The Anatomy of Deception (2 page)

We assembled in the staff room and found the Professor already present and in a jaunty mood. William Osler was small, a sprightly man, scarcely five feet five inches, but he moved with such energy, such spring, that he appeared larger.
He was already significantly balding, the loss of hair provoking him to pay scrupulous attention to his mustache, which was full and walruslike, perfectly framing his mouth and reaching to the jawline on either side. The backs of both hands bore signs of a recent eruption of
verruca necrogenica
, anatomist’s warts, a red and raised tubercular infection that gave the skin an appearance of dyed leather. It was a vile condition with which the Professor was regularly afflicted from contact with necrotized flesh, but he blithely treated each new outbreak with oleate of mercury until it receded.

“Well, well, well,” he said, rubbing those reddened hands together, his speech, as whenever he was excited, lapsing into the flat Canadian cant that betrayed his origins, “this will be a fine day, a fine day indeed, eh? I believe there are five cadavers available. Let us not keep them waiting.”

The Professor had every right to his enthusiasm. For all of his genius, it was rare he was given the opportunity to conduct a full day’s study in the Dead House. Like most of those who toil to advance human understanding, he was also engaged in a constant battle against human ignorance. Until the Anatomy Act in 1883, just six years earlier, the use of cadavers for teaching purposes was actually a crime. The great anatomist William Smith Forbes of Jefferson Medical College had only narrowly escaped a term in the penitentiary for “despoiling graves.” The liberalization of the law had done little to dispel the revulsion of many in society to the notion of cutting into a dead body, however, and resistance to the Professor’s researches remained strong. Although the more enlightened could occasionally be persuaded to allow Dr. Osler to determine the cause of death of a loved one or friend, for the most part our material was drawn, as it had been for centuries, from society’s most wretched classes.

Even here, however, there was opposition. A number of groups had recently been formed to attempt to end the “ghoulish practice” of dissecting the poor after death. The most
prominent and vocal of these was Reverend Squires’ Philadelphia League Against Human Vivisection. Either unaware or unconcerned that “vivisection” referred to the living, Reverend Squires blithely employed innuendo, humbuggery, and outright lies to entice society matrons to support his cause. He then used the money to thrust himself into the public eye, creating an outcry against the postmortem abuse of society’s least fortunate. As a result, although we did not have to compete with wild dogs for the corpse of a convict, as had Vesalius centuries earlier, cadavers available for examination had become increasingly scarce.

Emboldened by the uproar, the official Blockley pathologist, Henri Formad, an eccentric, ill-tempered Russian, had taken to denying Dr. Osler use of the facilities. The Dead House attendant, a gaunt, lumbering creature whom the Professor had dubbed “Cadaverous Charlie,” had soon followed suit. Whereas Formad acted merely out of professional jealousy and spite, Charlie, buoyed by the stipend he had received from the League, refused the Professor access to cadavers out of what he termed, in his broken English, “bazic human decency.”

But Charlie was an enterprising sort, and he had also shown himself willing to accept a second stipend from the Professor to absent himself from the Dead House for hours at a time and leave us to our work. For an additional remuneration, Charlie, as he had done on this occasion, would actually inform the Professor when a promising supply of unclaimed cadavers became available. Dr. Osler seemed unfazed at the necessity of paying for what should have been provided by a grateful citizenry, but I was appalled that so brilliant a scientist was forced to skulk about like a criminal.

At seven-fifteen, when we exited University Hospital to begin our day, I strode quickly to overtake Turk. My colleague was not brilliant, but quick and clever, with an offhand wit I envied. I had made a number of overtures when he joined the
staff, but Turk proved to be a man who resisted intimacy, and I had been unable to breach the wall of irony that he threw up around himself. The only member of the staff in whom he had shown any interest was the other George, Farnshaw, his complete opposite. But I continued to find myself drawn to Turk, even though my efforts at friendship were generally rebuffed.

“Five cadavers,” I whispered softly, looking up at him as we crossed the path. Turk was over six feet and quite thin. He had the manner of those who are very tall of leaning down slightly, and it gave him a predatory appearance. “Dr. Osler must think he has unearthed treasure.”

