Kevin R. Loughlin
Boston, Massachusetts, USA

 

Figure 1: Woodcut illustration from Fasciculus medicinae (1491) depicting a Lector, Ostensor, and Sector during a dissection

Their silhouettes surely would have been seen against the backdrop of a moonlit night in 1796 as they entered the North Burying Ground in Boston. Their hearts were likely filled with a blend of trepidation and anticipation. Their leader was John Collins Warren, the son of John Warren, one of the founders of Harvard Medical School. Among this cohort were likely the sons of Paul Revere and Sam Adams, who would also go on to become physicians.^1-3 Their mission was clear: to rob a grave of a freshly buried body and bring it back to Harvard Medical School, where the cadaver would be used to teach anatomy.

 

The spunker club and resurrection men

What this band of students did on that evening in 1796 had been the custom at Harvard for at least a quarter of a century. In fact it was John Warren who in 1770, with other Harvard students, had formed the “Spunker Club” to harvest bodies for anatomic dissection. This group was not officially recognized by the university and was so secret that nobody was allowed to write or speak its name.² Participants were referred to as “resurrection men.”

 

George Washington’s reaction to this abominable crime

The shortage of bodies available for dissection has a long history. At the time of the Revolutionary War cadavers for dissection were in short supply, which led to grave robbing of some of the fallen soldiers of the Continental Army. The issue came to the attention of George Washington who addressed it in his general orders of September 1, 1775:⁴

“Complaint has been made to the General, that the body of a Soldier of Col. (Benjamin Ruggles) Woodbridge’s Regiment, has been taken from his grave by persons unknown; The General and the Friends of the deceased, are desirous of all the Information that can be given, of the perpetrators of the abominable Crime, that he, or they, may be made an example, to deter others from committing so wicked and shameful an offence.”⁵

By the end of the war, the shortage of cadavers had become even more pronounced.

 

The Greek contribution

Historical records trace the earliest utilization of human cadaveric dissection to ancient Greece in the third century BC.⁶ The development of Greek medicine reached its apogee with the establishment of a school of Greek medicine in Alexandria during the third century BC.^7,8 Two Greek physicians, Herophilus of Chalcedon and Erasistratus of Celos, are credited with championing the use of human cadavers for dissections and the teaching of anatomy.⁶

However, the combination of the death of these two legendary Greek physicians and the burning of Alexandria in 389 AD caused the disappearance of human cadaveric dissection until the Middle Ages in Europe.

 

The European revival

The explosion of the establishment of European universities in the twelfth and thirteenth centuries laid the foundation for the rebirth of the use of cadaveric dissection in medical schools. A seminal contribution to this rebirth was a decree issued in 1231 by the Holy Roman Emperor Frederick II, which mandated that a human body should be dissected at least once every five years for instruction and that attendance was compulsory for all who would practice medicine or surgery.^6,9 The enthusiastic revival of human dissection continued throughout most of Europe and resulted in its legalization in several European countries between 1283 and 1365.¹⁰

However, there was some resistance by the Church when in 1299 Pope Boniface VIII issued a papal bull entitled De sepoturis (Of burial), which forbade manipulation of corpses.⁶ However, this resistance appeared to be transitory as the universities became more powerful, and with the rise of Renaissance artists such as daVinci, Buonorotti, and Bandonelli, whose work depended on a detailed appreciation of human anatomy.^6,9

 

Mondino de Liuzzi

The changing academic and artistic environment in Europe led to the emergence of Mondino de Liuzzi. In 1315 at the University of Bologna, he performed a public dissection on an executed criminal. He established dissections as part of the medical school curriculum.¹² The format of the dissections was elaborate. It consisted of a Lector, usually de Liuzzi, who typically read from an authentic text such as Galen’s; an Ostensor, who pointed to the part of the body to be dissected; and the Sector, a surgeon or barber who performed the dissection.⁶ (Figure 1) Grave robbing became necessary to procure bodies for dissection and this led to the prosecution of four students at the University of Bologna.¹³

At this point, particularly in Italy, there appeared to be a synergy between physicians and artists toward a renewed interest in anatomy. Some artists used “ecorches,” which were studies of peeled away parts of muscles, to achieve a more nuanced understanding of anatomy for artistic reasons.

