Stiff (6 page)

A series of modern-day Burke-and-Hare-type killings took place barely ten years ago, in Barranquilla, Colombia. The case centered on a garbage scavenger named Oscar Rafael Hernandez, who in March 1992 survived an attempt to murder him and sell his corpse to the local medical school as an anatomy lab specimen.
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Like most of Colombia, Barranquilla lacked an organized recycling program, and hundreds of the city's destitute forge a living picking through garbage dumps for recyclables to sell. So scorned are these people that they—along with other social outcasts such as prostitutes and street urchins—are referred to as

"disposables" and have often been murdered by right-wing "social cleansing" squads. As the story goes, guards from Universidad Libre had asked Hernandez if he wanted to come to the campus to collect some garbage, and then bludgeoned him over the head when he arrived. A
Los
Angeles Times
account of the case has Hernandez awakening in a vat of formaldehyde alongside thirty corpses, a colorful if questionable detail omitted from other descriptions of the case. Either way, Hernandez came to and escaped to tell his tale.

Activist Juan Pablo Ordoñez investigated the case and claims that Hernandez was one of at least fourteen Barranquilla indigents murdered for medicine—even though an organized willed body program existed.

According to Ordoñez's report, the national police had been unloading bodies gleaned from their own, in-house "social cleansing" activities and collecting $150 per corpse from the university coffers. The school's security staff got wind of the setup and decided to get in on the action. At the time the investigation began, some fifty preserved bodies and body parts of questionable origin were found in the anatomy amphitheater. To date, no one from the university or the police has been arrested.

For his part, William Burke was eventually brought to justice. A crowd of more than 25,000 watched him hang. Hare was granted immunity, much to the disgust of the gallows crowd, who chanted "Burke Hare!"—

meaning "Smother Hare," "burke" having made its way into the popular vernacular as a synonym for "smother." Hare probably did as much smothering as Burke, but "She's been hared!" lacks the pleasing Machiavellian fricatives of "She's been burked!" and the technicality is easily forgiven.

In a lovely sliver of poetic justice, Burke's corpse was, in keeping with the law of the day, dissected. As the lecture had been about the human brain, it seems unlikely that the body cavity would have been opened and notably rearranged, but perhaps this was thrown in after the fact, as a crowd pleaser. The following day the lab was opened to the public, and some thirty thousand vindicated gawkers filed past. The post-dissection cadaver was, by order of the judge, shipped to the Royal College of Surgeons of Edinburgh to have its bones made into a skeleton, which resides there to this day, along with one of several wallets made from Burke's skin.
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Though Knox was never charged for his role in the murders, public sentiment held him accountable. The freshness of the bodies, the fact that one had its head and feet cut off and others had blood oozing from the nose or ears—all of this should have raised the bristly Knox eyebrows.

The anatomist clearly didn't care. Knox further sullied his reputation by preserving one of Burke and Hare's more comely corpses, the prostitute Mary Paterson, in a clear glass vat of alcohol in his lab.

When an inquiry by a lay committee into Knox's role generated no formal action against the doctor, a mob gathered the following day with an effigy of Knox. (The thing must not have looked a great deal like the man, for they felt the need to label if. "Knox, the associate of the infamous Hare," explained a large sign on its back.) The stuffed Knox was paraded through the streets to the house of the real Knox, where it was hung by its neck from a tree and then cut down and—fittingly—torn to pieces.

It was around this time that Parliament conceded that the anatomy problem had gotten a tad out of hand and convened a committee to brainstorm solutions. While the debate mainly focused on alternate sources of bodies—most notably, unclaimed corpses from hospitals, prisons, and workhouses— some physicians raised an interesting item of debate: Is human dissection really necessary? Can't anatomy be learned from models, drawings, preserved prosections?

