A pauper dead-house: the expansion of the Cambridge anatomical teaching school under the late-Victorian poor law, 1870-1914

Acquisition of cadavers for anatomy education and research in Malawi

BACKGROUND

The use of human cadaveric dissection forms an essential part of teaching anatomy to health sciences students in Malawi. Despite worldwide struggles in acquiring sufficient human cadavers for anatomy education, the current recommendations on the best anatomy practices require the use of cadavers exclusively from the body donation programs. The current study aims to describe the sources of cadaveric bodies used for anatomy education in the Malawian context and reflect on the feasibility of using cadavers from the body donation program only.

METHODS

A retrospective audit of the cadaveric records for the 2006-2022 academic years at the Kamuzu University of Health Sciences was done. The perceived challenges when sourcing the cadavers were identified and described based on the authors experiences in Malawi.

RESULTS

The majority (97.3%) of the cadavers used between 2006 and 2022 were unclaimed bodies. The mean age of the cadavers was 45 years. Most (95.6%) of the unclaimed bodies were males. All the unclaimed bodies were sourced from hospitals. The body donation program in Malawi was patronized by populations of European descent only. Strongly held sociocultural and religious beliefs as well as economic reasons were perceived as significant barriers to acquiring cadavers of the indigenous Malawians through the body donation program.

CONCLUSION

Cadavers for anatomy education in Malawi are mainly from unclaimed bodies, similar to other African countries. The authors support the transition from using "mostly unclaimed bodies (and, less often, body donation)" to using "mostly body donation (and, less often, unclaimed bodies)" through awareness campaigns that are targeted to address the prevailing challenges.

Post-mortem in the Victorian asylum: practice, purpose and findings at the Littlemore County Lunatic Asylum, 1886-7

This article examines the purpose of the post-mortem in the late Victorian asylum and discusses what the findings reveal about contemporary understanding of mental health. By examining the practice at the Littlemore Asylum of Oxford, the definition of the asylum post-mortem will be questioned and issues of consent and ownership of the dead body explored. It will be argued that the purpose of the examination was partly to appease the demands of the Commissioners in Lunacy, to protect the asylum against accusations of malpractice, and to appease the resident assistant medical officer's own morbid curiosity. The examinations would therefore be better defined as dissections. This article will challenge understanding of institutional death, the legal processes required for dissection, and mental healthcare.

'Visitation by God': rationalizing death in the Victorian asylum

This article argues that death from insanity raised serious questions for the medical profession and for those who promoted the public asylum movement in the nineteenth century. While the medical emphasis on the somatic origins of insanity was increasingly accepted, limited observable signs of disease in the brain at post-mortem made it difficult to explain cause of death. This posed problems for a growing county asylum movement which was justified on the basis that insanity was a treatable disease and thus mortality rates would naturally decline. As asylum populations continued to grow and mortality rates remained little changed, statistics on lunacy ultimately became not the predicted measure of success but instead clear evidence of failure.

Death and the dead-house in Victorian asylums: necroscopy versus mourning at the Royal Edinburgh Asylum, C. 1832-1901

This article examines the management and meaning of post-mortem examinations, and the spatial ordering of patients' death, dissection and burial at the Victorian asylum, referencing a range of institutional contexts and exploiting a case study of the Royal Edinburgh Asylum. The routinizing of dissection and the development of the dead-house from a more marginal asylum sector to a lynchpin of laboratory medicine is stressed. External and internal pressure to modernize pathological research facilities is assessed alongside governmental, public and professional critiques of variable necroscopy practices. This is contextualized against wider issues and attitudes surrounding consent and funereal rituals. Onus is placed on tendencies in anatomizing insanity towards the conversion of deceased lunatics--pauper lunatics especially--into mere pathological specimens. On the other hand, significant but compromised resistance on the part of a minority of practitioners, relatives and the wider public is also identified.

'Abnormalities and deformities': the dissection and interment of the insane poor, 1832-1929

The body trade of anatomy schools in Victorian times that underpinned the expansion of medical education has been neglected. This article examines dissection records of insane paupers, sold to repay their welfare debt to society. Each cadaver was entered in an 'Abnormalities and Deformities' dissection book. Student doctors paid fees to anatomists to be taught the pathology of insanity under the Medical Act. Anatomists also dissected cadavers to do further brain and eye research on epilepsy and glaucoma in the insane. These bodies were often dissected to their extremities. Their fragmentary remains were then disposed of in a common grave. This secret body trade and its asylum supply-chain merit further work in disability studies and the history of psychiatry.

The reliance on unclaimed cadavers for anatomical teaching by medical schools in Africa

The study of gross Anatomy through the use of cadaveric dissections in medical schools is an essential part of the comprehensive learning of human Anatomy, and unsurprisingly, 90% of the surveyed medical schools in Africa used cadaveric dissections. Donated cadavers now make up 80% of the total cadavers in North American medical schools and all the cadavers used for dissection in the United Kingdom are donated. Because the sources of cadavers used in Africa are not clearly known, a questionnaire to gather information on cadavers used at medical schools was designed from the relevant literature and was sent by electronic mail to 123 Anatomy lecturers in 23 African countries (48 medical schools). Fourteen lecturers from 14 medical schools in ten countries responded to the questionnaires. The results indicate that, in most countries, the cadavers are unclaimed bodies from the hospitals and prisons, and the bodies of dead bandits. In South Africa and Zimbabwe, the donations are mostly from the white community, and medical school in the Islamic country of Libya is importing cadavers from India. The lack of knowledge about body donation programes and firmly held cultural and religious burial traditions may explain the lack of bequests from black communities. The use of unclaimed bodies may disproportionally affect people who were homeless and poor, criminals, people with fewer social links, and social outcasts. The Anatomy lecturers felt that there should be broader national awareness programes for body donations, although the benefits of this could take decades to materialize.

Cultures of death and politics of corpse supply: anatomy in Vienna, 1848-1914

Nineteenth-century Vienna is well known to medical historians as a leading center of medical research and education, offering easy access to patients and corpses to students from all over the world. The author seeks to explain how this enviable supply of cadavers was achieved, why it provoked so little opposition at a time when Britain and the United States saw widespread protests against dissection, and how it was threatened from mid-century onward. To understand permissive Viennese attitudes, we need to place them in a longue durée history of death and dissection and to pay close attention to the city's political geography as it was transformed into a major imperial capital. The tolerant stance of the Roman Catholic Church, strong links to Southern Europe, and the weak position of individuals in the absolutist state all contributed to an idiosyncratic anatomical culture. But as the fame of the Vienna medical school peaked in the later 1800s, the increased demand created by rising numbers of students combined with intensified interdisciplinary competition to produce a shortfall that professors found increasingly difficult to meet. Around 1900, new religious groups and mass political parties challenged long-standing anatomical practice by refusing to supply cadavers and making dissection into an instrument of political struggle. This study of the material preconditions for anatomy at one of Europe's most influential medical schools provides a contrast to the dominant Anglo-American histories of death and dissection.

Anatomy and embryology in medical education at Cambridge University, 1866-1900

INTRODUCTION

The teaching of anatomy remains controversial to the present day. This paper explores the arguments over its merits in medical and scientific education at one of the ancient universities.

HISTORY

Medical professors at Cambridge University relied upon the science departments to provide basic scientific instruction, whilst science professors relied upon medical students to make up numbers for their courses.

DISCUSSION

Human anatomy became a source of contention: did it really educate the mind, or was it simply a dry subject that medical students had to learn by rote? Could the university even cater for professional education?