Rest in Pieces: Body Donation in Mid-Twentieth Century America

Summary

By the mid-1950s, formal body donation programs began to supplant the decades-long reliance on the anatomy acts that made the bodies of the indigent and unclaimed available for medical education and research. By the mid-1980s, nearly all American medical schools relied on voluntary anatomical gifts of dead bodies. Throughout the nineteenth century, a handful of Americans requested through wills, letters, and suicide notes that their corpses be given to doctors and medical schools. The dramatic expansion of American newspapers after the Civil War helped establish bequeathing one’s body as an available, albeit eccentric, afterlife. A significant shift in American deathways in the twentieth century, the rise of blood donation and organ transplantation, and a serious decline in the number of unclaimed bodies spurred anatomists finally to accept, and then to promote, this new corporeal philanthropy.

In a provocatively titled article in the September 1956 American Mercury, Alma Merrick Helms recounted her discovery that death was very expensive. Visits from a salesman hawking burial plots in the local cemetery and her own outing to a nearby mausoleum with marbled halls filled her with dread. But one day a headline grabbed her attention: “Wealthy widow wills cornea.”¹ Helms learned that a small child—sightless from birth—would soon be able to see for the first time because of the widow’s bequest to the Eye Bank. “If her eyes are good for something after death maybe a whole body would be worth even more.”² After learning of the acute shortage of bodies for anatomical study and on the advice of her doctor, she wrote to Stanford Medical College volunteering her body and securing the necessary legal forms. She joked that she had always wanted to matriculate to Stanford, and she was delighted to receive “a charming letter” from the professor of anatomy thanking her for the gift and wishing her a long life. She concluded “I know where I am going. It won’t cost me a penny and it may be the most generous act of my career. Perhaps an embryonic medic will save the life of a child because of what he has learned on me. Could any future be more challenging?”³

By the mid-1950s in states like California, formal body donation programs had begun to supplant the decades-long reliance on the anatomy acts that made the bodies of the indigent and unclaimed available for medical education and research. By the mid-1980s, nearly all American medical schools relied on voluntary anatomical gifts of dead bodies. How formal, legalized, and bureaucratized programs whereby an American adult could register their intention to donate their body after death quickly superseded the reliance on the laws regarding the unclaimed dead—and other less formal, illegal, and transgressive methods of acquiring anatomical material—is the subject of this address and part of our larger book project.⁴

We make the following interventions. First, since the early nineteenth century, whether by a formal instrument such as a will or codicil, or via a suicide note, directing the body to a doctor, hospital, or medical school— although it has received very little attention—was an option exercised by Americans. Both doctors and laypersons opted for this unusual ending, even as they encountered considerable resistance. Second, in the twentieth century, as Alma Helms indicated, body donation received an enormous boost from hopes for organ transplantation, especially in the late 1930s, with the ability to graft corneal tissue to restore sight to the blind, and from blood donation in the 1940s, considered critical to the war effort and the welfare of America’s soldiers overseas.

Third, by the mid-twentieth century, there had been ongoing and profound changes in American deathways. Many Americans shared Helms’s concerns with expensive and ostentatious funeral display. Helms was among those Americans who found cremation of the body attractive because it required no coffin or costly burial plot for disposal of the ashes.⁵ For other Americans, there was less emotional and spiritual investment in the physical remains and a willingness to direct their disposition to a medically useful end. And fourth, anatomists pursued body donation only after the availability of unclaimed bodies dropped off. Then they finally tapped into some Americans’ desire to be useful after death and began to welcome donors. To exploit this population further, anatomists promised that bodies were needed for “medical science,” “medical research,” and “medical education,” deliberately vague categories that evoked enlightened progress and corporeal philanthropy. Americans responded with enthusiasm. To stress, whole body donation arose as a lay movement, not as one dreamt up by anatomists, doctors, or researchers.

