Over my dead body
John A Lee
Department of Histopathology,
Rotherham General Hospital,
Rotherham S60 2UD, UK
Correspondence to:
Prof John Lee
[email protected]
Dead bodies have not always generated the sort of bad
press, hysterical overreaction, and frenzied bureaucratic
response that has become typical of early 21st century
western society. Ancient Egyptians were quite calm
about the issue. Their dead were methodically packaged
for the afterlife on an industrial scale, and those trusted
with the task were awarded an exalted position in
society. The Incas went one step further. Not content
with letting their mummied ancestors rest in peace,
they regularly retrieved them from storage to play an
active part in ceremonial occasions. In the 17th century,
the Spanish priest Father Bernabe Cobo wrote:
. . . in the plaza of the temple, those charged with this
duty would bring into the said square the embalmed
bodies of the dead lords . . . The reason they brought out
these dead bodies was so that their descendants could
drink with them as if they were alive, and particularly
on this occasion so that those who were knighted could
ask for the deceased to make them as brave and
fortunate as they had been.
Reuters
The corpses, wrapped in ne clothes (but not as well
embalmed as their Egyptian counterparts), were
monitored by an attendant whose duties included
keeping the ies away. The square was thronged with
people drinking toasts to the dead, who (with help from
their assistants) returned the compliment.
It would be a mistake to assume that such striking
customs of communing with the dead are simply a
function of antiquity. Around the world today one
nds, without much difculty, actively practised
funerary traditions encompassing nearly the entire
A plastinated human specimen, part of Gunther von Hagens Body World
exhibition
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range of possibilities. From the minimalist approach of
the central Balinese tribe who place their dead, fully
dressed, on a sort of human compost heap beneath a
particular type of tree (quite an arresting sight), to the
high-tech embalming procedures of some in the
southern USA (satirically documented by Evelyn
Waugh in his novel The Loved One), where the dead are
preserved with xatives, dressed in their nest clothes,
hair styled, adorned with makeup, and placed in a
realistic life setting such as an ofce or living room,
ready for their nal interview. Usual western tradition
is comfortable with something between these
extremes: the body is tidied up, hygienically
embalmed, and refrigerated before brief viewing in a
supine position, usually in nightclothes, and often in a
cofn, before being whisked away for burial.
Why are some cultures so uneasy with the dead, but
others seem literally to embrace them? In particular,
why is modern western society so nervous about dead
bodies? Is the feeling rooted in an ancient and almost
instinctive association of death with disease? Is it the
fact that the extraordinary good health now enjoyed by
most westerners for most of their long lives makes
them unwilling to consider the inevitable end? Is it
because the grave-robbing antecedents of modern
anatomisation got the whole subject off to an
irreversibly bad start? Is it related to the fact that the
efcient organisation of our society means that most
people never see a dead body until a close relative dies,
if even then? Or is it simply that ignorance causes fear?
Most people, unaware of what a dead body looks like
and with little idea of what happens to one after
deathespecially if organ transplantation or
postmortem examination will be donesimply cannot
contemplate the issue at all, or, if they do, nd their
minds lled with worrying ideas having more to do
with the ctional tradition of Frankenstein than with
modern reality.
One suspects that each of these factors and more play
a part, but the last onethat ignorance breeds fearis
probably the most important and the one that, in
theory, we can most easily address. Unfortunately,
wanting wider public education about emotive medical
subjects and making it happen are two rather different
things. On Wednesday, Nov 20, 2002, I had a ringside
seat at an event that emphasised this point as the
anatomist Gunther von Hagens, the inventor of tissue
plastination and proprietor of the controversial Body
Worlds exhibition, did the rst public autopsy to have
taken place in Great Britain for 172 years.
The background to this event included the organ
retention scandal at Alder Hey hospital in the UK, in
which the public suddenly became aware of the well-
www.thelancet.com Medicine, Crime, and Punishment Vol 364 December 2004
Reuters
meaning, but paternalistic pathology practice, in which
tissue samples and organs had been retained for
diagnostic and research purposes without explicit
consent. The resulting political and media activity, while
helping to move medical practice towards a model based
more heavily on explicit consent (a position that,
incidentally, is not without its own problems), served
substantially to underline the fact that most
commentators and those in positions of power and
responsibility had little real understanding of the
relevant issues.
It was in this feverish atmosphere that von Hagens
brought his exhibition to London, featuring plastinated
anatomical exhibits of real human bodies (each of
whom had, in fact, consented to this use before death).
The exhibition generated massive public interest and
received more than 600 000 visitors. Worldwide, more
than 15 million people have seen this exhibition. My
own observations indicated that visitors found learning
about their bodies genuinely fascinating. One might
have expected the authorities to congratulate von
Hagens for facilitating public awareness of the reality
of dead human bodies at a crucial time. Instead, they
tried to ban the exhibition and drafted a code of
conduct concerning the import and export of human
body parts in such a way that once the exhibition was
nished, it would not be allowed to return. Von
Hagens told me that his main motivation for holding
the public autopsy was to draw attention to this draft
code, which would effectively have been censorship of
the general publics right to be educated about their
own bodies (the code was, in fact, subsequently
changed to permit exhibitions with educational intent).
The announcement of a proposed public autopsy had
a very interesting response, and will be a proper subject
of study for a future professional medical historian. In
my opinion, what we witnessed was not the sort of
mature, rational debate that one might expect in an
afuent and well-educated society, but something much
more primitive, in effect a taboo reaction. Not only was
an unopened dead body to be displayed in public, but an
autopsyone of the most generally misunderstood and
underrated procedures in medicinewas to be done on
it. One could have been forgiven for thinking that the
sky was falling. There was a crescendo of ill-considered
condemnation from all sides. Normally intelligent and
sensible people spouted hostile invective that was high
on emotion and low on rational content.
I attended the public autopsy at von Hagenss
invitation in a personal capacity as a practising
histopathologist. My main motivation was to help
maximise the educational benet of the event.
A plastinated human specimen, part of the Body World exhibition
Contrary to some of the medical opinions expressed
afterwards, I believe that what took place on the day
was clearly an autopsy. Consent for the procedure was
obtained, including consent for public display; the
individual was identied; the clinical record was made
available; the organs were removed and examined;
histological samples were retained; the body was
reconstructed; and a likely cause of death was recorded.
All these aspects were shown to the live audience,
although not all were shown on the hastily edited
televised version of the event.
And the sky did not fall. Feedback received after the
event suggests that the autopsy satised its
straightforward educational purpose for those who
viewed it with an open mind: beforehand they had
no real conception of what an autopsy involved,
afterwards they did. My main hope is that this public
autopsy will have brought us closer to a time when we
can have a more open and meaningful debate on our
attitudes towards dead bodies and what we do with
them; but the intensity of the taboo reaction elicited by
the public autopsy indicates that this debate will not
simply happen by itself and will need to be actively
promoted. Death is an important subject and clearly
is not about to go away. Replacing ignorance and fear
with understanding and acceptance is certainly a
prize worth striving for, something I believe will
benet both the medical profession and the
general public. I do hope that we make some
progress over the next few decades, because over my
dead body I would prefer enlightenment rather than
just hot air.
www.thelancet.com Medicine, Crime, and Punishment Vol 364 December 2004
Further reading
Chamberlain AT, Pearson MP.
Earthly remains: the history and
science of preserved human
bodies. London: The British
Museum Press, 2001.
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