Theme 5 Bodies and the body politic: life, death and organ transplantation

Tissues and treatments: organ transplantation

HI269

Week 18

Transplantation: Medical Miracle?

A verger's dream: Saints Cosmas and Damian performing a miraculous cure by transplantation of a leg Andrés Sánchez de Oña c. 1484-1510

"Felix, the eighth pope after S. Gregory, did do make a noble church at Rome of the saints Cosmo and Damian, and there was a man which served devoutly the holy martyrs in that church, who a canker had consumed all his thigh. And as he slept, the holy martyrs Cosmo and Damian, appeared

to him their devout servant, bringing with them an instrument and ointment of whom that one said to that other: Where shall we have flesh when we have cut away the rotten flesh to fill the void place? Then that

other said to him: There is an Ethiopian that this day is buried in the churchyard of S. Peter ad Vincula, which is yet fresh, let us bear this

thither, and take we out of that morian's flesh and fill this place withal. And so they fetched the thigh of the sick man and so changed that one for that other. And when the sick man awoke and felt no pain, he put forth his hand

and felt his leg without hurt, and then took a candle, and saw well that it was not his thigh, but that it was another…”

Saints Cosmas and Damian practised medicine and surgery without payment according to their legend, and were therefore represented to the lay public as medical ideals. In this Spanish altarpiece they are shown in the full finery of

academic doctors as they perform their miraculous operation. The painter shows only one bone running through the limb below the knee-joint, whereas empirical

research reveals that there are two, the tibia and fibula. This not uncommon fallacy may be derived from the fact that in classical antiquity the same word (tibia) was

used for both the larger bone in the leg and for the leg as a whole… Wellcome Library Catalogue http://catalogue.wellcome.ac.uk/record=b1203821, accessed 32/02/09

Transplantation: Medical Murder?

Heidi Cartwright, Brain in a Bowl

Transplantation: Medical

Monstrosity?

Bodies and Identities: Parts and wholes…

• Human bodies imbued with social meanings

• Bodies not regarded as either vessels or integrated wholes, but as simultaneously both: partially dualistic, but also partially ‘ensouled’

• So where does identity and ‘personhood’ lie in this complex entity?

The German context

• Ideas (and ideals) of the Volk (people) , Volkscörper (‘body’ of

society/body politic) and Volksgemeinschaft (nation as an integrated community/ extended family)

• Post WWI, rapid urbanization combined with loss of a generation of healthy young men, and economic despair concerns about ‘racial degeneration’ (not just in Germany)

• Policy responses mirror Progressivist thinking elsewhere (eg. USA), but with a greater emphasis on state and professional involvement and Social Darwinism: Rassenhygiene, Sozialhygiene, and Volkshygiene.

• Emerging disciplines like anthropology anxious to contribute to national drive to identify ‘undesirables’ ‘scientifically’

• Good fit with rapid growth of medical specialization and search for medical role in governance

The German context

• National Socialism builds on this foundation: national identity is tied to the physical bodies of its citizens, and social/national wellbeing is tied to physical vitality and regeneration

• In combination with common EuroAmerican preoccupations of the day – eugenics, fears of ‘race suicide’, racism, and rising status of science – this allows for the ‘scientific’ definition of lebensunwertes Leben, and the ideological stance that such lives must be subjected to medical and scientific categorization, ‘control’, limitation, and elimination.

So: how did Germany go from national regeneration to the death camps? Hogle argues for three linked factors: – Myth of a superior national biological and

social body;– Redefinition of all other bodies as essentially

different and lesser – as not fully human;– Development of social and technological

means for converting such lesser material into useful substances for the greater national good

• Note the central place taken by medicine and the sciences in this progression…

Petition of Bishop of Limburg to the Reich Minister of JusticeConcerning Killing of Patients at the State Hospital for the Mentally Ill at Hadamar

13 August 1941

“About 8 kilometers from Limburg … there is an institution which had formerly served various purposes and of late had been used as a nursing home; this institution was renovated and furnished as a place in which… euthanasia has been systematicallypracticed for months …Several times a week buses arrive in Hadamar with a considerable number of such victims. School children of the vicinity know this vehicleand say:" There comes the murder-box again." After the arrival of the vehicle, the citizens of Hadamar watch the smoke rise out of the chimney and are tortured with the ever-present thought, of the miserable victims, especially when repulsive odors annoy them, depending on the direction of the wind. The effect of the principles at work here are: Children call each other names and say," You're crazy; you'll be sent to the baking oven in Hadamar." Those who do not want to marry, or find no opportunity, say," Marry, never! Bring children into the world so they can be put into the bottling machine!" You hear old folks say, "Don't send me to a state hospital! After the feeble-minded have been finished off, the next useless eaters whose turn will come are the old people."