Alma Helms’s attitudes contrast sharply with the dominant views of nineteenth- and early twentieth-century Americans for whom dissection meant grave robbing or dying poor and unclaimed. As we know well from the work of Ruth Richardson, Michael Sappol, Helen MacDonald, and others on the body trade and the advent of anatomy acts in the Anglo-American world, the British and their dispersed colonists and ex-colonists found grave robbing horrifying, at least when it involved white bodies.⁶ Stealing from Black graveyards and exploiting the bodies of the enslaved raised few concerns among those with social power, but these sources could not supply enough corpses for medical schools in northern and midwestern states. The political solution, sending unclaimed bodies— both Black and white—to medical schools, however, was certainly no more palatable to the impoverished and marginalized, even if an acceptable option for those who were not at risk for ending up on anatomists’ tables.

Photographs of dissecting rooms with dead bodies, so popular from the 1880s to the 1930s, illustrate medical students with their anonymized cadavers, perhaps acquired under anatomy acts, perhaps stolen from graves. John Harley Warner and James Edmonson have analyzed how these images of aspiring doctors began to shape their professional identities.⁷ We also see them representing the fate of those who died and had no one who could pay to bury them, or, in some states, simply no one to claim them. In several states, public or charitable funds could be used to bury the bodies of the claimed, so friends’ and relatives’ poverty was not as punitive as it was in Britain. If not diverted to anatomy labs, those unretrieved bodies ended up unceremoniously crowded into unmarked graves in potter’s fields.

There is a possibility, however, that the occasional body on a dissecting table was there voluntarily, that individuals who expressed the desire to donate their bodies in the nineteenth century had their wishes fulfilled. All but invisible in the usual archival materials, requests and bequests for an alternate ending illustrate the obstacles to entering the dissecting room by choice. Instead, most of the evidence that we have for such events comes from newspapers that reported these desires for unusual afterlives, sometimes at great length.

The earliest recorded voluntary dissection took place in 1804. When French-born physician Lewis Leprilete died near Boston, “the forms of burial” were observed. But before his death and without alerting his neighbors, the well-known doctor “had given his body to Dr. [John] Warren of Boston, for anatomical purposes.”⁸ In light of the public opposition to human dissection, Leprilete’s body was removed from the grave “after his friends had left” and quietly transported to Harvard where anatomical material was welcome.⁹ Newspapers reported only his burial, not his ultimate disposition. Before the 1870s few Americans followed his example. The popular press reported occasional eccentrics—those fearing earthen burial and the worm, or disdaining traditional religious rites—who expressed their preference for the dissecting room. There was praise—along with active opposition—for the few physicians who, like Leprilete, made their own bodies available for dissection. When John Terry, a twenty-four-year-old medical student died in South Boston in 1840, “his attachment to the cause of medical science, and the nobleness of his disposition” prompted him on his deathbed to consign his body for dissection for the science “to which he had devoted his life, and which he could now serve only in death.”¹⁰ His classmates opposed his wish and immediately raised sufficient funds to erect a memorial to Terry in Mount Auburn, the first “rural” cemetery in America, emblematic of changes in American attitudes toward death, Christian theology, and the place of the dead in nature.¹¹

In 1843, physician William Copeland bequeathed his body for dissection to the Anatomical Department of the Willoughby Medical College in Ohio. The local press applauded his example: “Let physicians generally follow his example, and the point, that popular prejudices that prevail so extensively on the subject in our country, would soon be corrected.”¹² A decade later, there was similar praise for Harvard anatomist John Collins Warren (Figure 1) who had followed his father into medicine (his father was the beneficiary of Leprilete’s gift of his body). Upon his death in 1856, the younger Warren had left instructions that his body undergo dissection at the medical college and that his bones “be carefully preserved, whitened, articulated, and placed in the lecture-room of the Medical College.”¹³ Extolling Warren for “practice, with the preaching,” newspapers noted how the Harvard doctor’s efforts to break down “a superstitious reverence for the dead human body” were consistent with his crusade to legalize dissection and make available the bodies of unclaimed paupers to surgeons.¹⁴ Indeed, when doctors pushed for access to the unclaimed and indigent dead, several newspaper editors demanded that physicians be compelled to make their own dead bodies available on the dissecting tables.¹⁵

Figure 1.

