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The Allan Burns mummies: A history and future prospect of an anatomical collection J Lee1, G Štrkalj21 Department of Biomedical Sciences, Faculty of Medicine, Macquarie University, Sydney, NSW; Medical Imaging Department, The Canberra Hospital, Canberra, ACT, Australia 2 Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpgm.JPGM_8_17
Keywords: Allan Burns, anatomy, history of medicine, medical education
Human anatomy has traditionally been the backbone of medical education as the clear insight into the structure and function of the human body is a prerequisite for safe and efficient clinical practice. Anatomy has, therefore, played an important role in the progress of modern medicine for “the greatest benefit to humankind.”[1] However, the study of human anatomy throughout the centuries was also intertwined with a dark and morally fraught history that cannot be overlooked.[2],[3],[4],[5] This dark side of anatomy relates mainly to the way human tissue was obtained for anatomical study. Human cadavers have, and continue to be, important resources in anatomy teaching, but their acquisition has represented a challenge throughout the discipline's long history. Indeed, human tissue was often obtained in morally dubious and even illegal ways, which included theft, black market trade, and use of cadavers without a consent of the deceased or her/his family. This approach changed quite dramatically in the second half of the twentieth century when, in a large number of countries, regulations changed to allow only the bodies donated to medicine to be dissected in anatomy laboratories. However, a significant number of collections from the “pre-donation” era, housed in anatomy departments and museums worldwide, contain human tissue of unknown provenance, obtained in high likelihood in ways unacceptable today.[6] These collections contain dreadful reminders of the bad old days of anatomy, when human cadavers of adult individuals were sold according to their state of preservation and those of children by the inch.[2],[4] Although there has been a significant amount of research on the history of anatomy, there are relatively few works focused on the way human tissue/cadavers were obtained for anatomical study. Medical historian, Ruth Richardson, noted in her work, Death, Dissection and the Destitute, “the medical gospel according to the hagiographers horrified me – one long procession of great men – an ever ascending line of evolution up to the glorious and smug enlightened present, with hardly even a nod toward patients and their experiences.”[2] Modern anatomists should therefore face the challenges of readdressing both distant and recent histories of their discipline and the ethical issues implied.[7],[8] In this paper, we look at one of the most famous assemblages of dissected human remains, the Burns anatomical collection, and in examining its complex history, we aim to discuss the ethical issues surrounding the old collection and its role in contemporary anatomy.
The controversies surrounding obtaining human remains for anatomical study can be traced to the very beginnings of modern anatomy. The corpses of executed criminals, which for a lengthy period were the only legal source of bodies for dissection, were often not sufficient in number to satisfy the ever increasing demands of anatomists and medical men. Indeed, Andreas Vesalius himself was involved in these dubious practices, including the theft of human remains from mortuaries and graveyards. Some of these activities were described in his seminal work, De Humani Corporis Fabrica, a book that marks the birth of modern, empirically and experimentally based discipline of anatomy.[9] As modern medicine progressed and the place of anatomy in curricula became more prominent, the need for bodies increased. From the early 18th century, the demand for cadavers from medical schools in Europe constantly exceeded their availability, and obtaining specimens became increasingly difficult for training doctors and surgeons, leading to a well-developed black market trade in human remains.[2] In Britain, before the Second Anatomy Act of 1832, the only legal source of human cadavers came from executed criminals. However, this method of acquiring bodies became unsustainable for the growing needs of medical schools. This led to the notorious activity of grave robbing by anatomists and their students which transformed into a new, unexpectedly lucrative type of “industry” by organized groups of “resurrectionists.”[2],[3],[4] The majority of bodies resurrected and illegally sold to medical schools were those of the poor, whose families did not have the financial means to provide secure coffins, and guarded graveyards to prevent body snatching.[10] The drive for human bodies led to even more grievous transgressions, including murder. The most infamous and best known of these crimes were those committed by William Burke and William Hare in the early 19th century Edinburgh.