Until 2004 it was illegal in this country to practise surgical techniques on cadavers. Dissection, yes, but not surgery. Throughout history attitudes to dead bodies have been shrouded in paradox. In every culture, the living invent rituals to appease the spirits of the dead.
Humans have been preserving their dead for 7000 years. The ancient Egyptians did it so that the former owner’s soul could recognise the body and inhabit it again in the afterlife. Pre-Inca cultures in Peru probably had a similar purpose. In both areas the hot dry sand did a fairly good preservation job. Embalming appears to have evolved as a way to improve the prospects in the hereafter for those who could afford the expensive chemicals and rituals. The poor took their chances in the next world just as they did in this one.
Some things don’t change: in California, cryonics now offers the very wealthy the hope of a future life, though not in the hereafter. Some modern embalming is less satisfactory in the long run. Just take a look at Lenin and Mao in their mausoleums.
The word mummy comes from the Persian mummia, for bitumen, which, mixed with spices, has been used since pharaonic times for preserving the bodies of the dead. Now, any body which is preserved from decomposition, whether it be by accident, like the occasional bog man, or deliberately, is called a mummy. But in most places stopping corpses from rotting is unrealistic. They have to be disposed of quickly by whatever means climate and terrain permit. Practicalities can change traditions: in Europe most religions have relaxed their bans on cremation. In India there are no longer enough vultures to devour the corpses on the Towers of Silence, so the Parsi prohibition on burial is being lifted.
But, worldwide, the mystery of death demands rituals, and the deceased’s body must be treated with a dignity which respects its power. In medieval Britain, denying a body burial in hallowed ground was a punishment; criminals’ bodies were left on gibbets as a warning to the living. When anatomy became part of medical studies, a court could add the humiliation of subsequent dissection to a death sentence.
Come the Age of Enlightenment, more doctors and less capital punishment left anatomy schools undersupplied. Resurrection men filled the gap, digging up the recently deceased. In 1828 Burke and Hare sold the corpses of 16 people they had murdered to Edinburgh anatomist Dr Robert Knox. But public attitudes were slower to change. In 1788 poor New Yorkers rioted against the doctors and medical students they saw as responsible for the indignity visited upon their dead. The wealthy built elaborate fences and guards to protect the graves of their loved ones.
In the UK, the Anatomy Act of 1832 sought to meet the needs of the doctors and assuage the anxieties of the public: unclaimed and donated corpses could be dissected by licensed anatomy teachers. With the introduction of formaldehyde in 1867 cadavers lasted longer. The Human Tissue Act of 2004 permitted cadavers to be used for practising surgical techniques, but otherwise did not fundamentally change the law about dissection.
The public remains ambivalent about dead bodies. Egyptian mummies – cadavers, viewed from a safe distance in time – fascinated the Victorians. They held ‘unwrapping parties’ and shivered at the thought of the mummy’s curse. In many parts of the world, body parts and fluids are still sold as cures. Even in the West we remain ambivalent: individuals, institutions and the law have been uneasy about anatomist Dr Gunter von Hagens’ plastinated cadavers, but the public has flocked to his exhibitions and his public autopsy in 2002 attracted a lot of interest.
Modern techniques have also revolutionised medical training. The undergraduate initiation rite of the anatomy room is being swept away, more due to cost and doubts about its educational value than by sensitivity. Basic anatomy can be learned from virtual and plastinated bodies. But trainee surgeons cannot develop their skills on holograms, or even wax models. They need the real thing, or something very close. As anyone who did traditional anatomy remembers, bodies preserved in formaldehyde are unpleasant to work on and the flesh is stiff. But, using new methods of embalming like Theil soft fixing, tissues handle like living flesh. Now surgeons can gain useful experience without resorting to pigs. Or to us.
Now the mummy has returned. Four thousand-year-old cadavers, however preserved, can now be subject to virtual autopsy. Using modern imaging and investigative techniques, paleopathologists establish the age at death and often its cause, which has shaken a few myths. Ancient Egyptians had terrible dental health, not due to sugar but because the grit in milled cereals wore away their tooth enamel. Dental abscesses were very common – and must have been agonising. Atherosclerosis is not just a condition of our modern way of life: 35% of ancestral mummies from all over the world show evidence of it. So could there be a strong genetic element to ischaemic heart disease? Paleopathologists’ studies of the cancers and mycobacteria from millennia ago shed light on the evolution of modern diseases and may contribute insights into how they may be managed in the 21st century.
Those ancient cultures that preserved their dead may not have ensured their everlasting life, but they are helping their modern descendants live better in this world.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…