John Collins Warren (1778–1856) established the Warren Anatomical Museum at Harvard Medical School in 1847. Upon his death in 1856, he left instructions for his body to be dissected, and his skeleton prepared for exhibition. His family vetoed the museum display of his skeleton. Harvard Medical Library, Center for the History of Medicine in the Francis A. Countway Library of Medicine, Boston, Mass.

In the decades after the Civil War, American newspapers discovered that death interested readers. The number of death-related news articles expanded, including obituaries, “human interest stories,” crime and violent death, and mass death (accidents, epidemics, disasters).¹⁶ This new emphasis on death-reporting embraced stories about a growing number of individuals—doctors, nurses, businessmen, actresses, academics, workers, free thinkers, and prisoners about to be executed—who sought entry to the dissecting room at the time of their deaths.¹⁷ A search of American newspapers published between 1870 and 1945 produced the names of some 600 individual Americans whose wills, suicide letters, and dying requests indicated their desire to gift their bodies to doctors, hospitals, and medical colleges for education and research, recounted their reasons for doing so, and in most cases conveyed how such desires were thwarted by families, friends, and public authorities. These individual names in turn reflect hundreds of articles, discussions, and letters to the editor as versions were reprinted across multiple newspapers throughout the country. By the early twentieth century, the notion of sending a body to the doctors was an available trope in popular culture. The idea that the dead could give themselves away appeared not only in newspaper humor columns but also in comic strips, including one of America’s longest running and most popular comic strips, the Katzenjammer Kids. In December 1918, a strip ran featuring the boys (renamed the Shenanigan Kids because of anti-German feeling associated with World War I), who recount the notorious meanness of their Uncle Henry, who shortly before his death, “willed his body to a medical college—just to save funeral expenses!”¹⁸

What reasons did these unusual testators and those contemplating suicide give? In some cases, they expressed objections to earth burial and “the intense fear of being buried alive.”¹⁹ Others expressed “a bitter antipathy to all creeds” and sought to avert religious observance by their families at their funeral rites.²⁰ Like the comical “Uncle Henry,” a sizable number of individuals mentioned the expense of funerals, the fear of burdening their survivors, and their dislike of postmortem display. Others offered their bodies to medical schools to offset the cost of burial or in the hope that appreciative medical students would care for their surviving family members. In April 1901, F. Law, a San Francisco machinist, “heartbroken at the spectacle of his wife and children suffering for food,” reportedly penned a note willing his body to doctors and then swallowed prussic acid (cyanide). The front-page story in the San Francisco Call featured a portrait of Law, his wife, their son and daughter, and an engraving of his suicide note directing his body to the medical students and expressing the hope that they would help his wife and family in light of his gift.²¹

Many individuals cited their disabilities, chronic diseases, and suffering unrelieved by physicians as the reason for their bequests in anticipation of new knowledge that would help those burdened by infirmities. When Z. P. Chidester, a “deaf and dumb” Iowa man, willed his body to the University of Iowa in 1904 to “find out more about conditions which afflicted him,” his “horrified relatives promptly objected.”²² The university doctors “did not push it and the man’s noble intention will never be carried out.”²³

In the majority of cases in which individuals explained their desire for dissection, they made reference to medical science, medical research, scientific purposes, the interests of science, or more generally, “the benefit of humanity.” For many, these merged in the hope that their bequests would enable “medical science to enlarge its knowledge for the good of mankind.”²⁴ Perhaps not surprisingly, physicians and others more knowledgeable about the dearth of material for dissection explicitly called out the need for bodies, so that medical students could develop expertise with human structure and function.

In 1905, in perhaps the most widely reported American body bequeathal, George William Catt (Figure 2), a prominent engineer and husband of suffrage leader Carrie Chapman Catt, had often recalled

Figure 2.

