- Shopping Bag ( 0 items )
He came, he sawed, he chancred
'Speak with caution of what may be passing here, especially with respect to dead bodies' – William Hunter
In the eighteenth century medical men were either cultured physicians well-versed in the theory of medicine, or surgeons, practical men with saws. Both were steeped in ancient lore and received wisdom. Medical research was stagnant and patients were little better off than their great-great-grandparents had been. Then along came a Scottish farmer's lad called John Hunter who changed surgery from a trade into a science.
John's education was basic, but he had an unquenchable curiosity for nature that remained with him throughout his life. In 1748 he departed for London to join his elder brother William. Although he had trained as a surgeon, William sometimes fainted at the sight of blood so he was changing careers to become a fashionable physician and male midwife. John was enlisted to handle the bloody side of the business and was set to work preparing cadavers for teaching purposes. His skill at dissection was astonishing and he soon graduated to supervising William's students. After being apprenticed briefly to two famous surgeons he became a house surgeon at St George's Hospital, which had been set up to treat the 'deserving poor'. It also gave surgeons licence to practise on the uncomplaining poor. Those who unknowingly offered their bodies for the training of surgeons were the vulnerable and the beneficiaries were mostly the wealthy. John spent his mornings visiting paying clients, and devoted the afternoons to treating the poor for no fee. At St George's he attracted more poor patients than all the other surgeons combined.
John hoped that the hospital would give more emphasis to educating young surgeons, but failed to persuade the senior surgeons to give lectures. Eventually he gave evening lectures in his own home and over the years these became the inspiration for all young medics in London. They were well attended although on one occasion only a single student turned up. To augment the audience John hauled in a skeleton and began with his usual opener – 'Gentlemen.'
John Hunter never blindly followed current practice: he always observed, then improved. A stint as an army surgeon during the Seven Years War made him an authority on gunshot wounds. Battlefield surgery involved opening the wound to scrape out any debris and extract the bullet. Almost invariably the soldier died from an infection. Hunter achieved a much higher survival rate by simply staunching the blood and leaving the bullet in place. He learned that the human body could sometimes heal itself.
He dissected over a thousand corpses and knew the interior of the human body better than the layout of his own house. The more he knew, the fewer surprises there would be on the operating table. The acuteness of his mind matched the dexterity of his hands. He came to know not just the parts of the body, but 'their uses in the machine, and in what manner they act to produce the effect',
Hunter was not alone in his obsession; the artist George Stubbs spent eighteen months dissecting horses, working on each carcass for weeks. The rank smell would have turned the stomach of a less determined man, but the end result was his meticulous and monumental treatise on the anatomy of the horse.
John's brother William founded a private medical school in Great Windmill Street, where almost two centuries later the public's interest in anatomy would be satisfied by London's first strip club. William's aim was to provide the practical anatomical skills neglected elsewhere. Medical examinations, even for surgeons, were usually verbal affairs with no practical test whatsoever. Most courses taught surgery with students witnessing a dissection, or examining sample dissections prepared earlier. A parsimonious Scottish professor made a single cadaver last for an entire course of a hundred lectures. In those days it wasn't just the students that got high.
The first cut that an aspiring surgeon made might well be on a live patient. Both William and John believed that surgical mistakes were best made on the dead, not the living. John taught his students that: 'Anatomy is the basis of surgery, it informs the head, guides the hand and familiarises the heart to a kind of necessary inhumanity.'
In Hunter's school each student would have a corpse of his own to practise on. That meant a lot of bodies and they had to be fresh, although not fresh as Tesco and Sainsbury's know it. Dissection was largely a winter activity. Summer warmth rapidly dried the skin of a corpse as stiff as wood and turned its internal organs into glutinous porridge.
The school needed several bodies per week and John was given the task of finding them. There were over two hundred crimes – including pickpocketing – that carried the death penalty. The Murder Act of 1752 allowed anatomists to claim the bodies of executed murderers, so the surgeons converged on the gallows at Tyburn Tree. The bodies had to be warm from the scaffold and this led to unseemly tugs-of-war with the relatives of the deceased. One tussle was so vigorous that it revived the felon, who was reprieved and rechristened 'Half-hangit Maggie'.
The new provision of the Murder Act was not designed to help the progress of medicine but to punish criminals. Being dissected was feared as a fate worse than death; it added 'a further terror and peculiar mark of infamy'. Also, on Judgement Day when all the dead would rise again, some would reappear with important pieces of themselves missing and might be refused admission into Paradise on the grounds of their incompleteness.