[10] Burke and Hare murdered no less than sixteen people to sell their bodies to the famous anatomists Robert Knox, who was completely unaware of the provenance of these bodies and indeed, was not interested in their origin. Consequently, public outrage and disapproval grew in response to the abhorrent means of obtaining bodies for medical study. It was contended by many that the poor were sacrificed to enable functioning of the health system utilized mainly by the rich; this pervasive distrust of medical practitioners resulted in the passing of the Anatomy Act of 1832, which sanctioned the use of unclaimed bodies from any institution (hospitals, workhouses, asylums) and additionally abolished the use of dissection as punishment for murder.[2],[3],[4] Although at that time, medical professionals felt that this was the most uncontroversial source of bodies, in reality it simply sanctioned poverty as the main criterion for acquisition of bodies for dissections.[2] At the same time, to support anatomy training in addition to dissections, medical schools (in fierce competition with each other) engaged in building up additional teaching resources. Consequently, anatomy collections and museums mushroomed throughout Britain.[11] They contained human tissue preserved in various ways which included bottled specimens, mummies, and skeletons. Among the most comprehensive anatomy, collections of the early eighteenth century were the one gathered by Scottish anatomist, Allan Burns.
Allan Burns was born in Glasgow on September 18, 1781; his father was a minister, and older brother, John Burns, was a renowned anatomist and surgeon. Allan began studying anatomy and medicine at the young (but not uncommon at the time) age of 14. Two years later, he became the main demonstrator in charge of the dissecting rooms at the College Street Medical School in Glasgow, founded by his brother.[12],[13],[14] Although well studied and deeply involved at John's school (one of the several private teaching institutions with no formal ties to the University of Glasgow), Allan never obtained a surgical degree. This was quite common at the time as certificate of attendance to required courses could be sufficient to get credentials needed for surgical practice.[15] Allan was a superb dissector and skillful specimen preparer. He developed innovative methods of specimen preservation (mummification), involving a salt and sugar cure process, though the exact details remain unknown today [Figure 1] and [Figure 2].[13],[14] Furthermore, he introduced new techniques to preserve and highlight blood vessels. With the help of his assistants, Allan Burns created one of the most instructive anatomical collections of his day.
Burns, however, was more than a skillful technician. His knowledge of anatomy and pathology was profound. Allan often joined his brother during patient consultations and took detailed clinical records in attempts to correlate patients' symptoms and signs to the findings of his dissections.[12],[13],[14] His particular areas of interests were diseases of the heart and vascular system having been called “the first imaginative experimentalist to deal with the coronary circulation”.[16] In 1809, he published his first monograph, Observations on Some of the Most Frequent and Important Diseases of the Heart, based on his detailed findings.[17] Two years later, he published his highly acclaimed monograph, Observations on the Surgical Anatomy of the Head and Neck.[18] The second, slightly revised edition of this book was later published by Burns' student, Granville Sharp Pattison. In addition, Burns was the first to describe several anatomical structures. His name is attached to the anatomical eponyms of Burns' ligament (the falciform margin of the saphenous opening of the thigh)[19] and the space of Burns (the suprasternal space, found just superior to the suprasternal notch, between the two layers of the investing layer of deep cervical fascia). The former, but not the latter, is included in the latest edition of Terminologia Anatomica.[20] The foundation of Burns' work was based on meticulous research and direct observation carried out in dissections and autopsies. As Pattison noted, Burns' medical output “contains neither hypothesis nor theories, but consists entirely of pathological inferences, drawn from the most acute and accurate observations on the anatomical structure of the parts.”[12] Despite Burns' lack of formal medical qualifications, his reputation as a scholar spread globally. In 1804, he was invited by Empress Catherine of Russia, to assist in setting up a new hospital in St. Petersburg as its head.[12],[13],[14] However, his stay was short and when he returned to Glasgow in 1805, his brother, John, had become involved in a grave robbing court case and subsequently debarred from teaching anatomy at the college (he would, however, become the first Regius Professor of Surgery at the University of Glasgow in 1815).[15] This provided Allan the opportunity to fully take up John's mantle of main anatomy lecturer and in this role, he inspired many with his passion and enthusiasm for the discipline and his dissection skills. Allan Burns died at the age of 32 on June 22, 1813 from an abdominal abscess. This was described in vivid detail containing both medical acumen and morbid sentimentality by Pattison who carried out the immediate postmortem examination of his friend and mentor's body.[12] The rights of Burns' written work were bequeathed to Pattison and the specimen collection to his close collaborator, Andrew Russel.[21]