George William Catt (1860–1905) left instructions in his will that his body be turned over to a medical college for dissection. Despite her reluctance, his widow honored his bequest. Iowa State University Special Collections and University Archives.

the difficulties medical and surgical colleges experienced in finding material for their studies.²⁵ “The waste of a perfectly normal body” after death prompted him to insert a clause in his will: “It is my wish that my body be given to the medical college in which anatomy and surgery are taught nearest to the place of my demise, to be used by it in such manner as will be most conducive to the advancement of medical and surgical knowledge.”²⁶ When Catt died following abdominal surgery, the reading of that portion of his will at his funeral in his Fifth Avenue home surprised the assembled mourners.²⁷ Despite her reservations, his wife respected his decision. Instead of taking his coffin to the cemetery for burial, she escorted her husband’s body to Bellevue Hospital Medical College, where Dr. Egbert Le Fevre, dean of the college, formally received it on behalf of the anatomy department. The reporter from the New York Tribune noted the remarkable nature of the Catt bequest: “Various portions of the human body have been willed to medical schools from time to time, and it has not been unusual for men of science to will their brains to such institutions, but this is the first time in the remembrance of doctors in this city that a man of good position and generally normal conditions of health has given his entire body for the advancement of medical knowledge.”²⁸ The Catt bequest received enormous newspaper coverage and was likely the only body donation ever to be received by a dean of the medical school on behalf of the anatomy department.

The story of Harriet Cole, in contrast, illustrates how the increasingly respectable status of body donation elided the more ambiguous conscription of unclaimed corpses to dissecting rooms. Cole, a thirty-six-year-old African American woman employed at the Hahnemann Medical College in Philadelphia, died in 1888. According to her death certificate, she died of tuberculosis in Philadelphia Hospital and was “buried” one week later at the medical school. But parts of Cole survived. Hahnemann anatomist Rufus B. Weaver (1841–1936) embalmed Cole’s body and then worked to expose and preserve her entire cerebrospinal nervous system. His dissection of Cole’s nervous system was pinned to a blackboard as a teaching tool for Hahnemann medical students until Weaver entered the preparation in a competition at the 1893 World’s Columbian Exhibition in Chicago (Figure 3). The dissection of the nervous system received a blue ribbon scientific award and a medal. That much of the story is well documented. The nature of Harriet Cole’s participation, in contrast, was not well documented. How and why her body came to be used for anatomical dissection remains obscure.

In the years following the Columbian Exhibition, the anatomical specimen continued to receive attention. In 1915 when the faculty and students of Hahnemann Medical College celebrated Rufus Weaver’s fifty years as anatomist and keeper of the college’s anatomy museum, Harriet Cole’s place in Weaver’s biography received more elaboration. Physician William Weed Van Baun described Harriet Cole as “a poor, ignorant negro woman, age 36 years, with no superfluous flesh or fat,” who had “greatness and world renown forced upon her after death, by yielding up her entire Cerebro-Spinal Nervous System under the deft touch of the World’s greatest Anatomist.”²⁹ Van Baun emphasized Cole’s anatomical perfection (her emaciation, presumably from tuberculosis, rendered her a better subject for nerve dissection) but failed to make any mention of her willingness to direct her remains to the doctors. When Rufus Weaver died in 1936, newspapers noted that he had willed all his specimens—wet and dry—including his dissection of the cerebrospinal system known as “Harriet” to Hahnemann Medical College.³⁰

In 1936, and for the first time, Harriet Cole reportedly had gifted her remains to the institution. The New York Herald Tribune first described how the “scrubwoman” had “willed” her body to Hahnemann.³¹ When Time magazine reported Weaver’s bequest in late August, reporters added more detail about Cole, now described as “a big-hearted Negro” who worked in Hahnemann’s dissecting rooms and was inspired by Weaver’s dedication to anatomy.³² “She doubtless heard him complain about getting good specimens to dissect” leading to the fact that she “willed her body to the hospital.”³³ Despite thorough efforts to locate contemporary documents, there is no evidence that Cole knew Weaver or admired his anatomical

Figure 3.