For many criminals the real fear was that they might awaken on the dissecting table with their entrails out on display. In the days before 'long-drop' hanging that broke the neck the condemned were slowly strangled by the noose - sometimes it took thirty minutes or more. In the melee that followed, the doctor often had no opportunity to pronounce the victims dead and there were several examples of their 'corpses' sitting up under the surprise of the anatomist's knife.
With an understandable dearth of volunteers there was no legal way to acquire sufficient cadavers, so anatomists often had no choice but to bribe undertakers to put stones in the coffin and hand over the dead loved one. Gravediggers were also obliging as it was no more trouble to bury an empty casket than a full one. Even these means could not meet demand so John Hunter began 'hobnobbing with the resurrection men' – body-snatchers who dug up the recently deceased.
During Hunter's working life grave robbing grew from the occasional 'uplifting' experience to resurrection on a scale to rival the Day of Judgement. Cadavers were being supplied to order and transported all around the country in hampers and barrels. A body in a box was found on the stagecoach heading for Leeds. A similar incident in Dublin caused the local paper to request that 'for the sake of decency, they packed their treasures a little more carefully'. The price rose sixteen-fold and children's bodies were charged for by the inch. Some 'Sack 'em up' gangs complained of the frequency with which they dug up a coffin only to find it had already been vacated.
Grave robbing was not a criminal offence. Stealing a pig or a goose was punishable by death, but in the eyes of the law a body was not property and therefore couldn't be stolen. The body-snatchers were careful to leave the shroud and clothes behind in the coffin because they were property.
The public were alarmed and there were violent anti-anatomist riots from Carlisle to New York. A medical journal protested that 'If the traffic in human flesh be not prevented, the churchyards will not be secure against the shovel of the midnight plunderer, nor the public against the dagger of the midnight assassin.'
In the interests of ensuring freshness, some criminals streamlined the process by snatching the body before it was dead. The papers were full of the escapades of Burke and Hare who murdered sixteen people and sold them to Edinburgh surgeon Robert Knox.
Burke's the butcher, Hare's the thief, Knox the man who buys the beef.
When the murdered body of 'Daft Jamie', a well-known local character, was brought in, Knox decapitated the corpse before giving it to the students lest the victim be recognised.
Burke and Hare spawned a tribute gang, 'The Burkers', who supplied the still-warm to King's College London. The ringleaders were convicted of multiple murders and for 'resurrecting' a thousand newly buried bodies. The scale of this scandal led to the Anatomy Act of 1832 that gave anatomists the right to dissect all unclaimed' bodies from workhouses and morgues. Now the fate that terrorised the most hardened rogue was visited on the innocent poor.
To Hunter, acquiring dead bodies was a surgical necessity that in the long run would save lives. It was also a game. The President of the Royal College of Surgeons boasted to a Royal Commission that: 'There is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain.'
The problem of too few cadavers is not entirely buried in the past. Today anatomy teaching involves anatomical dummies, medical imaging techniques and students being encouraged to examine their own bodies and those of others. I seem to recall that students always examined each others' bodies at every opportunity. Even so, the classes at Guy's, King's and St Thomas' Hospitals need eighty bodies a year and only about sixty are donated. The dilemma is not helped by rejecting those that are obese, which will soon exclude everybody.
Most hospitals do their best to encourage people to donate their bodies, but some contrive to do the opposite. In 2004 a Californian medical school was found to have sold parts from around eight hundred corpses donated for medical research over a six-year period. A university in Louisiana had disposed of surplus cadavers to a broker and had no idea where they ended up.
The trade in organs is worth over one billion US dollars a year. Heart, lung or liver transplants are only a minor portion of it. The increasing longevity of people in the developed world has fuelled the demand for replacement parts such as corneas for failing eyes and bones for worn joints, not to mention skin grafts for burns, tendons and ligaments to mend injured athletes and collagen to make lips pout.
In Britain there were almost two thousand kidney transplants in 2007, but that left 8,600 patients on the waiting list for new kidneys. Over a thousand people each year die waiting for an appropriate organ to become available. The shortage of donors pushes up the price of parts. If fresh and sold separately, the marketable parts from a single cadaver can fetch $200,000; a head sells for $900 and fingers are $15 apiece. What a killing the body-snatchers would have made. But that was in the bad old days ...