There have been times and places, in history, when the answer to the question "Is human dissection necessary?" was unequivocally yes. Here are some examples of what can happen when you try to figure out how a human body works without actually opening one up. In ancient China, Confucian doctrine considered dissection a defilement of the human body and forbade its practice. This posed a problem for the Father of Chinese Medicine, Huang Ti, who, around 2600 B.C., set out to write an authoritative medical and anatomical text
(Nei Ch'ing
, or
Canon of
Medicine)
. As is evident from this passage—quoted in
Early History of
Human Anatomy
—there are places where Huang is, through no fault of his own, rather clearly winging it:

The heart is a king, who rules over all organs

of the body; the lungs are his executive, who

carry out his orders; the liver is his

commandant, who keeps up the discipline; the

gall bladder, his attorney general… and the

spleen, his steward who supervises the five

tastes. There are three burning spaces—the

thorax, the abdomen and the pelvis—which are

together responsible for the sewage system of

the body.

To Huang Ti's credit, though, he managed, without ever disassembling a corpse, to figure out that "the blood of the body is under the control of the heart" and that "the blood current flows in a continuous circle and never stops." In other words, the man figured out what William Harvey figured out, four thousand years before Harvey and without laying open any family members.

Imperial Rome gives us another nice example of what happens to medicine when the government frowns on human dissection. Galen, one of history's most revered anatomists, whose texts went unchallenged for centuries, never once dissected a human cadaver. In his post as surgeon to the gladiators, he had a frequent, if piecemeal, window on the human interior in the form of gaping sword wounds and lion claw lacerations.

He also dissected a good sum of animals, preferably apes, which he believed to be anatomically identical to humans, especially, he maintained, if the ape had a round face. The great Renaissance anatomist Vesalius later pointed out that there are two hundred anatomical differences between apes and humans in skeletal structure alone.

(Whatever Galen's shortcomings as a comparative anatomist, the man is to be respected for his ingenuity, for procuring apes in ancient Rome can't have been easy.) He got a lot right, it's just that he also got a fair amount wrong. His drawings showed five-lobed livers and hearts with three ventricles.

The ancient Greeks were similarly adrift when it came to human anatomy. Like Galen, Hippocrates never dissected a human cadaver—he called dissection "unpleasant if not cruel." According to the book
Early
History of Human Anatomy
, Hippocrates referred to tendons as "nerves"

and believed the human brain to be a mucus-secreting gland. Though I found this information surprising, this being the Father of Medicine we are talking about, I did not question it. You do not question an author who appears on the title page as "T.V.N. Persaud, M.D., Ph.D., D.Sc, F.R.C.Path. (Lond.), F.F.Path. (R.C.P.I.), F.A.C.O.G." Who knows, perhaps history erred in bestowing upon Hippocrates the title Father of Medicine.

Perhaps T.V.N. Persaud is the Father of Medicine.

It's no coincidence that the man who contributed the most to the study of human anatomy, the Belgian Andreas Vesalius, was an avid proponent of do-it-yourself, get-your-fussy-Renaissance-shirt-dirty anatomical dissection. Though human dissection was an accepted practice in the Renaissance-era anatomy class, most professors shied away from personally undertaking it, preferring to deliver their lectures while seated in raised chairs a safe and tidy remove from the corpse and pointing out structures with a wooden stick while a hired hand did the slicing.

Vesalius disapproved of this practice, and wasn't shy about his feelings.

In C. D. O'Malley's biography of the man, Vesalius likens the lecturers to

"jackdaws aloft in their high chair, with egregious arrogance croaking things they have never investigated but merely committed to memory from the books of others. Thus everything is wrongly taught,…and days are wasted in ridiculous questions."

Vesalius was a dissector such as history had never seen. This was a man who encouraged his students to "observe the tendons while dining on any animal." While studying medicine in Belgium, he not only dissected the corpses of executed criminals but snatched them from the gibbet himself.

