Photographs show doctors in training posing with cadavers.

Health and medicine explained.
April 24 2009 6:55 AM

Gather 'Round the Cadaver

A new book examines photographs of medical students posing with the bodies they dissected.

Click here to launch a slide show about doctors in training posing with cadavers.

The photographs in the remarkable new book Dissection shocked me, even though I spent a year in anatomy class during medical school. Dissection includes dozens of images of late-19th- and early-20th-century medical students posing, often in comedic manners, with cadavers and skeletons—scenes that, from our modern eye, appear disrespectful and unprofessional. Most disturbing of all are photographs, bearing racist inscriptions, of white medical students dissecting African-American cadavers.

Dissection's compilers, John Harley Warner and James M. Edmonson, a historian of medicine and a museum curator, respectively, strive to place the often-jarring images in their proper historical context. Still, one has to wonder if some type of apology to these unwitting participants is in order. It is not the first time that medicine has used the bodies of the poor—especially poor blacks—to advance its agenda.

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This lost genre of photographs, Edmonson explains, dates roughly from 1880 to 1930. The images, which were taken at medical schools across the country, generally display groups of student dissectors posing with their cadavers. At times, the students—who are mostly male but occasionally female—are actively dissecting. Not surprisingly, many of the cadavers look less like human beings than pieces of meat.

But in other images, especially those involving the skeletons that students used to help identify the bones and other landmarks in their cadavers, the dead are in unnatural positions, either by themselves or with students. A cadaver smokes a pipe; skeletons play cards; skeletons hug their dissectors; skeletons are even propped up to appear as though they are dissecting sleeping students.

At times, the students sketched epigraphs onto the dissecting tables. "She lived for others but died for us," wrote students at the Medical Department of the University of Louisville. "Her loss is our gain," reported students at the University of Maryland School of Medicine. Students at the same school wrote, "A thing of beauty is a joy forever" on their table. And, perhaps predictably, students at an unknown school hoped that their cadaver would "rest in pieces."

Although there was surely dark humor in these photographs and inscriptions, Warner writes in an essay, they were not candid shots meant primarily to entertain. Indeed, the facial expressions of the participants are often solemn and even reverential at times. It was not uncommon for students to replicate these images on souvenir or holiday greeting cards that they sent to friends and relatives.

How can these photographs be understood? Warner believes that dissection was a "communal rite of passage" for medical students at the turn of the 20th century and the images served as a "professional coming-of-age narrative." This function is made especially clear by a series of "class portraits" in which cadavers appear among dozens of formally attired students. Although the photographs may appear inappropriate to us, Warner argues, they commemorate a bonding experience between student and cadaver that was actually lost after 1930. After that point, he says, a new era of objectivity and detachment entered medical education, ending the earlier emotional attachment to the dissection process.

I dissected my first cadaver in the 1980s—a "politically correct" era. Our introductory anatomy lecture implored us to respect the bodies and even referred to them as our "teachers." The year ended with a memorial service for the now-dissected specimens, another tribute to their memory. Aside from giving our corpses a few silly nicknames, we more or less behaved ourselves.

While Warner and Edmonson are right to emphasize that these photographs come from a very different era, I wish they had raised the issue of contemporaneous objections. Did anyone within the medical schools or among laypeople viewing the various holiday cards decry what was happening, suggesting that the cadavers were inappropriately being used as a means to an end? Whatever society believed about the privileges of future doctors and the fate of the poor, did this justify voyeuristic displays of dead human beings in various comical and indecent states?

Of course, one reason that the images may not have raised objections is that most of those being dissected appear to have been African-Americans, while most of the dissectors were white (although students at African-American medical schools like Howard also dissected black cadavers and took photographs). "Unlike bodies in the anatomy laboratories of American medical schools today, not one of them willed him- or herself to end up there," Warner writes. "These cadavers were either stolen from their graves or claimed by the state. … These were people whose class, ethnicity, race or poverty made them vulnerable to dissection."

Warner rightly makes an analogy to the gruesome lynching photographs of the same era that were also distributed to genteel society through various souvenir cards. In a clever bit of historical detective work, Warner and Edmonson even discover that a particular photographer, G.H. Farnum of Oklahoma, actually took both types of photographs. Some of the dissection images contain racist inscriptions, such as "Sliced Nigger," from the Wake Forest School of Medicine and "All Coons Smell Alike to Us," from the College of Physicians and Surgeons of Baltimore.

Warner goes on to cite the infamous Tuskegee Experiment, in which the U.S. Public Health Service deliberately withheld treatment for syphilis from poor African-American men from 1932 to 1972. Both Tuskegee and what went on in these anatomy laboratories, he concludes, contribute "to a legacy of distrust against American medical institutions among many people of color."

That is where Dissection leaves things. But I believe the descendants of these anatomical subjects—black and white—deserve some type of apology. Just because we might never identify their actual kin does not render this task unnecessary. Generations of physicians benefited from the use of these bodies—but also chose to treat them in an undignified, and at times repulsive, manner.

I suppose it can be argued that we have had enough apologies from representatives of the medical profession—not only for Tuskegee, the Human Radiation Experiments, and eugenics but most recently for organized medicine's treatment of African-American doctors. Maybe no one is even paying any attention anymore. So here is another suggestion: Every medical school in this country should get a hold of the images in this remarkable volume and show them to incoming students before they set foot in an anatomy lab. The mistakes of their predecessors might impart a needed dose of humility.

Barron H. Lerner is a professor of medicine and population health at the New York University School of Medicine and the author of The Good Doctor: A Father, a Son and the Evolution of Medical Ethics.

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