In 2004 the new owner of a New York funeral parlour was shocked to find that it had a concealed operating theatre and much of its income had come from tissue-transplant companies. The previous owners had treated the dead as commodities to be exploited. The 'operating theatre' had been a cutting room for harvesting human organs. Instead of embalming clients' loved ones they had pillaged their interiors. Stolen bones were replaced with plastic piping and the space left by filched organs was packed with cloth and the morticians' discarded surgical gloves. Then the bodies were sewn up and returned to the family for burial. One of the victims was the revered broadcaster Alistair Cooke. He was ninety- five and his bones were riddled with cancer. The morticians are thought to have made $4.7 million from their sideline.
To make the organs more marketable they had faked the paperwork: a 104-year-old woman was listed as dying aged seventy, those who had nasty diseases that should have precluded their tissues from being used for transplants were said to have succumbed to heart failure. The organs were dispatched all over the world by unwitting tissue-supply companies. Forty people in Britain received transplants from this source. All the known recipients of these dubious organs were tested for HIV, hepatitis C and syphilis, but some diseases don't show themselves for years.
The case is not unique. A doctor in Denver uncovered an identical scam perpetrated by a funeral director who handed relatives any old ashes with one hand while sawing the deceased into useful bits with the other. The total number of bodies desecrated by these two firms was well over a thousand.
Even living patients may be harvested for profit. Human cells that grow readily in culture are useful for studying cancer. In 1990 the California Supreme Court ruled that patients do not own tissue removed from their body. Doctors are entitled to exploit and even patent these cell lines. They are worth millions of dollars and the only person who doesn't profit is the donor.
Like many anatomists, the Hunter brothers collected specimens of organs and bones in their museum. Eventually it contained 13,500 specimens. The poet Southey paints a lurid picture: 'I have made candles of infant's fat ... I have bottled babies unborn, and dried hearts and livers from rifled graves.' Medical museums were for educational purposes, but anatomists were also fascinated by anatomical oddities and abnormalities and were ruthless collectors. At Guy's Hospital a patient with a curiously enlarged head died. While a mock funeral took place for the unsuspecting relatives, his skeleton was on the slab being prepared for the hospital museum. When Charles Byrne, the nearly eight-feet-tall 'Irish giant', was dying, he made the undertakers promise to sink him in the sea in a lead coffin to avoid the anatomists. But John Hunter offered them £500 (approximately £30,000 in today's money) and Byrne's reluctant skeleton now has pride of place in the Hunterian Museum at the Royal College of Surgeons.
When he became more successful John moved into a new house in Leicester Square – in fact, two houses that he linked together. This gave ample space for his museum and a dissecting room in the attic. Few families can have had quite so many skeletons in their cupboards. Only once was an over-ripe cheese mistaken for a parcel of anatomical over- ripeness. It was a Jekyll-and-Hyde house, for while his cultured wife held soirées in the drawing room to entertain Haydn, dead bodies were being sneaked in by the rear door and dragged up the back staircase. I recall that Stevenson's Dr Jekyll bought his London house from 'the heirs of a celebrated surgeon'.
John Hunter was the most accomplished and innovative surgeon of his day. William Hazlitt described how he 'set about cutting up a carcass of a whale with the same greatness of gusto that Michelangelo would have hewn a block of marble'. Unlike most of his contemporaries he never favoured theory over experience and firmly believed in autopsy (literally, 'to see with one's own eyes').
Surgeons routinely amputated infected or damaged parts of the body, but John's superior skill and perception led to new and better treatments. Aneurysm is a fatal condition which arises when the walls of a blood vessel weaken so that the vessel inflates with blood and can burst. Hunter operated on a patient with a large aneurysm at the back of his leg. By tying off the affected length of the artery, in the belief that the blood would naturally find an alternative route through adjacent blood vessels, he saved the man's leg. It wasn't a wild guess; he had previously done similar surgery on a dog and a deer to see if it would work. When a year later the man died of a fever unrelated to the operation, Hunter bought his body and re-examined the blood vessels in the leg to confirm that his conjecture was correct. By this time his 'bypass' technique was becoming the standard procedure for aneurysms of the leg in all the best hospitals of Europe.
The Hunter brothers made significant advances in medical knowledge. Sometimes their joint projects were William's idea, as when they revealed the extent and function of the lymphatic system, but John did all the dissections and experiments, and it was he who recognised that the lymph system was implicated in a certain type of cancer.
Excerpted from Smoking Ears and Screaming Teeth by Trevor Norton. Copyright © 2010 Trevor Norton. Excerpted by permission of Pegasus Books LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.