When I was working on the first part of the APT training process and aiming for the Certificate, I dreaded my examination portion. The actual learning, however, was fantastic, especially because it was literally hands on and I had the resources I needed. When being questioned about human anatomy by the pathologist or Jason I could see it there in front of me, and when attempting a certain incision I would watch it several times before trying it myself. I had a valid reason to be learning these skills – skills that would be for the greater good of society, helping to diagnose disease or assisting pathologists in forensic autopsies which could put murderers behind bars – and there were no real obstacles to me achieving that.
But imagine trying to obtain anatomical knowledge and learn invasive techniques with nothing to practise on. This has been an issue faced by medical students of many eras: how can you become a surgeon or doctor if you aren’t familiar with the human body? In the absence of humans for dissection, what can be used? Artificial models? Animals? Perhaps, but only to a point. As the eminent English surgeon and anatomist Sir Astley Cooper said two centuries ago, ‘He must mangle the living if he has not operated on the dead.’
Human dissection and examination for education has fallen in and out of favour over millennia depending on political and religious beliefs. The enlightened Ancient Greeks didn’t consider dissection to be an immoral desecration of the dead: they thought of it as an extension of science’s empirical nature. The Greek physicians Herophilus of Chalcedon and Erasistratus of Chios are therefore considered the first to have systematically dissected human cadavers and recorded their findings, in the third century BC, and they went on to found the great medical school in Alexandria. The problem, however, was that all that free rein may have made Herophilus a bit too enthusiastic: it has been said he actually vivisected – that’s dissected alive – around six hundred prisoners. But with the advent of the Roman Empire, dissection became illegal anyway. This was due to religious beliefs: Roman law held that interference with a dead body was impious or blasphemous. This forced physicians like Galen of Pergamon, who was a follower of Herophilus, to dissect and examine Barbary apes and other animals in around AD 200, then apply that knowledge to humans. Galen suggested that we have two jawbones like a dog, but we don’t. He also thought that blood passed from one side of the heart to the other via tiny holes, rather than the circulatory system we know about today. There were many inconsistencies in his work but this didn’t stop Galen’s ‘knowledge’ being uncontested for over 1300 years. Galen had done the best he could with limited means but without the correct resources much of his inference was purely speculation.
It was finally discovered to be guesswork with the advent of the Renaissance, when medical teaching began to flourish during a systematic growth in the sciences which continued over a few hundred years. As part of this more enlightened culture eighteenth-century Paris, for example, developed a system of donating cadavers to medical schools that was much more advanced than in the UK and US. But cadavers were still in short supply even for established institutions. The students’ anatomy demonstration would consist of a learned professor instructing a barber-surgeon to carry out the dissection of a single corpse while they all observed. Their education was not quite ‘hands on’.
If Galen could be considered the ‘Mel Gibson’ of anatomy and dissection (old has-been with some funny ideas) then the ‘Ryan Gosling’ (young upstart heart-throb) of the art would be Vesalius. Anatomist Andreas Vesalius, born 1514, was a child of the new era – a real rebel, but certainly one with a cause. He was also quite good-looking if etchings from the time are anything to go by. (Perhaps rosy-cheeked Renaissance ladies pasted these etchings of him on their bedroom walls and made euphemistic comments about his anatomy, who knows?) He was a determined and intelligent student who’d entered the University of Paris in order to fulfil a lifelong desire to be an anatomist, beginning in a childhood spent catching and dissecting small animals. At eighteen years old he was excelling in his studies and, eager to learn as much as he could, he would often sneak out to steal the recently executed cadavers from the notorious Gibbet of Montfaucon outside Paris’s city walls, and examine skulls and bones in the Holy Innocents Cemetery. He’d return home silently with his precious quarry, and carry out his examinations of corpses in the dead of night, by candlelight. But this apparently sinister behaviour paid off: by the age of only twenty-two Vesalius was presenting his own anatomy lectures to budding students and dissecting the cadavers himself. His illustrated magnum opus De Humani Corporis Fabrica (‘On the Structure of the Human Body’), published in 1543, finally showed that Galen wasn’t a reliable source of anatomical knowledge.