Although Burns' anatomical collection was bequeathed to Russel, Pattison, through financial compensation, eventually gained full ownership.[21] The collection travelled with him as he changed academic positions in Britain and the USA, eventually arriving at the University of Maryland (UM) in Baltimore, where he became Chair of Surgery and later Professor of Anatomy. On his appointment in 1820, Pattison sold the collection to the university for $7,800, and it was kept in the Practice Hall, built specifically to house the collection. The collection, one of the biggest in North America at the time, not only served as a prime educational resource but also contributed toward increasing Pattison's academic standing. However, in the forthcoming decades, the collection's importance in teaching anatomy and surgery started to gradually diminish, and specimens were utilized with decreasing frequency. They eventually became forgotten curios rather than a teaching resource. Indeed, over the next 170 years, the specimens sadly fell into a “lamentable condition”. Of the original specimens, recorded to number over 1000, about 60 only have survived to this day.[13] Many specimens were displaced or stolen, one recently being offered for sale on eBay.[22] When Ronald Wade, the current curator of the collection, came to UM in 1974, the Burns specimens lined a hallway in one of the medical school buildings and had been reduced to a “sight-seeing” interest among students and visitors.[13] Although some suggested to dispose of the collection, Wade's passion for history and anatomy managed to get the specimens boxed and stored away. Decades later in 1992, when Wade unearthed the specimens for restoration, he examined them “only to find that they were still perfectly preserved.”[13] Most recently, eleven specimens of the current collection have “resurrected” yet again to become part of an exhibition, Mummies of the World II travelling around the USA to educate about the evolution of disease over time as well as provide insight into the history of anatomy.[22]
The historical analysis into the dubious methods in which human remains were obtained for anatomical study enables better understanding of anatomy's history and also encourages reflection into the current practices.[8] In regard to the Burns Collection, and others like it, the ethical issues of using body remains of people who did not give consent should be addressed. Bearing in mind that Burns did not have affiliation with the university and the scarcity of cadavers available to medical schools at the time, there is no doubt that the majority of cadavers in the large anatomical collection he created were from bodies acquired illegally, mainly through grave robbing. Significantly, the College Street Medical School was also strategically positioned in proximity of several churchyards and as historian Geoff Holder remarked, within the “body-carrying distance.”[23] The cadavers used to make anatomical specimens endured dramatic transformations. While in their graves and when dug up by resurrectionists, they were simply corpses of recently deceased. Grave robbers regularly stripped these corpses of their clothes and all belongings found in graves to avoid harsh punishment if caught. This was because dead human bodies were not considered commodities and effectively, could not be stolen. The British legal system was somewhat dismayed concerning grave robbing and how to sanction it, eventually settling for the relatively benign “violating a sepulchre” offence.[2],[4],[23] As they reached anatomy rooms, corpses would transform into “potential teaching resources” and a source of knowledge, thus becoming a commodity with market value. Furthermore, once medical knowledge and anatomists' work were invested into them – through the processes of dissection and tissue preparation, they would actually become “teaching resources” and their market price would vastly increase. In addition, as they became “anatomical specimens,” they would generally acquire legality (unless recognized and identified) as their provenance was rarely questioned. They were therefore ready to be utilized in teaching, traded, and exchanged. Nowadays, however, these remains are transformed yet again, becoming historical artifacts and reminders of the dark side of the history of anatomy, rather than resources for anatomy education. While much changed in medicine since the days of grave robbing, historians still warn about the “fearful symmetry” between anatomy of the past and that of the present.[2] Now, in many countries, bodies for anatomical study are acquired exclusively through body donation programs. However, in a considerable number of places, unclaimed cadavers and even bodies of executed criminals are still sent to anatomy departments.[24],[25] Furthermore, incidents of abuse happen even in places which seem to be well regulated. Thus, a public outcry over several scandals exposed in the late 1990s, related to the retention and nonconsensual use of human tissue in a number of institutions, prompted a change of legislation in the UK and the introduction of the Human Tissue Act (2004).[26] This legislative act was designed to prevent the use of human tissue without an informed consent and to enhance the regulation of the handling of human tissue in all contexts, including its use in anatomy laboratories. The recent instances of abuse [3] also seem to suggest that the existence of good regulations alone might not be sufficient prevention. This highlights the need for change of culture in anatomy departments, based on empathy and humane approach to human remains, informed by humanities and incessant reflection.[7],[8],[27],[28] Bearing in mind the provenance of cadavers, the current usage and future prospects the Burns Collection (and other similar anatomical assemblages) represent an ethical conundrum. It would appear that there are generally three main approaches in dealing with old anatomical collections. The first approach is to continue using the collection in ongoing anatomy and medical teaching, where advocates believe that this is the best way to honor the people who could not consent, and ultimately, make them useful for the “greater good”. However, advancements in ethical acquisition of human tissue, medical imaging, three-dimensional-printing, and the widespread access of multiple anatomical resources in the current day seem to override the need to use these historical specimens in teaching anatomy fundamentals.[3],[22] Indeed, human remains from the Burns Collection have long ceased to be used in anatomy teaching at the UM as their role has been taken over by a variety of other educational resources.[13],[14],[22] The second option is to treat the human remains from the collection as valuable “witnesses” of the history of anatomy, and as such, use them to teach history and medical ethics. A similar argument for this option has also been put forth with other ethically challenging resources in anatomy such as Eduard Pernkopf's Topographische Anatomie des Menschen ( Atlas More Details of Topographical and Applied Human Anatomy).[29],[30] In terms of its content, this is one of the most instructive atlases ever produced, but it has been demonstrated recently that at least some of the bodies used to produce its images were those of political prisoners during the Nazi era. It was suggested that the atlas can now do “more than teaching anatomy” as “they remind us of the horror that any 'objective' science can impose…. The crimes of Nazi doctors teach us what we physicians must not do.”[31] This option can further be utilized in the teaching of “humanistic anatomy.” The analysis of historical and ethical implications of a murky medical past can change the approach to anatomy – one that is more empathetic, respectful, and grateful for the donations of others as opposed to “the desensitized and often brutal anatomy of the past.”[8] Finally, the third possibility would be to repatriate these remains, bury them in their land of origin, and in doing so, provide a memorial service they were not able to properly receive in the past. In addition, a memorial place or a monument could be erected for the people whose remains were posthumously abused in the name of anatomical science.[32],[33] This memorial would not only honor the victims of “anatomical abuse” but also serve to remind and educate medical students and practitioners as well as the general public about the importance of ethics in medical research and practice.
The history of the anatomical collection created by Allan Burns and his associates seem to be as complex as the history of anatomy itself. Rooted in both dubious cadaver sourcing and cutting edge medical expertise of the early nineteenth century, the collection transformed in many ways as its educational, medical, and social status changed. Its current status represents a challenge for scholars and outlooks about the ways in which the specimens should be treated today vary and are still debated. But ultimately, this ongoing process of critical thinking and evaluation about the history of these specimens, and others like them, is vital in providing a foundation for teaching medical history and ethics to the future generations of anatomists, doctors, and scientists. Acknowledgment We thank Mr. Ronald Wade from the UM for his valuable comments and photography of the collection. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
[Figure 1], [Figure 2]
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