In 1898 anatomist Rufus Weaver posed with the prize-winning specimen of the human nervous system. The circumstances of Harriet Cole’s participation (whether she did volunteer her body for dissection) remain obscure. Photo 008_HU_Weaver_Harriet1898.jpg. Legacy Center Archives, Drexel University College of Medicine, http://Drexel.edu/LegacyCenter.

works, nor any evidence of a will or letter that she desired to give her body to the medical school.³⁴ But casting Harriet Cole as someone who responded to the need for anatomical material and the interests of science demonstrates just how available this gesture had become in the popular imagination by the mid-1930s.³⁵

As the references to Cole’s race in popular media make clear, her transformation (and fetishization) into a medical specimen reflects a significant dimension of American medical history that is increasingly receiving greater attention. Since the 2010 publication of journalist Rebecca Skloot’s The Immortal Life of Henrietta Lacks, the exploitation of the bodies—living and dead—of people of color in research and education has fostered much greater probing of a once-invisible, certainly less-explored racialized, medical violence that fostered the development of medical knowledge, enhanced professional careers, and established lucrative industries.³⁶ Recent work in the history of medicine and public health has generated sophisticated analyses of how assumptions about racial identity and the implications of racial differences not only materially altered knowledge production and patient and/or research subject experience, but continue to contribute to current disparities and inequities in disease experience and health outcomes.³⁷ Elsewhere we explore at greater length the structural and racialized dimensions that influenced how Harriet Cole as a working-class African American woman became a source of human material for Weaver’s specimen creation, and the exquisite irony—given the historical exploitation of bodies of color in American anatomical research and education—of her media canonization in the 1930s as “a big-hearted Negro” who willed her body to Weaver and the medical college.³⁸

In addition to what appeared in newspapers and magazines, occasional traces of lay interest in donating surface in anatomists’ records in the early decades of the twentieth century. Minnie G. Faber, for instance, wrote to the Anatomical Board of Pennsylvania on July 21, 1922, “saying that she wants to leave her body to science.” The board secretary did not record his answer to this inquiry.³⁹ In 1928–29, the curator for the unclaimed dead for Northern California (certainly the best job title we have encountered) included in his report to the Department of Public Health a note about Eric B. Morton, who died indigent. He died indigent and he left a will giving his body to a doctor in San Francisco, Dr. Ethan Allan Smith. Smith, the note continued “had no use for it.” Morton’s relatives consented to send his body to the College of Physicians and Surgeons where, presumably, it was dissected.⁴⁰

In 1932, Frank Ritter wrote to the Missouri Anatomical Board saying that he wanted to donate his body. The chairman of the board returned a nice letter saying that since Ritter lived in Kansas, he needed to contact a medical school in that state; he also wished him “to look forward to using that body of yours for some time to come.”⁴¹ This response showed no surprise about the request and expressed gratitude, if not enthusiasm, for this potential gift. As the Great Depression worsened, medical schools in Missouri had no trouble stocking their anatomy departments and did not think to solicit donations—yet.

In a 1922 radio broadcast longtime New York City health commissioner Hermann Biggs reminded his listeners that “the human body is the only machine for which there was no spare parts.”⁴² With the spectacular arrival of corneal transplantation in the late 1930s, many Americans would have questioned his claim. “In the past few years,” noted Dr. Sidney A. Fox in his 1944 book, Your Eyes, “nothing about the eye has received more publicity than corneal transplant. . . . It has restored vision to many eyes that would otherwise be blind.”⁴³ Even before the first eye bank was established in 1944, a group of Californians had organized the Dawn Society, whose members pledged to make their eyes available for transplantation for postmortem use. By 1944, this lay organization was receiving more than a thousand letters a month from individuals seeking to pledge their eyes after death.⁴⁴ At the same time, unprecedented numbers of Americans participated in blood drives organized by the American Red Cross as part of the American war effort.⁴⁵ The body politic had developed a radically new understanding of participatory citizenship.

Just as the idea of blood donations and postmortem gifts of corneas made a significant impact on popular consciousness, the number of available unclaimed bodies began a slow, steady decline in most areas. We see this trend in data from cadaver records, in anatomists’ papers, and in the minutes of anatomical boards. In Missouri, for instance, the number of bodies obtained under the Anatomy Act plummeted 46 percent in just a few years, from 490 in 1939–40 to 226 in 1943–44.⁴⁶ While the numbers of unclaimed recovered from that low for a while, they never reached the level of the 1930s again. In California, to take another example, the number of unclaimed bodies in Los Angeles County went from a high of 1,742 in the fiscal year 1934–35, to a low of 321 in 1944–45.⁴⁷ Given the number of unclaimed dead that typically went to autopsy or were otherwise unusable for dissection, this was not a comfortable margin to provide an adequate supply of cadavers for medical education. With the opening of a new medical school at UCLA on the horizon, the pressure intensified.