He nodded without turning to face me. “Yes. Treasure soon to go into the ground, instead of coming out of it. I hope he won’t keep us here through the night.” Turk was rumored to be well acquainted with the city’s more disreputable elements, although he was silent as to where and with whom he passed his free evenings.

“It would be time well spent,” I replied.

“You might think an evening elbow-deep in entrails is well spent,” Turk observed grimly. “I prefer the theater.”

At the Dead House, we paused just outside the heavy oak door that had seemingly been installed to prevent the dead from escaping. Pipes and cigarettes were lit. Even those who did not ordinarily take tobacco did so here in an effort to kill the stench. Still, as we entered the building, we were immediately overwhelmed by an ambiance so powerful that it seemed as if we had struck a wall. The first moments were always the most difficult, when eyes teared, breath came in gasps, and stomachs refluxed. These reactions soon passed, however. Human senses have a remarkable ability to adapt quickly to even the most objectionable stimuli.

The autopsy room was two stories high, with a gallery walkway on the second floor and a grimy skylight at the top. When the Professor attracted an especially large group of observers, the overflow stood upstairs, much as medical
students in the 1530s had watched Sylvius perform his anatomies from the balcony of the operating theater at the University of Paris.

The room itself contained three large postmortem tables, the tops of which were soapstone, the legs iron. Shallow channels were cut into each tabletop, leading to a drain covered by a brass grating in the middle, which allowed the fluids released during the examinations to be discharged. The drain led to a ventilating shaft, which extended down into the floor and out of the building to a ditch in the rear that was regularly sprinkled with calcium oxide—quicklime.

A set of drawers with a zinc top was set against one wall, holding bottles of fixatives, sponges, basins, enameled dishes, empty bottles, and museum jars. Next to the drawers sat a capacious sink and, adjacent to the sink, a table held the scales used for the weighing of organs. A crude, high, red-painted desk stood on the other side of the room, upon which rested the book for recording autopsy findings. During each procedure, the Professor provided a steady stream of dictation and one of the students took down the information. Dr. Osler reviewed the notes at the conclusion of each postmortem to ensure that the record was complete and accurate. A coat rack abutted the desk and held aprons and gowns, next to a case on the wall housing autopsy instruments.

Beyond the sink, a doorway led into the mortuary, which contained a bank of cast-iron ice chests that could accommodate sixteen bodies. Charlie was responsible for maintaining the ice, which, even in early spring, required regular changing. A rear door led out to a gravel path where bodies and ice were received, and where wagons of undertakers took the remains away. Occasionally, simple services for the dead were conducted within the mortuary itself.

On the second floor, four rooms were set aside for study and research. It was here that we performed urine analysis, prepared culture media, and examined slides. One of the rooms was a small library and records storage area.

The Dead House held not only the deceased from the two hospitals, but also the bodies of paupers, criminals, and any unidentified, unclaimed corpse encountered within the city limits by the Philadelphia Police Department. Today’s subjects represented a typically diverse assortment. The five chests holding cadavers available for autopsy had been marked by Charlie with white chalk; he had also left a scrawled note detailing the particulars of each case. The Professor could choose from a carpenter who had succumbed to a respiratory disorder in the hospital, a male Negro and a young woman found dead in the streets, an elderly woman who had probably died of stomach cancer, and a Chinaman with a gunshot wound.

“Quite a bounty, eh?” he exulted, a wide smile disappearing under the ends of his mustache. “Who shall be first?” He moved to the nearest chest. “Let’s start with our carpenter.” He opened the top to reveal a bald man of about forty, heavily muscled about the arms. Three of us lifted him out of the ice onto a wheeled table and rolled him into the autopsy room.

After the carpenter had been transferred to a postmortem table, the Professor assigned tasks. “Who’ll take notes?” he asked. “Turk … no, you observe. Corrigan. You get the chore.” Corrigan, a stocky, goggle-eyed, bandy-legged young man from South Philadelphia, was eerily reminiscent of a bulldog. He possessed the talent to be a first-rate physician but his dedication was suspect. He had taken notes just two weeks before, and assigning him the tedious chore again so soon was the Professor’s way of chiding him to greater application.