Like all revolutionaries, Vesalius had his detractors who refused to believe in the credibility of this young maverick and he was continually forced to justify himself. But for medical students and anatomists it was now clear that the old ideas could not be relied upon, and that dissection, which had been prohibited in Britain until the sixteenth century, was necessary for the advancement of their education. Soon they would stop at nothing to have the experience themselves.
In the UK, when formal universities began to teach young surgeons, the only cadavers legally donated to medical schools for examination were done so via the Murder Act of 1752. This meant that executed criminals would find themselves the star of the show on the stage of the dissection theatre, whether they wanted to or not. The Act’s intention was twofold: it supplied research materials to desperate students, but it also acted as a deterrent for would-be criminals. It was one of many sadistic double-punishments in operation at the time, because back then death wasn’t enough: the corpse itself had to suffer some form of abuse, which usually involved it being chopped into pieces. Examples include being hanged, drawn and quartered, or decapitated post-mortem and having your head thrust on to a stake like a marshmallow on a skewer. The rationale was simple: come Judgement Day, when the dead were to be raised from the Earth to stand before the gates of Heaven (according to the Bible), there was no chance of being let in if you were in four chunks, or missing parts of yourself and dripping all over the place like a leaky rubbish bag. Apparently, no one wanted Heaven to look like the waiting room in Beetlejuice. Being dissected was the Christian equivalent of not getting into the club because you aren’t wearing a tie. The negative associations with human dissection, organ donation, plastination and even cremation that are still evident today are in part a hangover from that particular religious fear.
Despite the Murder Act, there were not enough cadavers for the nine or ten UK universities offering Medicine as a degree in the 1800s and the shortage led to the infamous trade of body snatching carried out by Resurrection Men. Just like Vesalius, the body snatchers would head to graveyards in the dead of night in search of freshly interred corpses. They were professionals who used wooden spades rather than metal ones so that the tell-tale clank of spade on soil couldn’t be heard by passers-by. They opened the coffin at the head end, then tied a rope around the upper portion of the deceased and heaved them out with minimal disruption. All clothing and any jewellery had to go back into the coffin because there was a law against grave-robbing, but not body snatching – something the Resurrection Men were well aware of. It was a tightly run operation with one goal: to claim a body for dissection. The difference was that they weren’t medical men themselves carrying out these acts to advance their own knowledge, they were just ordinary men in it for the money. These gangs were the go-betweens of the medical schools and the mausoleums, paid by those who ran the universities to retrieve as many viable corpses as possible for their students. And they were paid well – some earned a few months’ average salary in just one week of body snatching – plus they had summers off: dissections, for refrigeration reasons, were only carried out in autumn and winter. In fact, some medical school students paid for their tuition with the revenue they made from body snatching; Ruth Richardson writes on the subject, ‘in Scotland anatomy students could pay for the
ir tuition in corpses rather than coin’.
St Bartholomew’s Hospital, where I’m now based, was no stranger to the body trade once surgeon John Abernethy set up the successful medical school in around 1790.* The infamous Fortune of War pub stood right across from the hospital, although it was demolished in 1910, and there is just a monument there now. The inscription is very telling:
The Fortune of War was
The chief house of call
North of the River for
Resurrectionists in body
snatching days years ago.
The landlord used to show
The room where on benches
Round the walls the bodies
Were placed labelled
With the snatchers’
names waiting till the
Surgeons at Saint
Bartholomew’s could run
Round and appraise them.
This engraving doesn’t make it clear whether or not there was a separate room for the corpses, or if they were on benches in the main bar where all the ordinary workers were trying to wet their whistles. If the latter, I’m assuming it spurred a few of the punters to drink more than they normally would.
Many of the deterrents created to stop tradesmen from gaining access to fresh corpses were expensive and only the rich could afford them. These included paying guards to watch the grave night and day, mort-safes (iron cages placed over the grave that dug deep into the soil and protected the cadaver) and even cemetery guns to fire at those who would enter the graveyard under the cloak of night. Eventually, people started to grow tired of having to watch over their dead loved ones for days on end to ensure they weren’t stolen and sold on. The final straw came with the case of Burke and Hare in Scotland. The pair had decided that digging up corpses was just too much effort and instead started simply to murder people and sell their (very fresh) merchandise to Dr Robert Knox, who taught anatomy at the Royal College of Surgeons of Edinburgh and was willing to turn a blind eye to their crimes (quite literally, as it happens: he was blind in one eye after contracting smallpox as a child). The subsequent outcry at these murderers’ motives meant that the ‘abhorrent trade in body snatching’ was put to an end with the Anatomy Act of 1832 which ensured that, just as Paris had been doing for years, bodies of the unclaimed dead from hospitals and workhouses and from the streets could be donated to reputable schools.
Although it may seem like the history of anatomy is populated with the odd weirdo, in general it comprises upstanding scientific men who simply needed a way to learn and teach. It’s the scarcity of cadavers which explains medical collections like the one I currently work with. These potted anatomical and pathological specimens were specifically removed from the few bodies available at the time, as well as some live patients during surgery, as a lasting testament and a teaching aid for many years to come. They were displayed in specialist medical collections for trainee surgeons, and even in museums, open to the public, complete with other ‘oddities’ like anatomical waxes and strange animal preparations. They eventually evolved into carnival sideshow attractions at the beginning of the twentieth century but their original use had been honourable and, even as a public spectacle, they still had the ability to teach as well as horrify. This meant that initially exhumations and dissections were not carried out in vain and as much good came from them as possible. In the years before my examinations for my mortuary work I also used specimens from similar collections, like the Hunterian Museum in London, in order to learn. They were hundreds of years old but still had the ability to teach anatomy and pathology to a modern-day APT. Now, as technical curator of the collection at Bart’s, I feel like I’ve come full circle and I do what I can to impart that same knowledge to others.
* * *
Most examinations aren’t possible without a simple piece of paper, and the external exam of a corpse is no different. The typical ‘external form’ used in mortuaries is fairly similar all over the world and has two images on it: one is a naked, bald, asexual figure from the front, and the other is the same but from the back.
These universal representations of the human form are to be populated by little symbols that correspond to any external features witnessed on the deceased once they’ve been undressed. You can simply put a big ‘X’ in the relevant place to demarcate a tattoo or an injury, for example, but I liked to draw tiny versions of tattoos, birthmarks and scars on my forms, in part for realism and in part just because it helped me bestow the case with a true identity.
As with much else, it was Jason who first introduced me to these external forms, but after a while he left the Municipal Mortuary and moved on to one at a hospital five minutes away from ours. He was replaced by June, another locum from Liverpool, who would oversee the rest of my training. It was fantastic to have someone new to learn from and particularly refreshing for that person to be a woman. It was the beginning of a real shift in the gender of mortuary workers, when women seemed to start entering the ranks. Interestingly, it wasn’t actually a first for women. In nineteenth-century Germany, so-called Waiting Mortuaries employed the very first attendants of the dead: females called leichenfraus (‘corpse brides’) who laid out the deceased, tended to their appearance and made funeral arrangements. Then, once those Dead Houses were established in England, the deceased would be ‘guarded and watched day and night by a resident attendant. The appointment of a woman as the first keeper and the purchase by the burial board of a “suitable black dress” for her to wear, would have helped to reassure the public that the bodies of their family members would have been treated with care and dignity.’*
Since then we’d been through two world wars, but times were changing. Women were beginning to enter all sorts of previously male-oriented careers including the death industries, and June had been one of the first, having trained as an embalmer from the age of only sixteen as part of a Youth Training Scheme – a vocational training course for those who wanted to leave school at sixteen or seventeen. She had seen everything and, as well as having a lot to teach me, she was utterly hilarious.