Vesalius produced a series of richly detailed anatomical plates and text called
De Humani Corporis Fabrica
, the most venerated anatomy book in history. The question then becomes, was it necessary, once the likes of Vesalius had pretty much figured out the basics, for every student of anatomy to get right in there and figure them out all over again? Why couldn't models and preserved prosections be used to teach anatomy? Do gross anatomy labs reinvent the wheel? The questions were especially relevant in Knox's day, given the way in which bodies were procured, but they are still relevant today.

I asked Hugh Patterson about this and learned that, in fact, whole-cadaver dissection is being phased out at some medical schools. Indeed, the gross anatomy course I visited at UCSF was the last one in which students will dissect entire cadavers. Beginning the following semester, they would be studying pro-sections—embalmed sections of the body cut and prepared so as to display key anatomical features and systems. Over at the University of Colorado, the Center for Human Simulation is leading the charge toward digital anatomy instruction. In 1993, they froze a cadaver and sanded off a millimeter cross section at a time, photographing each new view—1,871 in all—to create an on-screen, maneuverable 3-D rendition of the man and all his parts, a sort of flight simulator for students of anatomy and surgery.

The changes in the teaching of anatomy have nothing to do with cadaver shortages or public opinion about dissection; they have everything to do with time. Despite the immeasurable advances made in medicine over the past century, the material must be covered in the same number of years. Suffice it to say there's a lot less time for dissection than there was in Astley Cooper's day.

I asked the students in Patterson's gross anatomy lab how they'd feel if they hadn't had a chance to dissect a body. While some, said they would feel cheated—that the gross anatomy cadaver experience was a physician's rite of passage—many expressed approval. "There were days," said one, "when it all clicked and I gained a sort of understanding I could never have gotten from a book. But there were other days, a lot of days, when coming up here and spending two hours felt like a huge waste of time."

But gross anatomy lab is not just about learning anatomy. It is about confronting death. Gross anatomy provides the medical student with what is very often his or her first exposure to a dead body; as such, it has long been considered a vital, necessary step in the doctor's education. But what was learned, up until quite recently, was not respect and sensitivity, but the opposite. The traditional gross anatomy lab represented a sort of sink-or-swim mentality about dealing with death. To cope with what was being asked of them, medical students had to find ways to desensitize themselves. They quickly learned to objectify cadavers, to think of the dead as structures and tissues, and not a former human being. Humor—

at the cadaver's expense—was tolerated, condoned even. "There was a time not all that long ago," says Art Dalley, director of the Medical Anatomy Program at Vanderbilt University, "when students were taught to be insensitive, as a coping mechanism."

Modern educators feel there are better, more direct ways to address death than handing students a scalpel and assigning them a corpse. In Patterson's anatomy class at UCSF, as in many others, some of the time saved by eliminating full-body dissection will be devoted to a special unit on death and dying. If you're going to bring in an outsider to teach students about death, a hospice patient or grief counselor surely has as much to offer as a dead man does.

If the trend continues, medicine may find itself with something unimaginable two centuries ago: a surplus of cadavers. It is remarkable how deeply and how quickly public opinion regarding dissection and body donation has come around. I asked Art Dalley what accounted for the change. He cited a combination of factors. The 1960s saw the first heart transplant and the passing of the Uniform Anatomical Gift Act, both of which raised awareness of the need for organs for transplantation and of body donation as an option. Around the same time, Dalley says, there was a notable increase in the cost of funerals. This was followed by the publication of
The American Way of Death
—Jessica Mitford's biting exposé of the funeral industry— and a sudden upswing in the popularity of cremation. Willing one's body to science began to be seen as another acceptable— and, in this case, altruistic—alternative to burial.

To those factors I would add the popularization of science. The gains in the average person's understanding of biology have, I imagine, worked to dissolve the romance of death and burial—the lingering notion of the cadaver as some beatific being in an otherworldly realm of satin and chorale music, the well-groomed almost-human who simply likes to sleep a lot, underground, in his clothing. The people of the 1800s seemed to feel that burial culminated in a fate less ghastly than that of dissection.

But that, as we'll see, is hardly the case.

Footnotes: