Gone are the murderous days of Burke and Hare but medical science still relies on cadavers donated for doctor training
THE CARETAKER: Dr Gordon Findlater outside the receiving room for bodies to be dissected for medical study. PORTRAIT: NEIL HANNA
DEEP in the heart of Edinburgh's New Town, in a fashionable flat down a cobbled mews, Tim Maguire is contemplating his own death over a pot of Earl Grey tea. "It doesn't frighten me," he says. "I just hope I will be some use."
Maguire, who is 55, has arranged to bequeath his body to Edinburgh University Medical School. He is a humanist celebrant, and thus has no belief in the afterlife. However, it is fairly certain what will happen to him when he dies, in a physical sense at least. His body will be taken by a firm of undertakers to the grand 19th-century building on Teviot Place. It will be stripped, embalmed and dissected – the muscles, blood vessels and organs exposed – and used to instruct medical students in the wonders of human anatomy. Within three years of arriving at the university, his body will be cremated and his ashes scattered within the grounds of the crematorium.
He is quite blithe about all this. He has signed up for it. He is one of around 160 Scots each year who arrange to donate their bodies to medical science. Five university medical schools in Scotland accept bodies – Aberdeen, Dundee, Edinburgh, Glasgow and St Andrews. The act of giving away your body feels quite dramatic, but the process is mundane – a simple filling in of forms. The university sends out a Declaration of Bequest in which you fill your details and tick boxes giving or refusing consent for, to give one example, the extended retention of parts of your body. Most people tick everything. Their attitude to their corpse is intensely pragmatic – once you're dead, you're dead.
For Maguire, the decision was prompted by learning that there was a shortage of bequests. "I was surprised to find that in the city of Burke and Hare, Edinburgh's Medical School weren't getting the bodies brought to them that they need," he says. "It's a way of being altruistic at a point when it costs you nothing. It's a way of being generous with yourself."
It didn't take long, did it, for Burke and Hare to be mentioned? That Edinburgh is strongly associated with the study of anatomy is largely due to the murderous reign of the infamous "resurrectionists" who killed 17 people between 1827 and 1828 and supplied their bodies to Dr Robert Knox, who ran a popular anatomy school. They were caught and Burke was executed. Afterwards, his body was dissected publicly by Alexander Monro, the third Professor of Anatomy of that name to hold the post at Edinburgh University.
Several film adaptations have been made of the Burke and Hare story, including John Landis's version, which will be released later this month. Burke's remains are displayed high up in the Medical School on Teviot Place. "Irish (Male)," reads the sign. "The skeleton of William Burke, the notorious murderer hanged at Edinburgh, 28th January, 1829. Dissected by Monro, Tertius." The terror of the West Port reduced to just another labelled specimen behind dusty glass.
One far-reaching consequence of the Burke and Hare murders was the passing of the 1832 Anatomy Act which allowed licensed anatomists legal access to unclaimed corpses, a group which often included those who died in prison or the workhouse or the fetid backstreets, as well as individuals who arranged to donate themselves to medical science. Previously, executed criminals had been the only group legally available for dissection.
Since 2006, the Human Tissue Act has allowed bequeathed bodies to be used for the practice of surgical techniques as well as for the study of anatomy. Edinburgh University requires in excess of 40 bodies each year for postgraduate surgical training. The other fundamental change brought about by the Human Tissue Act is that individuals who want to bequeath their bodies must now state that in writing and have it witnessed. In the mid-Eighties, Edinburgh University required around 60 bodies each year in order to teach anatomy; they now get by with about 12 for undergraduate teaching. This is the result of a UK-wide change in emphasis on how medicine is taught which has meant that few students now dissect bodies themselves. Instead, they observe and handle bodies which have already been dissected by departmental staff and post-graduates. This is known as prosection.
But what exactly happens when you donate your body to medical science? To find out, we must enter those quarters that are usually closed to all except the dead and those who deal with the dead - the anatomy rooms.
The Medical School on Teviot Place is a brooding Victorian building entered through grand wooden doors above which is engraved: SURGERY. ANATOMY. PRACTICE OF PHYSIC. The sense of history is tangible. Britain's first ever Professor of Anatomy, Robert Elliot, taught in Edinburgh from 1705.