As Corrigan sulked off toward the desk, Turk cast a grin his way. “Be sure to form your letters clearly,” he called.

The Professor laughed and the rest of us chuckled as well. He rarely tolerated sarcasm in anyone else, but seemed to give Turk extra latitude. Perhaps he admired, as I did, Turk’s rise from poverty. “Simpson,” the Professor went on, “you will handle weights and measures, and Carroll will assist.”

Simpson and I were almost always given the most responsible tasks. I was senior in experience, with almost five years in practice, and Simpson was without question the most devoted and hardworking young physician I had ever encountered. Fully cognizant of the risk the Professor had taken in including her on the staff, she seemed determined to leave not a scintilla of doubt that his decision had been the correct one. She was a square-faced, slightly thickset woman, three years my junior. Her speech, while lacking the lilt of the upper classes, was precise and well enunciated, indicating good schooling and, I assumed, an upbringing to match.

When we had all taken our places, the Professor doffed his coat, donned a heavy apron, removed the appropriate implements from the cabinet, and strode to the body. The jauntiness he had exhibited earlier had vanished, replaced by self-assured professionalism.

“We have here what you all can see is a large, powerfully built man, who the note says is German by extraction and was a carpenter by trade. He was admitted to the ward Wednesday last complaining of a cough and swelled feet. Chest measured eighty centimeters, with two-to-five centimeter expansion. Both sides functioned equally, percussion over lungs was normal, and there was nothing special on auscultation.

“After admission, he grew steadily worse, spending most of his time sitting up in bed to ease his breathing. Cough became hacking with expectoration of a bright red color and like currant jelly, dyspnea increasing. Feet became increasingly edematous, expectoration bloody, dyspnea exaggerated. Three nights ago, he became almost insensible with a highly weakened pulse. He was briefly roused with stimulants, but died late Tuesday.”

The Professor grasped the anatomist’s scalpel, larger and heavier than its surgical cousin. “We shall begin by opening the thorax.” Starting at each armpit, the Professor made a deep incision diagonally downward, so that they met at the
sternum. He worked smoothly and quickly, the lines straight and true like a draftsman’s. There was a soft hiss as gases were released from the body, and the smell became almost overpowering. Each of us tried to remain stoic, but only the Professor seemed genuinely immune to the stench.

From this juncture, the Professor made a third incision down through the abdominal wall to just above the pubic bone, bypassing the umbilicus, leaving a Y-shaped cut. He then peeled back a fold of skin to either side of the rib cage and one over the face. The carpenter had been dead for thirty-six hours. That, combined with lying in the ice, kept the flow of blood minimal, although it was sufficient to cover the Professor’s hands and wrists. What fluid did escape, I quickly sponged into the channels of the autopsy table.

While the Professor rinsed his hands after the skin had been cleared, I grasped a set of rib cutters, which resembled large garden pruning clippers. I cut through the ribs at the far side of both lungs, just under the skin fold, each snap of the cutters making the sound of a breaking twig. When the ribs were free, the Professor removed the anterior chest wall to expose the organs underneath. From here, most anatomists used the Rokitansky method, extracting all the organs simultaneously after cutting off their connections to the body, but the Professor, although he had studied with Rokitansky at the Allgemeine Krankenhaus in Vienna, preferred the Virchow technique, removing the organs one at a time. Of course, he had studied with Virchow as well.

“The body presents the appearance of a man dead of heart disease,” he began, as Corrigan entered the data into a journal. “There is a small amount of fluid in the abdomen.” Using a siphon, I drew off additional fluid in the lining over the lungs and heart, placing each in a graduated cylinder, which Simpson measured and noted.

“In the right pleura, sixty ounces of clear serum, thirty ounces in the left, and eight ounces in the pericardium,” she reported. The Professor then severed the coronary arteries,
freeing the heart, which Simpson removed from the chest cavity and placed on the scale.

“Heart is large,” she said. “Seven hundred ten grams.” The heart was brought to an examining table and the Professor lanced it open. He spoke continuously as he cut, unmindful of the blood and other sera that once more drenched his bare hands, Corrigan scribbling furiously to get it all down.