Introductory Anatomy

Dr D.R.Johnson, Centre for Human Biology

Anatomy is an unusual subject because the material we use is human. This gives, at one and the same time, a fascination and a repugnance, simply because the material is human.

'The study of anatomy by dissection requires in its practitioners the effective suspension or suppression of many normal physical and emotional responses to the wilful mutilation of the body of another human being' - Richardson

In other words, in normal society, outside the medical school we would probably be locked up for dissection, and its not very nice anyway, is it? The name given to the ability to suppress physical and emotional responses is 'clinical detachment'. Clinical detachment is the way in which we deal, as anatomists, with the repugnant, the distasteful, and what, if we did it to a living human being, would be criminal. It is acquired slowly, bit by bit, and to different extents. William Harvey, discoverer of circulation of the blood, dissected both his father and his sister. Few of us would wish to be so clinically detached.

If we did it to a living human being is the key phrase. The cadaver is not a living human being but neither is it a pound of offal.. Perhaps we should examine our attitude to our own, and other peoples' bodies.

Man has always been fascinated by the interior of his body. The first written documents to survive are clay tablets from around 4000BC in Nineveh. The cuneiform script impressed upon these tablets can be translated, and tells us many things. Some tablets are inventories for warehouses, some are the equivalent of laundry lists, and some tell us about the insides of men and animals opened in a form of fortune telling - trying to predict the future.

The next landmark was anatomical detail set down by Galen in the second century AD. This was meagre, distorted and bore little relationship to the dissected body.
In the Renaissance a change of attitude occurred: in Italy this took the form of patronage and the setting up of schools of anatomy, notably at Padua, and the work of the first two great anatomists, Leonardo da Vinci and Versalius. Da Vinci's work was hidden until the late eighteenth century but Versalius De Humani Corpus Fabrica, published in 1543 was the first anatomy textbook as we know it, drawn from life (or death), accurate and painstaking.

England, as usual in things European, lagged behind, but Scotland granted royal patronage to the Edinburgh College of Surgeons and Barbers in 1506. England followed suit in 1540. (Surgeons thus have a long connection with barbers: this is because medical men denied them professional status, and leads to the inverted snobbery of the consultant surgeon whose title is still MR . The low status of the surgeon, which dated from the Council of Tours edict in 1163 whereby the church abhorred the spilling of blood. Ecclesiastics who were also medics were thus discouraged from surgery, although they continued to practice medicine, and subcontracted surgical procedures to others, often barbers, who performed blood letting, tooth drawing and later midwifery.)

It is at this point that things get complicated and that Anatomy starts to get a bad name. Part of the patronage given by James IV of Scotland was the bodies of certain executed criminals for dissection. In England Henry VIII granted the annual right to the bodies of four hanged felons. Charles II later increased this to six . Now bodies had to come from somewhere, but the conjoining of anatomy and hanging offences was very bad news, and the basis of an association which lasted until the first Anatomy act in 1832. Dissection was now a recognised punishment, a fate worse than death to be added to hanging for the worst offenders.
The dissections performed on hanged felons were public: indeed part of the punishment was the delivery from hangman to surgeons at the gallows following public execution, and later public exhibition of the open body itself. The punishment replaced the earlier hanging drawing and quartering, in which the four quarters were exhibited on spikes in various parts of the city, and differed only in that it was performed by medical men, and, incidentally that anatomical knowledge was obtained. This state of affairs was accepted by surgeons because it was, oddly, good for their image to achieve royal patronage and to be linked with the law. In France, incidentally surgeons acquired respectability by the back door. In 1687 surgeons performed a successful operation for anal fistula on Louis XIV. It was successful, probably because they practised for a year on lesser mortals with the same complaint. In 1752 an act was passed allowing dissection of all murderers as an alternative to hanging in chains. This was a grisly fate, the tarred body being suspended in a cage until it fell to pieces. The object of this and dissection was to deny a grave. After the act the number of available bodies increased, and the act itself was pro anatomy in that the execution had to follow smartly upon conviction, and the body conveyed immediately to the surgeons. Dissection was described as 'a further terror and peculiar Mark of Infamy' and 'in no case whatsoever shall the body of any murderer be suffered to be buried'. The rescue, or attempted rescue of the corpse was punishable by transportation for seven years.

The act benefited anatomists immediately. In 1775 the royal college of surgeons acquired eight bodies at once before rigor mortis had set in: one was 'put in an attitude and allowed to stiffen' by William Hunter, Professor of Anatomy, flayed and a mould prepared. A cast from this is still on view at the Royal Society of Arts in London.
Hunter was a key figure in Anatomy. He ran his own private anatomy school in Great Windmill St in London where he thought in the 'Parisian manner', each student having access to an individual corpse. He also set up a museum of human and comparative anatomy. The Company of Surgeons was 'intellectually stagnant' at this time, had no hall and was more interested as a City livery company in giving public dinners than offering public dissection. Despite this, in the period between 1701-1744, 24 lecturers in anatomy are known to have been active in London alone. The private schools had no legal status and no legal source of material. The question was, where did Hunter, his brother and the other anatomists setting up private schools get their cadavers - certainly not from official sources. The suspicion, probably justified, was that people were being paid to obtain corpses. The corpse was now a commodity: it had cash value and could be bought and sold. Harvey's solution of keeping it in the family did not become popular: most anatomists bought from the gallows or the grave.

Agents representing surgeons would bargain with condemned prisoners not under sentence of dissection (remember this only happened for murder: hanging was in vogue for stealing a sheep or even a loaf) : occasionally prisoners struck a bargain to pay expenses, to provide for a family or to buy the customary decent apparel for the hanging. Supply was unreliable, however: riots at public hangings became common, partly because of the paltry nature of hanging events, partly from superstition. The body was often reclaimed by relatives and the unpopular anatomists stoned, defeated and out of pocket. Competition was often so fierce that a rival anatomy school carried off the body. Dissection was unpopular and other medical uses were to be found for a recently hung body - the cure of scofula, goitre, wens, ulcers, bleeding tumours, cancers and withered limbs for example. To prevent riots and disorder the Sheriff of London took all bodies of hanged men, except those sentenced to dissection, into his own custody and handed them to the relatives for burial.

However in 1826 592 bodies were dissected by students at London anatomy schools. Most of these must have come from grave robbers. The earliest grave robbers seem to have been the surgeons themselves. In 1721 a clause was inserted into apprentices indentures issued by the Edinburgh college of surgeons forbidding trainee surgeons from becoming involved in exhumation. Later, students accompanied professional body snatchers as observers. In Scotland it was possible to pay fees in corpses rather than in cash. By the 1780s the work was left to the professionals -Ressurectionists or Sack' em up men. A professional gang of 15 body snatchers was rounded up in Lambeth in 1795 . They worked, winter only, serving 'eight surgeons of repute' from 30 burial grounds. Corpses cost two guineas and a crown -£2.35 and children six shillings for the first foot and nine pence for each extra inch. By 1820 the cost was up to 20 guineas for an unremarkable corpse for dissection. Freaks cost a lot more. O'Brien, the Irish giant, well over seven feet tall, who died in 1783 was bought by John Hunter for £500, despite his wish to be buried at sea to avoid such a fate. He now stands in the entrance of the Royal College of Surgeons in London.

Oddly body snatching was not an offence. The body was not regarded as property, and, once dead, could not be owned or stolen. Occasionally a body snatcher would be whipped, on unclear legal grounds. Only if property - such as a shroud was removed was the robber a thief.

The grave robbers job was easier if the graves of the poor were robbed. Pit burials, or mass graves were common, and often a large square pit up to 20 feet deep would be excavated, filled with coffins gradually over a period of weeks then closed. Stealing bodies from such graves cannot have been difficult. The wealthy, of course could buy a metal coffin (1781), Bribgeman's patent cast iron coffin (1818) or use a mortsafe - a kind of cage of iron bars surrounding a tomb. They could also, and did, employ guards, even armed guards to ensure their eternal rest. The poor, acting in concert to reduce the cost often had a parish mortsafe or 'jankers' where bodies were kept until too high for the anatomist to use.

The demise of the body snatcher is perhaps one of the first cases of consumerism. Since the law was unable or unwilling to help, because of the lack of a clear offence, it was left to the public to intervene. Thus in 1828 two medical students caught attempting to snatch a body were committed to gaol at their own request as they were threatened by a large crowd. The following afternoon a crowd of several hundreds 'assembled round the gaol , provided with axes'. In Yarmouth, Hereford, Greenwich and Lambeth (we are now in the age of steam, and rapid reliable transport, at least by sea) similar scenes ensued. A full scale riot broke out in an Aberdeen anatomy school in 1832 when a dog unearthed human remains. The School was looted and burned. The crowd, estimated at 20,000 denied access to the fire engine.

By the time the Aberdeen Riots took place at least 16 citizens of Edinburgh had been murdered in order to stock the anatomy school. Burke and Hare gained a poor living in Edinburgh mending shoes. When a lodger at Mrs Hare's lodging house died the pair sold the body to Dr Knox's anatomy school for £7.50. Another lodger fell ill, and was befuddled with whisky , smothered and sold for £10. Fifteen more followed.