In a modest office sits a man who, though he would likely deny it, is the descendent of that eminent teacher. Dr Gordon Findlater, 59, is the senior lecturer in anatomy and head of the department. Bald on top, with a white beard and blue eyes, he is originally from Nairn. He speaks with passionate eloquence about anatomy. What he says is candid and often unexpected.
"When you are producing a dissection, I do honestly think it's like a work of art," he says in a soft Highland accent. "There's a challenge to present this in the best way possible, to make it – what's the word? – attractive. It's not a case of just doing it. It's got to be aesthetically pleasing. I can show you an atlas and you'll see what I mean."
He gets up from his desk and pulls a book from the hundreds of volumes on his shelves, flicking through until he finds the page he wants. "Have a look at that. Now you might not find this particularly attractive. This is the back of your forearm. Just look at the intricacy." The picture shows the tendons as a series of lines converging towards the palm; there's a balance to it, an elegance of proportion, and a level of abstraction that is undeniably aesthetic.
"You have to understand how difficult it is to produce something like that. Just like a sculptor removes bits of stone, we remove fat and skin, fascia, to reveal the underlying tissues and structures. So what you end up with is something that is not just useful from a teaching point of view, but which is pleasing to the eye. I think you owe it to the family to not just chop up a body."
Findlater's experience of dissection is fascinating. "You can lose yourself in it. You can get completely engrossed. It's a challenge, and very body-dependent. Some bodies are easy to dissect. Some are difficult. It's therapeutic. It's relaxing. When I'm teaching students the skills, I'll say, 'Look, I'll show you how to do that,' and 20 minutes later I'm still doing it. I get carried away because I enjoy it."
Is it reasonable to derive pleasure from this, given it's based on someone else's misfortune? "I think so," Findlater replies. "Somebody left the body to you, so you owe it to the dead person to do them justice. It's a wonderful gift to leave your body to students to look at, and we have so much respect for a dead body. My colleagues and I try to get across to students that this isn't just a body. This is actually somebody's mum, somebody's dad, somebody's brother, somebody's sister. They are to remember that when they are handling the body. We also expect them to dress accordingly. We don't want to see flip-flops or hats. We ask them to present themselves in a decent way."
Each May, the Medical School hosts a service at Greyfriars Kirk for family and friends of those whose bodies have been received. First-year medical students are expected to attend. It's a way of expressing gratitude. Findlater is fond of quoting Winston Churchill's famous line about Battle of Britain pilots. "Never have so many owed so much to so few. The so few being the 12 bodies we receive in one year. That will educate 250 medics. And how many thousands will they go on and treat?"
Students working on a body are not told the name. Although they are expected to remember that this was a person, there are protocols that make the situation bearable emotionally. When a body comes in, the hair is removed, as hair is considered one of the signifiers of individual personality. Similarly, the faces of bodies are kept covered at first, for the sake of new medical students who may be as young as 17 with no personal experience of death; grief, for them, is as abstract as that dissected forearm.
Bodies that come into the Medical School are given a unique four-digit code. It's interesting to note that gender stereotyping continues even after death; signifying male and female, the labels on the bodybags are either blue or pink. It would be easy, in these circumstances, for the person's living identity to be entirely forgotten. Findlater, however, always makes a point of knowing whose body has come into his department. "I want to personalise it," he says. "I want to know their name and where they came from.
"I see dead bodies every day But it doesn't make death any easier when somebody in your own family dies. My brother was in a wheelchair and was hit by a drunk driver. I was starting my degree when he was killed. I wasn't aware then, and I'm still not aware of there being any link between his death and the body I was working on. They felt quite separate. This work doesn't make you immune to death. If it's family, it's just as traumatic."
Two bodies have come into the department that day, and are to be embalmed. Downstairs, through a number of locked doors, is what is known as the receiving room. It is painted magnolia with pale blue wall tiles, and dominated by two silver tables. The atmosphere is cheery and professional. This is a workplace, not so different from any other.
Drawers are labelled for the implements inside – hemostatic forceps, scissors, knives, bone-cutting forceps. A blackboard, divided into a grid, tells staff – in chalked code – which bodies are on which shelf of which room. The embalmed bodies are kept separate from those which are frozen. The former are used to teach anatomy, the latter for surgical training. Freezing flesh allows it to keep the "life-like" consistency necessary for attempting techniques that will later be used on living patients.
A body is wheeled into the room and lifted on to one of the tables. The white sheet is removed to reveal an elderly man. He died the day before and is still in his pyjamas. Those pyjamas are the hardest thing to look at. Dead bodies often appear fake somehow – waxen and too small – but to see someone in his clothes makes him real and begins to tell a story about who he was and what he might have meant to others.
Most of the bodies received by the Medical School are elderly. The youngest person to bequeath his body to Edinburgh was a 39-year-old who died of a brain tumour. Recently, paperwork was sent out to a 103-year-old. The pyjamas are removed and a technician makes an incision in the inner left thigh in order to access the femoral artery. A tube is inserted and embalming fluid is pumped into the body from a machine. The technicians wear face masks during this part. Every anatomy department has its own embalming solution, but all use the same basic mix; here, it is known as the "Edinburgh formula" – a blend of formaldehyde, phenol, alcohol and water. Around 15 litres, depending on size, will "fix" a body so it does not decompose.
Findlater moves his hands through the air above the body and intones the names of those parts through which the embalming fluid will move: "Femoral artery, external iliac, common iliac, abdominal aorta, thoracic aorta, arch of aorta, ascending aorta, left ventricle, left atrium, pulmonary veins, lungs." The movement of his hands and the Latin terms are striking. It feels as though a sacrament is being given.
Findlater is an elder in the Church of Scotland. You might think a job like his would be a challenge to faith. In fact, it appears to strengthen his belief. He can see, in these mortal remains, that something – "for want of a better word, the spirit" – is absent.
Later, we go upstairs to the teaching room. It's a large white space flooded with light from the roof and from arched windows looking out over an internal courtyard. Anatomy has been taught here since the late 19th century, yet – were it not for the insistent smell of formaldehyde, and the gentle outlines of bodies under sheets – you might think yourself in the loft studio of a successful artist or couturier. The anatomical paintings on the walls are a century old.
Findlater folds back the sheet on the embalmed body of a woman. He uses scalpel and forceps to remove part of the skin on the left foot. He points out tendons and nerves on the leg, explaining how easily these can be injured, and the great saphenous vein which is used in coronary bypass surgery.
He lifts off the front of the ribcage to reveal the organs beneath. The colours are autumnal. The branching aorta looks like a tree root. "This is the abdominal cavity," says Findlater. "We're looking at the blood supply to the bowel, the small intestine in particular. This is what we call an arterial arcade. I think it's beautiful." The organ is roughly fan-shaped. The deep brown bowel is the rim. Dissection has revealed the blood vessels running to it. They have a delicate skeletal quality, like antique lace, or fallen leaves.
"You could look at that in a textbook, but it would be nothing like as meaningful as seeing it for yourself," says Findlater. "There's a lot of argument about why do we need bodies? Why not just use plastic models or computers? Because you wouldn't have the experience. The difference is that it's real. True understanding comes from handling the body." He presses the aorta. "Hear it cracking? That's atherosclerosis, hardening of the arteries. You can't get that from a book." He puts the ribcage back and covers the woman with the sheet. "We've got the perfect 3D model here. It's called a body."
ON a wet afternoon in Edinburgh, Iain Campbell, senior technician in the anatomy department, is busy preparing bodies for cremation. The law states that bodies can be kept for up to three years. Today, ten are leaving the building. They are placed in white cardboard coffins.
"We get special requests sometimes," says Campbell. "I had to dress one with American flags and put a photograph of his father in with him."
Two undertakers in sober suits carry the coffins out to a silver Mercedes van with darkened windows. They drive to Mortonhall Crematorium, a striking modernist building, and unload through the side entrance. In the dim chapel, the pews are empty, the curtain still, and no one seeks comfort by gazing upon the wooden cross. There is no music, no mourners. The tears were shed when these men and women died.
This lack of ceremony may seem sad and a little lonely, but the true ritual and remembrance took place when the bodies were dissected and examined. The dead were honoured through use, and their memory will live on, not only in the hearts of their families and friends, but also in the skills of the doctors who held their stilled hearts and learned, through them, how to heal.
In Edinburgh, in Scotland, and no doubt throughout the world, there will be people unaware that they owe their lives to the generous few who, years ago, chose to sign their names on some simple forms. Though their flesh is now ash, they could not hope for a more enduring and impressive memorial.