Not Just Any Cadaver Would Suffice
By David Brown
Good cadavers are hard to find. This was true for the anatomists of old, and it turned out to be true for the people running the Visible Human Project.
If anything, a high-quality cadaver was especially imperative in this effort because the anatomical structures would be depicted in exquisite detail. Unlike drawings, the images could not be corrected or interpreted by the human hand. Any defect or anomaly would remain part of the permanent record of what was supposed to be a "typical" human body.
The National Library of Medicine (NLM), which financed the Visible Human Project, required that at least three bodies of each sex, fitting all the necessary criteria, be found and compared before final choices were made. The source of the bodies would be state anatomy boards, which receive the remains of people who "give their bodies to science."
The boards of Maryland, Texas and Colorado the three states whose medical schools won the NLM contract totaled about 3,000 bodies a year.
Despite that large pool, most of the cadavers were never in the running to become the Visible Human male or female. Bodies of the very old or emaciated were eliminated, as were those with obvious signs of trauma or disease.
Candidates had to be free of communicable infections, such as viral hepatitis or tuberculosis, that might threaten those handling the bodies. Even healed fractures visible on X-ray were grounds for disqualification. For practical reasons, bodies had to be no taller than 6 feet and be an "appropriate" weight.
The search, conducted in 1993, was complicated by the need to preserve the body immediately after death. Tissue decays in important, if not always obvious, ways when kept at room temperature for more than about 24 hours after circulation stops.
In the end, the bodies of seven men and three women were considered. Two of the males were judged to be equally good. The final choice was a 39-year-old, 5-foot-11, 199-pound Texan, convicted of murder and executed by injection. The woman chosen, a 59-year-old Marylander who died suddenly of heart disease, was clearly the best of three female candidates, said Victor Spitzer, anatomist and computer scientist at the University of Colorado who was in change of preparing the specimens.
That a murderer became one subject of this historic anatomical study was fitting. For centuries, criminals had been the main source of raw material for scientific scrutiny. [Related story, Page H8.]
Greek physicians dissected the bodies of condemned criminals in Alexandria, Egypt, about 350 B.C. However, the most important ancient anatomist, a Greek named Galen born in Pergamon in 129 A.D., almost certainly never studied human remains, apart from skeletons. The culture of the Roman Empire wouldn't permit it, so Galen drew his conclusions about human internal structure from what he learned dissecting apes, sheep, swine and goats.
Galen's influence was so great and dissection so uncommon that it took nearly 1,000 years to correct some of his mistakes. He claimed, for example, that the human liver had five lobes, as does that of many animal species, whereas in truth it has only four.
The importance of human dissection was recognized anew in late medieval Europe. From about 1300, for example, physicians trained at the university in Bologna, Italy, were required to supplement their study of animal anatomy with observation of at least one human dissection.
In 1482, Pope Sixtus IV ruled that, as long as convicted criminals were the source of cadavers and that they ultimately were given Christian burials, the church would not oppose human dissection.
Executed criminals provided the material for Andreas Vesalius, whose book On the Fabric of the Human Body (1543) was the most important atlas of anatomy from the Renaissance.
The shortage of criminals' corpses in centers of medical education, such as Edinburgh, occasionally led to crime itself. In 1829, a boardinghouse lodger named William Burke was convicted and hanged after being found guilty of suffocating men, with the help of his landlord, and selling their bodies to medical anatomists.
The convict who became the Visible Human male was Joseph Paul Jernigan. On July 3, 1981, he stabbed and then killed with a shotgun a 75-year-old man who surprised him during a robbery. He was convicted of murder and, after more than a decade on death row, was executed Aug. 5, 1993.
Jernigan had willed his body to the Texas anatomy board but almost certainly did not know that he was a candidate for the Visible Human Project at the time of his death, Spitzer said recently.
Nevertheless, he was. The advantage of using executed prisoners was obvious. Their deaths could be anticipated, and work on preserving their remains could begin almost as soon as they were officially declared dead. Of seven male cadavers under consideration, one other besides Jernigan's was that of an executed murderer.
Jernigan's body was not perfect. He had gained nearly 50 pounds since his arrest and was just under the weight limit. One testicle had been removed surgically when he was 15, and his appendix was taken out when he was 21. He was missing a tooth.
The Texas anatomy board took custody of the body 90 minutes after the lethal injection and infused it with 19 liters (about five gallons) of formaldehyde. It was shipped on a commercial flight to Colorado and arrived at the Colorado anatomy board in Denver eight hours after death.
Four and a half hours later, it was undergoing X-ray examination. At 15 1/2 hours after death, various markers essential to lining up cross-sectional images, should the body ultimately be chosen were attached to the skin surface.
By 18 hours, the cadaver was at a university hospital in Denver undergoing nearly four hours of "image acquisition" in a magnetic resonance imaging (MRI) scanner. At 22 1/2 hours, it was in the computed axial tomography (CAT) suite.
Fewer CAT scan pictures were taken than was planned because X-rays showed that the colon was expanding slightly, a sign of early decomposition. By hour 26, the body was surrounded by dry ice and stored in a freezing chamber, where it remained until January 1994, when cutting began.
Neither the NLM nor the Colorado team identified Jernigan as the Visible Human male. However, his date and cause of death, as well as his state of origin, were public information. His identity has been widely known and reported previously.
The identity of the female cadaver is known only to a few people, not including those in Colorado, who prepared the body.
The Maryland State Anatomy Board receives about 1,200 bodies a year. Of those, about 800 are donated. The remaining 400 are of people whose bodies are unclaimed. Slightly less than half of the bodies in the latter group ultimately are claimed by relatives, said Ronn Wade, the board's director.
The bodies of two men and one woman were sent to Colorado in 1993 for possible use in the Visible Human Project.
All donated bodies used are ultimately cremated, and their ashes are returned to the board. At that point, officials contact the deceased's next of kin. If the latter ask, board officials will describe in general terms how the cadaver was used. No survivor of the woman who became the Visible Human female ever asked what became of her, Wade said.
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