Across the country, anatomists blamed a host of factors to explain the decline in the number of anatomy act bodies: poorly conceived new laws that allowed county, city, and state welfare departments to bury the unclaimed; overeagerness of hospital staff to perform autopsies; World War II; the start of broad Social Security Death Benefits in 1950; easier ways to find and contact relatives; increasing numbers of veterans eligible for military death benefits; and the general rise in prosperity.⁴⁸ In some areas, anatomists put considerable energy into trying to increase the supply of unclaimed bodies, reaching out to state, county, and city public hospitals to discourage them from turning over unclaimed bodies to welfare officials and from performing excessive postmortems.⁴⁹

In the reports of the California curators of the unclaimed dead, Dr. Guy Milberry, in Northern California, noted in 1936 that his office had received “four inquiries concerning the bequest of bodies to the University.”⁵⁰ These brief notes continued for the next eight years, but now without any indication that anyone ever accepted a bequeathed body, likely out of concern that not all relatives agreed to the donation. In a case that went to the California State Supreme Court in 1900, the justices had ruled that no person could will his or her body to anyone, following general English and American precedents that the dead human body was not property. In the 1900 case, John Enos had left a will declaring that Rachel Snyder, the woman with whom he was living at the time of his death, could decide where, when, and how his body would be buried. Enos’s wife and daughter objected strenuously and sued to obtain his corpse. The justices agreed that Enos’s will was invalid and that the wishes of the deceased, whether in a will or not, were irrelevant if those with the legal duty to inter the body rejected them.⁵¹

Making premortem plans to will one’s body for dissection or body parts for therapeutic use thus had ambiguous legal status in midcentury America.⁵² So, according to his own account, in 1946, John Bertrand deCusance Morant Saunders, professor of anatomy at the University of California Medical School in San Francisco and curator of the unclaimed dead for Northern California, decided to push for new legislation. He knew from the start that he had to connect whole-body donation with a legal right to will tissues, especially eyes, to an organization or institution.⁵³ He found a helpful legislator in Ernest C. Crowley, a representative who had been blinded in an accident at the age of twelve. While corneal transplants could not restore his own sight, Crowley’s advocacy added moral weight to the new laws.⁵⁴

Governor Earl Warren approved the bills changing public health law (law of cadavers) and probate law (law of wills) on May 1, 1947, despite the qualms of one of his advisors. Deputy Attorney General E. G. Benard felt that “however well intentioned . . . such legislation may be, it completely ignores the sensibilities and feelings of even the closest surviving relatives.”⁵⁵ Another advisor responded that “although there are instances where injustice may prevail, such cases will be outweighed by the benefits of this bill.”⁵⁶ A key part of the new law “relating to control of the disposition of the remains of a deceased person” was the clause that individuals could not be sued if they followed the instructions to donate the body in the deceased’s will, even if the will later turned out to be invalid.⁵⁷

The effects of the enabling legislation for its first few years are still unknown, but by the fall of 1952 positive stories reached the newspapers. In November, for example, the San Bernardino County Sun reported that “100 Alumni to give bodies to UCLA” medical school, which had opened in 1951.⁵⁸ By 1958, the anatomy department had more than fifteen hundred will forms on file and began to refer those wishing to donate their bodies to anatomist Harold Shryock at the School of Medicine of the College of Medical Evangelists at Loma Linda, California. Among those turned away was urologist Elmer Belt, who had been instrumental in the founding of the UCLA medical school. In 1958 the physician returned his signed forms to the chair of anatomy at the College of Medical Evangelists, and when he received a wallet card stating his intention to donate his body, promised to place the card in his pocket to have with him at all times.⁵⁹ By 1959, Charles Sawyer, chair of anatomy at UCLA’s medical school, reported that the school’s dissection material came exclusively from their Willed Body Program. Because the program received nearly a hundred completed and signed will forms each month, they were compelled to institute a “second moratorium on the acceptance of forms for the calendar year 1960.”⁶⁰ When they reopened the program in January 1961 for two weeks, they received some two hundred requests for will forms during this time.⁶¹