 

Figure 2: Andreas Vesalius performing a dissection and lecture in Padua

Andreas Vesalius

The next major figure in the use of cadaveric dissection was Andreas Vesalius. Vesalius arrived at the University of Paris in 1533 after completing his studies at the University of Louvan.^6,14 At about the same time, in 1537, Pope Clement VII accepted the teaching of anatomy by dissection. In the following years, Vesalius revolutionized anatomy teaching in Europe. He questioned the teachings of Galen as they were based on animal studies. He objected to the format popularized by deLiuzzi of Lector, Ostensor, and Sector and dismissed the barber surgeons, whom he replaced with trained anatomists like himself. (Figure 2)

This fundamental change in the philosophy of teaching anatomy placed an even greater demand on acquiring corpses. Due to natural decomposition, cadavers were only suitable for about three or four days after death. Vesalius would often obtain his own cadavers and was accused of having performed a dissection on a Spanish aristocrat while the heart was still beating.⁹ In 1543 Vesalius published his classic text, De humani corporis fabrica (On the fabric of the human body). The work of Vesalius established the necessity of cadaveric dissection in the teaching of anatomy. In many ways, he provided the foundation for the principles of modern medical school curricula.

 

The British experience

Parallel to the evolution of cadaveric dissection that was occurring in Europe, similar progress was seen in Great Britain. In 1565 a select group of physicians from the Royal College of Physicians and Company of Barber Surgeons were given permission to do a limited number of human cadaver dissections.¹⁵ Most of the bodies obtained for study were of hanged criminals and few were voluntarily donated.¹⁶ It was an outgrowth of this enthusiasm for the study of fresh corpses that resulted in the publication of William Harvey’s treatise De moto cordis et sanguinis (On the motion of the heart and blood) in 1628.¹⁷

As the demand for cadavers increased, Parliament intervened. In 1752 the Murder Act was passed, which legalized the dissection of bodies of executed murderers in medical schools for research and education.¹⁸ Grave robbing continued into the nineteenth century. A notorious case occurred in 1828 when two Irishmen living in Edinburgh, William Burke and William Hare, murdered and sold the bodies of at least sixteen men and women to Robert Knox for his anatomy class.⁶ The murder method used was smothering after intoxicating the victim with alcohol. These circumstances were initially undetected by the physicians who purchased the corpses. However, this method of murder ultimately became known as “Burking.” The ironic denouement occurred when Burke was convicted and condemned to death. Afterward, his corpse was dissected.¹⁹

Parliament continued to address the growing demand for bodies and in 1832 passed the Warburton Anatomy Act. This legislation provided that unclaimed bodies of the poor could be removed from workhouses and dissected at medical schools. This marked the first time that criminals were not the major source of cadavers for dissection and study.²⁰ Body snatching had become so common that graves were protected by a framework of iron bars called mortsafes.¹ (Figure 3)

 

Figure 3: A Mortsafe covering a grave in Edinburgh

The United States: Progression to the modern era

Throughout the nineteenth century, there was a gradual rethinking of the ethical issues of corpse procurement. In 1815 Massachusetts passed an Act to Protect the Sepulchers of the Dead, which made it a felony to disturb a grave to obtain a corpse.² Massachusetts also passed the Anatomy Act of 1831, which permitted unclaimed bodies of the imprisoned, insane, and the poor to be legally obtained for study.² However this legislation presaged the ongoing dilemma that continued into the twentieth century, where a disproportionate percentage of cadavers were obtained from the marginalized sectors of society such as the mentally infirm, minorities, and immigrants.²

The performance of the first kidney transplant in 1954 ushered in the era of organ transplantation, which further intensified the need for legislation governing post-mortem organ procurement. This culminated in the passage of the Uniform Anatomical Gift Act in 1968, which established the human body as a property such that a donor’s wish now supercedes those of the next of kin in a court of law.²¹

 

The Future

Fortunately, the era of body snatching has matured into an era of profound respect for the use of cadavers and the ethics of body and organ donation. Many medical schools provide special lectures in ethics related to the bequest of human remains. The University of Oklahoma College of Medicine has introduced a “Donor Luncheon” whereby medical students meet the families of donors before dissection in the anatomy course.⁶

There are also discussions whether in this “cyber” age, cadaver dissection is still necessary. This remains an area of intense controversy and it is unclear what the role of anatomic dissection will be in future medical school curricula. However, it is important to acknowledge that a recent survey of 842 physicians revealed that only 27.9% thought cadaveric dissection was the most effective method for teaching anatomy.²² Medical school teaching continues to evolve. Hopefully, Professor Warren would be proud of us.

