Dr John Wallace addresses the importance of anatomical dissection in medical education and also outlies the problems previously encountered in procuring sufficient ‘subjects’ for dissection
As early as 1542, Henry VIII allowed the surgeons to take four bodies of executed criminals for the purposes of anatomical dissection. This number, however, was totally inadequate given the increasing need for medical doctors with a good knowledge of anatomy. Unfortunately, the alternative method of obtaining ‘subjects’, by ‘resurrecting’ dead bodies under the cover of darkness, cast medicine in a lurid light.
In England and Scotland, the extraction of dead bodies from recently dug graves by professional gangs was often accompanied by excessive drinking. It gave anatomy a bad name and buildings where anatomical dissections were carried out were often attacked by angry relatives.
The teaching of human anatomy through dissection is believed to have originated in Bologna, Italy in the 14th century. The first recorded public dissection was conducted in 1315. Anatomical dissection was normally held in winter, over three days, and was a combination of ritual and teaching.
The practice extended to other European universities by the 16th century when purpose-built anatomy theatres were designed, such as the theatre in Padua.
Flemish-born Andreas Vesalius began to reorganise the teaching programme at Padua University in 1537. He performed the cutting, the showing, and the teaching. Vesalius stressed the importance of anatomy as the basis of medicine and he firmly placed anatomy within the framework of science.
Dissection, however, was problematic as it separated the soul from the body. The practice provoked emotional discomfort.
An anatomical theatre was opened in a former church at Leiden University in 1592 making Leiden an important Dutch university with a permanent anatomy theatre.
Later the well-known teacher, Herman Boerhaave, exported his style of anatomical and bedside training to other medical institutions in Europe.
Disease was now increasingly understood in terms of pathological changes within the body. Post-mortems were conducted so that pathology found in the dead could be correlated with symptoms previously elicited in the living.
Anatomy was shown to be clinically useful and courses in anatomy became increasingly vocational. During the 1800s, anatomical dissection was firmly established as a discipline. It had become institutionalised and each student would now dissect as part of his training.
Ireland had a great many private medical schools between 1804 and 1880. The history of these schools is largely the story of a constant battle to get enough bodies for dissection. It was accepted that oral teaching was not sufficient for surgical training.
Practical anatomy was needed to generate the necessary rational principles to guide surgical technique. However, consigning the bodies of executed ‘malefactors’ to the anatomy house had increased prejudice against the practice of dissection. And ‘the required means of instruction’ were not easily obtained in Dublin or Cork.
The Resurrection/ ‘sack-em-up’ men
There had been no provision for the supply of the anatomy house “except the scaffold”. Even then, the cart carrying the corpse of the executed man was frequently followed “by howling and yelling relatives”. So, churchyards became “the only available source” where bodies could be obtained.
In England and Scotland, the “sack-em-up” men engaged in churchyard desecration. The resurrection men despoiled newly made graves, with the retrieved bodies selling for between 10s and £2 per corpse, mainly females as they were easier to transport. Prices tended to fluctuate wildly, with teeth and hair being sold separately.
The resurrecting of bodies was frequently accompanied by much drinking and fighting. Metal screens or mort safes were used to secure the newly dug grave, in an effort to protect the recently deceased.
In Dublin it was up to the teaching staff or the medical students to retrieve the “subjects”. Bodies were obtained from St Andrew’s graveyard, near where Molly Malone’s statue now stands in the city centre. Corpses were also resurrected from St Mark’s churchyard on Pearse Street. Bully’s Acre in Kilmainham was an unguarded, unfenced graveyard for the poor and so was much availed of.
The dissecting room porters marked recent graves and the students employed an iron hook to open the coffin lid. Using a rope, the whole body was then drawn up. While the law did not recognise property in a dead body, it was a crime to steal the winding sheet.
So, the shroud was quickly discarded in order to avoid a penalty of transportation.
In 1830, during an attempt to steal a body from Glasnevin Cemetery, a battle took place lasting over 30 minutes, with 60 shots reportedly fired.
A letter from the physician Dr John Cheyne to Dr Edward Perceval in 1818, notes that the bodies used in most of the dissection rooms in Dublin were acquired from local graveyards or Bully’s Acre. There are “no regular resurrection men” in Dublin so the bodies were procured by the medical students.
The pupils needed to have a “disregard for danger which sometimes is great”. The bodies were “extracted by main force” and were then “tied up in a sack”. They were often “dropped from a high wall” with the neck and heels often “subject to insult”.
However, there were clear limitations to what could be learned from these bodies. The subjects raised were often in “an advanced state of putrefaction”. They would have been underground for up to three weeks. The bodies did not give a “fair representation” of disease in the human frame. Little about the capillary system could be learned from these bodies.
Prof James Macartney, anatomist at the Trinity Medical School urged people to bequeath their bodies for the purposes of dissection, for “the benefit of the human race”. The medical historian, Davis Coakley, points out that Prof Macartney got the signatures of 100 worthies stating that they would donate their bodies to science. He placed his own name first on the list. Prof Macartney did not want a renewal of the “horrible crimes” involved in order to obtain bodies from Dublin graveyards. He wished to encourage and legalise the voluntary donation of bodies.
The Anatomy Act
In 1832 the Anatomy Act was passed encapsulating Jeremy Bentham’s utilitarian ideas. Henry Warburton MP presented his revised Anatomy Bill with the help of Robert Peel. The Act did away with many of the limitations under which dissectors operated.
Boards of guardians now allowed unrecovered bodies to be claimed for dissection. The Poor Law became the official supplier of the anatomy house.
The immediacy of Christian burial had always been an issue. Now however, a person could state in advance that they did not wish to be dissected and the remains also had to receive decent treatment.
In the House of Industry, the whole process of receiving the dead body was more efficient. The body was promptly removed to the dead room, in a coffin, and the dissection was made within 24 hours.
The resulting conclusions of anatomical dissection were more realistic. The Act also put an end to “the revolting scenes” that had occurred by night in graveyards.
Medical education, however, is never static. Progress is never linear or, indeed, inevitable. By 1850, the emphasis had moved from the French anatomy theatres to the German research laboratories. The social reformer Rudolf Virchow had made pathology a separate discipline. Though still central to medical education, anatomy was now no longer the premier science.
Dr John Wallace, DPhil (Oxon), Wolfson College, University of Cambridge.
B. Kennedy, D. Coakley (eds.), The Anatomy Lesson, (Dublin: The National Gallery of Ireland).