One of the first patients June and I autopsied together was a harrowing case of a man who’d jumped from the top of a building, and by the time he was brought into the mortuary he was in several pieces. Over the two years or so I had been working in the mortuary I had seen many disturbing cases, from road traffic collisions to suicides, but this was one of the most fragmented. That so much damage could be inflicted on what I knew to be a sturdy frame left me curious but shaken. The human instinct is to both turn away and look at the same time – a natural oxymoron. The sight left me stunned. The left side of his skull had been completely crushed and this injury, along with his torn limbs and bones bursting through his flesh, rendered the external examination pretty difficult. I had to depict huge Frankenstein’s monster-like stitches across the limbs on the external form to demarcate where they had been torn off. Some of his brains had been scooped up from the ground, deposited into a small plastic bag and brought to us along with his body.
I’ll never forget June’s casual question to me: ‘Did you find his left eyeball in that bag of brains?’
‘Er, I haven’t looked yet,’ I’d answered nervously. Still trying to wrap my head around this difficult case, I hadn’t got to the point of sifting through the soft grey matter for an eyeball that I wasn’t yet sure was missing.
‘Oh – it’s OK, here it is,’ June said, pointing to his right calf. The eyeball had somehow rolled underneath him and was poking out and staring up at us like a salmon’s eye from a fishmonger’s counter.
She took the clipboard from me and drew an eyeball poking out of the leg on the external form. She even gave it eyelashes and a little optical nerve. I laughed out loud but it turned into a sob – a sob I could just about hide with the laughter. I knew June was being facetious for a reason. She needed to take me out of my head for a second before I lost it. With that eyeball drawing she enabled me to spill out a bit of the emotion that might ha
ve hindered my work on the case. I felt relieved after that, as if I’d sneezed to clear my head, and could focus on the task at hand once again.
I took the clipboard back from her and continued cataloguing the severe injuries before me, all the while thinking I’d come a very long way from those days at university labelling dry bones on the page with technical terms like ‘tibia’ and ‘calcaneus’ and ‘spheno-occipital synchondrosis’. As I’d guessed, the lectures and the textbooks just don’t prepare you for the reality of the mortuary.
Four
Difficult and Decomposed Examinations: ‘Pulp Fiction’
Decline is also a form of voluptuousness. Autumn is just as sensual as springtime. There is as much greatness in dying as in procreation.
—Iwan Goll
The scent of decomposition is formulated of molecules so meaty and musky it almost becomes corporeal. It nudges the back of your throat with an insistent, demented sweetness which feels as though you’re being kissed far too deeply by a rotting tongue. But unlike TV programmes where rookie cops and jaded detectives alike shove menthol cream up their nostrils to mask the odour, APTs and pathologists have to learn to live with it. This is because all decomposing patients smell different, and in some of those dark olfactory rainbows there are clues as to how the deceased passed away – sometimes absolutely vital ones in a case where the organs have decayed into pulp and show no discernible pathologies. But in addition to this it’s simply better to surrender yourself to the odours because eventually the brain stops receiving strong olfactory signals (like when you’re convinced you can’t smell the perfume you applied earlier but everyone else definitely can) and the smell becomes bearable, even comfortable.
I mentioned that, for the most part, unzipping the new body bags in the morning was a fairly positive experience for APTs who welcomed the opportunity to use their skills on a diverse range of cases. But there is something an APT may dread and it’s not the distinctive and lovely powdery smell of Keypers, it’s that ominous, cloying scent of a decaying corpse. It’s implied as soon as you walk into the mortuary in the morning and get a whiff of the unmistakable odour, and it’s confirmed when the deceased is pulled out of the fridge in a black body bag. A dramatic orchestral ‘dun-dun-duuun’ may as well erupt, followed by a cymbal crash and a lightning flash. The dreaded black body bags were much more hard-wearing than the thinner white bags, so among other things they were mainly used for what we called ‘decomps’ for short. If a black bag wasn’t available then the deceased was double-bagged in the ordinary white ones – sometimes even triple-bagged – which was just as ominous for the APT. When staff opened the bag’s zip to reveal yet more white plastic and another zip, it was like a game of pass the parcel they didn’t want to play.
The Chick and the Dead Page 7