 

References

1. Body Snatching, Wikipedia. https://en.wikipedia.org/wiki/Body_snatching accessed 2/26/2019
2. Harvard’s Colonial-Era Body-Snatching Club. https://www.history.com/news/harvards-colonial-era-body-snatching-club accessed 1/15/2019
3. Samuel Adams-contributed by George A. Simmons, Centennial Collection. The Pennsylvania Magazine of History and Biography Vol.1,no.4 pp. 439-443. JSTOR www.j.stor.org/stable/20084309 accessed 3/31/2019
4. Bell JL. George Washington and the Bodysnatchers. Journal of the American Revolution 9/3/14
5. Papers of George Washington, Revolutionary War Series, Philander D. Chase, Dorothy Twohig, Frank E. Grizzard, Edward G. Lengel et al. , editors(Charlottesville: University Press of Virginia, 1985-1:395 accessed 2/11/19
6. Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat. Cell. Biol. 2015; 48(3): 153-169
7. Serageldin I. Ancient Alexandria and the dawn of medical science. Glob. Cardiol. Sci. Pract. 2013;4: 395-404
8. Sallam HN. The ancient Alexandria school of medicine. Gynecol. Obstet. Fert. 2002;30: 3-10
9. Persaud TV. Early history of human anatomy: from antiquity to the beginning of the modern era. Springfield, Illinois. Charles C. Thomas, 1984
10. Prioreschi P. Determinants of the revival of dissection of the human body in the Middle Ages. Med. Hypothesis 2001; 56:229-234
11. Sellmer R. Anatomy during the Italian Renaissance’s brief history of how artists influenced its development. In Whitelaw WA ,editor. The Proceedings of the 10th Annual History of Medicine Days. Calgary, Alberta Faculty of Medicine, The university of Calgary; 2001, p.341
12. Mavrodi A, Paraskovas G. Mondino de Luizzi: a luminous figure in the darkness of the Middle Abes. Croat. Med. J. 2014; 55: 50-53
13. Park K. The criminal and saintly body: autopsy and dissection in Renaissance Italy. Renaiss Q. 1994; 47:1-33
14. Holomanova A, Ivanova A, Brucknerova I, Benuska J. Andreas Vesalius: the reformer of anatomy. Bratis. Lek. Listy. 2001; 102: 48-54
15. Robinson JO. The barber-surgeons of London. Arch. Surg. 1984; 119: 1171-1175
16. Payne L. With much nausea, loathing and foeter: William Harvey, dissection and dispassion in early modern medicine. Vesalius 2002;8: 45-52
17. Gregory A. Harvey’s heart: the discovery of blood circulation. Cambridge. Icon Books, 2001
18. Fielding S. The executioner’s bible: the story of every British hangman of the twentieth century. London: John Blake Publishing; 2008
19. Rosmer L. The anatomy murders: being the true and spectacular history of Edinburgh’s notorious Burke and Hare and of the man of science who abetted them in the commission of the most heinous crimes. Philadelphia, Pa. University of Pennsylvania Press. 2011
20. Persaud TV. A history of anatomy. The Post-Vesalian Era. Springfield, Illinois. Charles C. Thomas , 1997
21. Dailey AF, Driscoll RE, Settles HE. The Uniform Anatomical Gift Act: What every clinical anatomist should know. Clin. Anat. 1993; 6: 247-254
22. Ghazanfar H, Rashid S, Hussain A, Ghazanfar M, Ghazanfar A, Jarvard A. Cadaveric Dissection, a Thing of the Past? The Insight of Consultants, Fellows and Residents. Cureus 2018; 10(4); e2418

 

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KEVIN R. LOUGHLIN, MD, MBA, received his undergraduate degree from Princeton University. He received his MD from New York Medical College and his MBA from Boston University. He is a former trustee of the American Board of Urology. He is a professor emeritus at Harvard Medical School. He lives in Boston, Massachusetts.

 

Highlighted in Frontispiece Volume 11, Issue 3 – Summer 2019

Spring 2019 |  Sections  |  Anatomy