All God-fearing men consider this destruction of helpless beings as crass injustice. … The official notice that N. N. had died of a contagious disease and that for that reason his body has to be burned, no longer finds credence, and such official notices which are no longer believed have further undermined the ethical value of the concept of authority….”

Resistance

Nazi Medicine on trial: NurembergHalf of the German medical profession joined the Nazi party from 1933-45; only those

who faced discrimination under Nazi policies actively protested them.The Nuremberg trials detailed the nature of Nazi medical experimentation on death camp

inmates, presented evidence of those experiments, and crucially, judged not only individuals but the profession and science of medicine in the Nazi era.

– A. High Altitude ExperimentsB. Freezing ExperimentsC. Malaria ExperimentsD. Mustard Gas ExperimentsE. Ravensbrueck Experiments on Sulfanilamide & Other Drugs; F. Ravensbrueck Experiments on Bone, Muscle, and Nerve Regeneration and Bone TransplantationG. Sea-Water ExperimentsH. Epidemic JaundiceI. Sterilization ExperimentsJ. Typhus (Fleckfieber) and Related ExperimentsK. Poison ExperimentsL. Incendiary Bomb ExperimentsM. Jewish Skeleton Collection

• Conclusion of the Prosecution’s Opening Statement: “I have now completed the sketch of some of the foul crimes which these defendants committed in the name of research. The horrible record of their degradation needs no underlining. But German medical science was in past years honored throughout the world, and many of the most illustrious names in medical research are German. How did these things come to pass? I will outline briefly the historical evidence which we will offer and which, I believe, will show that these crimes were the logical and inevitable outcome of the prostitution of German medicine under the Nazis.”

Post-War medical reform and regulation

• Nuremberg trials and establishment of the Nuremberg code (next slide);

• Personhood laws incorporated directly into the Basic Law of 1949, formalizing ideas of ‘human dignity’ and protecting bodily integrity of the living and the dead and heavily regulating the removal of tissue from either:

• “The worth of persons is inviolable” • “Everyone has the right to life and bodily integrity”

• Virtually no medical involvement in promoting organ or tissue donation, or in debates with opponents of organ/tissue donation and experimentation.

SO: after privileging the interests of the Volk and Volkskörper over those of individuals under national Socialism, Germany now privileges individual rights most highly.

THE NUREMBERG CODE [from Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. Nuremberg, October 1946–April 1949. Washington, D.C.: U.S. G.P.O, 1949–1953.] Permissible Medical Experiments The great weight of the evidence before us is to the effect that certain types of medical experiments on human beings … conform to the ethics of the medical profession generally. … All agree, however, that certain basic principles must be observed in order to satisfy moral, ethical and legal concepts: 1. The voluntary consent of the human subject is absolutely essential. … 2. The experiment should be such as to yield fruitful results for the good of society, unprocurable by other methods or means of study.... 3. The experiment should be so designed and based [on reliable data & animal experiments] that the anticipated results will justify the performance of the experiment. 4. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. 5. No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur... 6. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment. 7. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death. 8. The experiment should be conducted only by scientifically qualified persons. .... 9. During the course of the experiment the human subject should be at liberty to bring the experiment to an end... 10. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he has probable cause to believe … that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject.

Compare

http://adweek.blogs.com/adfreak/2008/11/dont-let-the-giant-maggot-eat-your-corpse-.html

Explaining German attitudes towards the body

Hogle puts forward two theories. either of which could explain German views of the sanctity of the body:

• Reactions to Nazi atrocities and utilitarian attitudes towards the bodies of the lebesunwertes leben – national guilt/shame; fear that ‘the world is watching’ and will condemn, etc.

• Blut und Boden – Romantic notions of the body as emblematic of the nation, of purity, etc. Note German attitudes towards other sources of impurity – eg. bio-engineered food, environmental pollution etc.

Seminar: ‘Medicine gone mad’: Nazis, Nuremburg, and national

identity• Have German responses to the revelations of

Nuremberg and the post-war era created a distinctive ‘German medicine’, or merely reinforced differences that were already embedded in German culture?

• Why is it shocking that medicine and medical professionals participated fully in the Holocaust, turning some bodies into commodities?

• And to what extent are suspicions of organ transplantation specific to Germany?

REMINDER: Papers are due NEXT WEEK, no later than 4PM Monday,

to my Pigeonhole outside the History Main Office.

Remember to include a coversheet, to double space your paper, and to submit it online as

well as to me in hard copy!