Other states followed California’s lead in the 1950s. Florida, preparing for the opening of its first medical school in 1952, passed a portmanteau law that officially went into effect in 1953. It was both an anatomy act, directing that unclaimed bodies be turned over for “the promotion of medical science,”⁶² and a whole-body donation act, allowing “any person being of sound mind” to will “his or her body . . . for the advancement of medical science.”⁶³ Relatives started to donate bodies right away, with the first arriving in July 1952, along with three unclaimed dead; the first donor who had signed a premortem donor form appeared three years later, in August 1955.⁶⁴ By that year, eight other states had passed laws enabling anatomical gifts. By 1959, the total was twenty-four. According to a report compiled by the National Society for Medical Research (NSMR), a research advocacy group formed principally to defend animal experimentation from its post–World War II critics, anatomists in Connecticut, Vermont, Washington, and the District of Columbia were all accepting whole-body gifts as well, even without enabling acts.⁶⁵

Acceptance of anatomical gifts was only one way in which American deathways were undergoing profound changes. Scholars Gary Laderman, Lawrence R. Samuel, Karla F. C. Holloway, and others have mapped the transformation of death and dying in American culture in the first half of the twentieth century. In so doing, even as they have pointed to the ways in which the hospital slowly began to take center stage in the dying of Americans, they have privileged the consignment of the dead body to the funeral director and the professionalization of the funeral industry.⁶⁶ As funeral directors (trained in “mortuary science”) displaced more humble undertakers, these professionals presided over such technologies as embalming, arrangements for viewing the deceased, and interring the dead body. The outsourcing of the dead body, to no one’s surprise, greatly inflated funeral costs. As noted earlier, already by the late nineteenth century many Americans worried that the cost of providing even a “bare-bones” funeral was beyond their means, let alone body preparation and a funeral with more extravagant and ornate details and flourishes. Concerns about the economic burden of funerals grew more strident by midcentury, when even funeral directors themselves recognized the need for reform (like other professionals, they had created a Code of Ethics to guide their members).⁶⁷

Within the complex changes in American deathscapes, two developments intersected that fostered the growing acceptance of body donation. The first is the development of the movement toward simple burial. Energized by the creation of memorial societies (the first originated in 1939) the movement, fostered by Unitarians, Quakers, and other denominations, actively sought to advance “simplicity, dignity, and economy in funeral arrangements through advance planning.”⁶⁸ As Reverend Josiah Bartlett, a Unitarian minister and a founder of the Bay Area Memorial Society, noted, “my people are in increasing rebellion against the pagan atmosphere of the modern funeral.”⁶⁹ The emphasis on opulence and excess in funerary display obscured the spiritual meaning of death and the transition to another world. In their materials, memorial societies emphasized the opportunity for use of the dead body by providing information about bequeathing a body to a medical school and donating one’s eyes to an eye bank. In the 1962 edition of A Manual of Simple Burial, the “bible” of memorial societies, Ernest Morgan included a directory of Eye Banks and explained the procedure for donating one’s eyes, as well as a directory of schools of medicine and dentistry who would accept whole bodies, along with a sample bequeathal form.⁷⁰

Morgan’s efforts to promote body bequeathals received a sensational boost when he provided similar information to English journalist Jessica Mitford, who included his directory of medical schools in her 1963 bestseller The American Way of Death.⁷¹ Mitford’s scathing exposé of the American funeral industry, with its searing depiction of the greedy exploitation of vulnerable survivors, rocked the funeral industry and represented a major turning point in American attitudes toward the disposition of the dead. Among the thousands of letters that Mitford received from her magazine articles and her 1963 book were letters seeking even more information about body donation, expressing admiration for her work, and reflecting the shifting attitudes toward the afterlife of the dead. Jessie Hirschl, for example, wrote that “I belong to a Memorial Society, my eyes go to the eye-bank, the rest of me to the University of Ill. Med. School. My tongue will be employed, until then, in encouraging people to read this civilized and useful book.”⁷²

