ScienceWeek

HISTORY OF MEDICINE: CADAVERS AND MEDICAL EDUCATION

The following points are made by Neela Dasgupta (J. Am. Med. Assoc. 2004 291:122):

1) Although no studies have conclusively demonstrated that anatomical dissection is necessary to future clinical abilities, use of cadavers to teach anatomy has long been deemed essential to medical education. In an 1824 Lancet editorial described by Shultz,(1) Thomas Wakely wrote, "If dead bodies can not be procured, it will be impossible for the pupils to learn anatomy, and without anatomy, neither surgeons nor physicians can practice with the least prospect of benefiting their patients."

2) Procuring cadavers from willing donors has never been easy, however; accounts of early medical instruction dwell on the prisons, grave robberies, and pauper murders that often supplied early American anatomy labs. Two hundred years later, with regulations forbidding the sale of human bodies and programs encouraging people to donate their bodies to medical science, anatomy departments receive little criticism. However, unclaimed bodies are still the source of cadavers in anatomy laboratories at about 20% of US and Canadian medical schools.(2)

3) Historically, the desire for dissection-based learning was so strong that medical institutions often supported acts of grave robbery, and some physicians passively condoned murder for medicine. In 1829, two Irishmen, William Burke and William Hare, committed 16 murders and delivered the victims' corpses to Dr Robert Knox for payment.(3) Similarly disturbing stories of grave robbing and murder in the name of anatomy were reported in US cities, including Baltimore, Cincinnati, and Philadelphia. Even today, medical schools in some countries benefit from questionable methods of cadaver acquisition. In Barranquilla, Columbia, in 1992, janitor Oscar Rafael Hernandez survived an attempt by local guards to murder him in order to sell his body to the local medical school's anatomy laboratory.(4) As stories of grave robbing circulated in the 1800s, US states responded with specific anatomy acts to prohibit the use of bodies thus acquired.(1) However, medical schools soon faced cadaver shortages, leading some states to introduce new acts specifically permitting the use of unclaimed bodies for medical school dissection.(1)

4) With the passage of Uniform Anatomical Gift Acts in the 20th century, voluntary donations became a substantial resource for anatomy departments.(5) These acts permit individuals to bequeath their bodies to the state for the purpose of medical education and research. Some programs moved to entirely donor-based body acquisition while others continued to supply anatomy labs with unclaimed bodies. Geographic, demographic, and socioeconomic factors contributed to each state's decision regarding the use of unclaimed bodies.(5) States relying entirely on voluntary donors have faced cadaver shortages in the past several years.

References (abridged):

1. Shultz S. Body Snatching: The Robbing of Graves for the Education of Physicians. Jefferson, NC: McFarland & Co Inc; 1992:78-82

2. Liles KL, Ross LM. Donor program survey. Paper presented at: American Association of Clinical Anatomists Conference; June 10, 1998; Lexington, Ky

3. Guttmatcher A. Bootlegging Bodies: A History of Body-Snatching. Fort Wayne, Ind: Public Library of Fort Wayne and Allen County; 1955

4. Roach M. Stiff: The Curious Lives of Human Cadavers. New York, NY: WW Norton & Co; 2003:50

5. Coelho D, Caplan A. The unclaimed cadaver. Acad Med. 1997;72:741-743

J. Am. Med. Assoc. http://www.jama.com

ScienceWeek http://scienceweek.com