The riots, the murders and public opinion meant that something had to be done and the outcome was the 1832 Anatomy Act which was a key issue in the election of 1832. A key figure behind this was Jeremy Bentham, founder of University College London. His idea was essentially that anyone applying to a hospital for treatment was in effect giving permission for the use of their body, in the event of a poor result, being available for dissection, followed by Christian burial. Although forgoing a Christian burial Bentham was publicly dissected at University College in 1828. There is a sub text to this. Anyone applying to a hospital for treatment meant, in effect the poor who could not afford to pay a doctor. Hospital also meant workhouse. After much argument with Peel, the Prime Minister and political manoeuvring designed so that the death rates in the workhouse should not be made public the bill became law. The situation was now this: the bodies of those maintained by the state (i.e. in Workhouses) if not claimed by relatives (for burial at their expense) became the property of the Anatomist. The fate of these bodies had become, and still is, anatomical examination - not dissection. Administration was by an Inspector of Anatomy, working for the Home Office. Unsurprisingly the residents of workhouses, unconsulted, were not happy with the act, but powerless to do much about it. Many evaded examination by signing a declaration that they did not wish to be dissected: the supply from workhouses was unexpectedly low: there were riots: there was scandal, maladministration and indecency and plain mistakes. Burial services and coffins were often rudimentary. Burial clubs became common - like a Christmas Club - pay so much a week for your funeral. Just before World War 1 ten percent of the income of women in Lambeth was set aside for 'Industrial insurance'. There is still a dread amongst the older generation of a 'pauper's funeral' The only change to the act, however, was in response to repeated failure of the anatomists to bury remains within the stipulated period: the period was extended in 1871.

We operated under the 1832 act until very recently. What has changed? Well, the workhouse has gone. From the Anatomists point of view this meant that the supply of material declined: there were shortages in the 1920s. The Inspector of Anatomy at the time suggested 'a modest fee of five shillings' to officials in mental homes - by then the main source of supply.
At this point something odd happened, perhaps allied to the rise of socialism and atheism. There was continued outcry against the bodies of the poor being used, and against token burial services in token coffins. But there was also a rise in donations. From almost zero before world war one, to 5% between the wars, then rising again after world war two to almost 100%. The cause of this is unknown: it parallels a rise in cremation rather than burial and perhaps tokens a change in our attitude to our bodies. Perhaps it parallels the demise of the paupers funeral and the idea that poverty and misfortune could qualify a person for dismemberment against their will. Who knows ? But all bodies dissected in Leeds are now donations.

So what does donation entail? Around 100 people a year from the area contact us wanting details of this philanthropic act. We ask only that a letter stating their wish is placed with their effects. At the time of death we are informed and, if the next of kin agree, the body (which is technically their property) is donated to us. If the donation is accepted by a Licensed Teacher ( reasons for refusal include post mortem examination, notifiable disease, gross over- or underweight and certain diseases which change the anatomy of the body). The deceased , having been certified as dead, is collected by an Undertaker and transferred to our mortuary. After a statutory period (there are constant stories in the papers of the certified dead waking in the mortuary) the deceased is given a coded label, undressed, shaved and embalmed with a mixture of alcohol, formaldehyde and phenol in water. Embalming fluid is introduced via an artery, usually the femoral artery in the leg. The process of embalming renders the cadaver sterile, discourages decomposition and prevents the spread of disease. The cadaver is then wrapped an placed in a refrigerator until used.

Certain provisions of the Anatomy Act are taken very seriously in this University.
First we are obliged, after a statutory period, to bury or cremate all the remains of Mr X, unless he has given consent that certain portions are retained as museum specimens. We do not wish to confuse bits of Mr X with bits of Mr Y. At this point we should distinguish between the kinds of anatomical specimens you will see

• first of all the cadaver which students may dissect.
• Secondly the prosection, where the dissection has already been done for you. These are either wet specimens ie embalmed or plastinated -embedded in a plastic resin which leaves them flexible but dry to the touch.
• Thirdly the museum specimen or pot, which, as it name implies is sealed in a jar.
• Fourthly dried bones
• Fifthly radiographs, CAT scans etc.

In order to keep all pieces of Mr X together the rule is that he stays on the same table until finished with. Parts will then be removed in labelled bags and placed in the mortuary. After a statutory period all remains will be collected together, placed in a coffin and buried or cremated according to the wishes of the deceased. Members of staff attend funerals as a mark of respect. We must also remember that Mr X was someone's husband, father, uncle, lover. and treat him accordingly.
A few rules of elementary hygiene are also necessary in anatomy classes. Wear a white coat, tie your hair back if it is long and wear plastic gloves if you wish. You will not catch anything from the corpse, but the embalming fluid irritates some people's skin and human fat smells. If you come to classes in street clothes you are guaranteed a seat on the bus home. Do not eat or drink in anatomy class. The other resource which we have not mentioned is you, the student. You are young, healthy and alive. Wherever anatomy can be demonstrated on the living we do so. You will therefore find yourselves called upon to act as models for your fellows for all the bits conveniently seen from the outside - surface anatomy. This means that you should be appropriately dressed for the relevant classes and be prepared to remove clothing as necessary. So we are back to Richardson's problem of suppression of physical and emotional responses. We try to help you with this by a first class which is really compare and contrast yourselves with cadavers: we hope that this will breed familiarity, and familiarity will in turn breed respect rather than contempt.

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