdecades, many other states followed suit, legislatingthat unclaimed bodies of people who died in hospitals,

asylums, and prisons would be allocated to that statesmedical schools for the purpose of anatomical dissec-tion. Due to these laws, the price of illegally obtainedcorpses declined, making grave-robbing neither profit-able nor practical (Garment et al. 2007). The laws wereacclaimed both by medical schools and by local govern-ments, which were previously responsible for buryingunclaimed bodies. Proponents were also enthusiasticabout the idea that criminals (not just the executed) andpaupers, who were considered a burden to society dur-ing their lives, could now offer some compensation bybenefiting future medical training and knowledge.

Modern critics have pointed out, however, that under

the new laws, the same marginalized part of the pop-ulation was being subjected to dissection, while themajority of the population still viewed dissection neg-atively (Halperin 2007). This sentiment is seen in someof the detailed exceptions to the anatomy laws. Severalstates forbade dissection of the unclaimed bodies oftravelers, presumably allowing for the time it mighttake for a travelers family to get in contact with thegovernment. At the same time, they stipulated that thisexception did not apply to that class commonly knownand designated as tramps. Other states exempted theunclaimed bodies of soldiers from being dissected, asthey had already served society during their lifetime. Sothe anatomy acts solved the problem of grave-robbing,

but they did little to change societys perception of dis-section (Garment et al. 2007).

BODY DONATION AND THE CHANGE IN THE SOCIETALVIEW OF DEATH AND DISSECTION

At the turn of the 20th century, most Americans disap-proved of dissection, and voluntary body donations werequite rare. There were religious objections to dissection,and it was now associated with unclaimed bodies, andtherefore, a mark of poverty. There were a few notableexceptions. A wealthy citizen named Thomas Orne, aprosperous horse dealer who donated his body in 1899,

according to local newspapers, had no concern that thedonation of his body would signify that he lacked themeans for a proper burial. In addition, citizens withunknown medical ailments sometimes wished to donatetheir bodies in order to aid those with similar diseases.The bodies of suicides could be dissected while still inprime condition. Still, such occurrences made headlinesprecisely because they were the exceptions. In 1912, 200New York physicians publicly pledged to donate theirbodies after death in an effort to remove the stigmaassociated with dissection (Garment et al. 2007).

While these efforts to promote a positive view of bodydonation and dissection may have helped in minor ways,public opinion was more dramatically affected by theexposure of the corrupt funeral industry in the middleof the 20th century. In the mid-19th century, when theUnited States was still generally rural, many funerals

were small affairs arranged by the deceaseds family. Asurbanization progressed, crowded cities led to the birthof funeral homes, which ultimately led to fancier coffins,open caskets, and expensive funeral rituals. In 1951, BillDavidson wrote an article, The High Cost of Dying, inwhich he noted that over the previous 122 years, whilethe cost of living had increased by 347 percent, the costof dying had increased 10,000 percent. In 1961, RoulTunleys article Can You Afford to Die?said that thecountrys annual funeral costs were much higher thanits annual hospital costs. Around the same time, JessicaMitfords book The American Way of Deathdetailed thescams and price-fixing practices of the funeral industry.In order to avoid the high costs charged by the funeral

industry, Mitford recommended that people donatetheir bodies to science, and her books appendix evenlisted medical schools that would accept donated bod-ies (Mitford 1963). Ironically, such exposs did notremove the stigma associated with dissection, but ratherundercut the notion that a proper burial was a respect-able practice. While the fear of dissection discourageddonation, the fear of being victimized by underhandedfuneral directors made people reconsider body dona-tion (Garment et al. 2007).

THE UNIFORM ANATOMICAL GIFT ACT

Even while efforts were being made to improve societalattitudes toward dissection and donation, the actual actof donation remained a complicated matter in the mid-dle of the 20thcentury. Over the years, a confusing con-glomeration of anatomy acts, common laws, and statestatutes made body donation a legally complicated mat-ter. Noting this difficulty, along with increased societalinterest in body donation, the National Conference ofthe Commissioners on Uniform State Laws approved theUniform Anatomical Gift Act (UAGA) in 1968. The UAGAofficially made body donation a right, morally based onfree choice and volunteerism. A second act was signedin 1987 and served to clarify the donation process fur-ther. Together, these two acts, often still referred to as

the UAGA, clarified ambiguous laws regarding donationand tried to standardize laws among states. Perhapseven more significantly, the UAGA established thehuman body as property, a new privilege that allowedfor a donors wishes to be honored in court even if hisor her next of kin objected to the donation after death.Within four years, 48 states had adopted the UAGA, andtoday every state has some form of the law (Jones andWhitaker 2009; Garment et al. 2007). However, evenwith these advances, the legal rights of a person over hisor her own body postmortem remain ambiguous.


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CONCLUSION

Despite the successful promotion of body donation andthe UAGA, medical schools high demand for cadaversstill requires many schools to use unclaimed bodies, par-ticularly in states with multiple medical schools. While

many schools have incorporated computer-based learn-ing tools into their courses on anatomy, these tools arestill viewed as a supplement to dissection, not a sub-stitute for it (Garment et al. 2007). Understandably,many students view the use of unclaimed bodies as aless-than-ideal situation in comparison to willed dona-tions. Students are much more comfortable believingthat the person, when alive, had authorized his or herown dissection, rather than it being authorized by themedical establishment (Jones and Whitaker 2009). Afuller knowledge of the history of body procurementmay, it is hoped, allow students to appreciate the legaland ethical progress that society has achieved in orderto make anatomical dissection a respectable act for both

donor and recipient. There was a time when anatomicaldissection was possible only when either the donor orthe recipients had committed a crime. In our times, thatsame act is viewed as a privilege.

REFERENCES

Garment, A., S. Lederer, N. Rogers, and L. Boult. 2007. Let the dead teach theliving: The rise of body bequeathal in twentieth-century America.Acad. Med.82:10001005.

Halperin, E. 2007 The poor, the black, and the marginalized as the source ofcadavers in United States anatomical education. Clin. Anat. 20:48995.

Hildebrandt, S. 2008. Capital punishment and anatomy: History and ethics ofan ongoing association. Clin. Anat. 21:514.

Jones, D. G., and M. I. Whitaker. 2009. Speaking for the dead. 2d edition.________, England: Ashgate.

Korf, H. W., and H. Wicht. 2004. The public cadaver. Nature428:805.

Mitford, J. 1963. The American way of death.New York: Simon and Schuster.

Tward, A., and H. Patterson. 2002. From grave robbing to gifting: Cadaver sup-ply in the United States.JAMA287:1183.

Warner, J., and L. Rizzolo. 2006. Anatomical instruction and training for pro-fessionalism from the nineteenth to the twenty-first centuries. Clin. Anat.19:40314.

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