Mention of donated bodies in cadaver records are exceedingly rare until the late 1940s, and even then have an aura of ambiguity. For example, Bertha H. died in Maryland on July 27, 1947. Her record simply reads “This body turned over to Med. School by son.”⁷³ It is not at all clear what “turned over” meant. Given at the wish of the deceased? Given because the son wanted to benefit medical science? Given because the son did not want to deal with the body of an estranged mother? Was this an autonomous donation or not? This long-standing uncertainty haunts cadaver records in the 1950s and 1960s in cases where no donor forms survive. In Maryland, some relatives “released” bodies to the anatomy board;⁷⁴ others “gave consent for Anat. BD. disposal.”⁷⁵ In 1966, one family, faced with a brother’s death, “because of lack of funds donated his body to the Anatomy Board.”⁷⁶ What was technically an unclaimed body because the relatives could not pay for its disposition became a virtuously donated body with just a shift in perspective.⁷⁷

Even as anatomy departments were developing forms for individuals to establish premortem consent for use, what mattered was the relatives’ decisions about body disposition, from abandonment to donation. The records regularly noted when family donated a body at the deceased’s request, even if they never filled out donor forms. But relatives’ decisions continued to trump donor wishes, despite properly filled out donor forms and the laws that legitimized anatomical gifts. If anatomists received a donated body and the family wanted it back for burial or immediate cremation, anatomists acquiesced.⁷⁸ (They still do.)⁷⁹ Some early donor forms required the signature of one or more immediate next of kin to document their advanced consent, although anatomy departments or boards could hardly hold relatives to the agreement if they were never informed about donors’ deaths.⁸⁰

The important question here is not simply why postwar Americans started to donate their bodies to medical science and education, since the wish to do so dates to before the Civil War. The important question is: “Why did donation take off so quickly to be a self-sustaining movement?” (The Missouri records demonstrate this shift quite vividly—just follow the dotted line’s upward trajectory after 1957 in Figure 4.) The very people who passed anatomy acts to protect themselves and their families from ending up on a dissecting table were the ones who, two generations later, volunteered to be dismembered: predominately white, middle-class Americans.⁸¹

Figure 4.

Missouri Anatomical Board, unclaimed and donated bodies, 1907–8 to 1977–78. Compiled from the Annual Reports of the Missouri State Anatomical Board, Box 1, State Anatomical Board, Record Group 106, Dept. of Higher Education, Missouri State Archives, Jefferson City.

We approached this question already by noting the overall increasing acceptance of memorial societies and the criticism of expensive funerals in American culture in the 1950s and 1960s. The reasons that donors gave in their letters to anatomists help us to move from hypothesizing about the broad role of changing attitudes toward the body, death, and funerals to glimpsing what individuals wanted anatomists to believe about their motivations. Donor letters are, of course, simply fragments of evidence about past choices, just as the bequests and suicide notes in newspapers are, but they provide much needed insight into the varied and overlapping goals that donors expressed. They underscore the challenge of understanding Americans’ perceptions of just what it was they thought they were doing.⁸²

Several donors expressed their utter disregard for their bodies’ fates. “It is of no concern to me what becomes of my carcass after death,” wrote one Florida donor in 1956. A woman in 1960 demonstrated her lack of interest in “proper” disposition by remarking, “If my body isn’t wort[h] any thing [sic] just t[h]row me in the ocean.”⁸³ “I am a freethinker,” stated Harry F., a toolmaker, in 1958, while Louis W., in 1962, proclaimed that he did not believe in God.⁸⁴ Such comments mark Americans’ increasing willingness to openly reject any nod to religious belief surrounding their physical remains. In the coming decades, anatomists would promote statements by religious authorities who assured Catholics, Protestants, and Reformed Jews that not only did body donation follow sound theological doctrines, but in many states the body could also be present (if properly embalmed) for a viewing or funeral.⁸⁵ Such assertions helped to dispel any worries that donating was irreverent; “dissections shall have as their end the physical and spiritual welfare of man so that dissection never becomes an end in itself,” opined Cardinal Cushing, Archbishop of Boston, in 1962.⁸⁶

Some donors wrote about their descent into poverty or their distaste for funerals and were relieved that anatomy departments covered the costs of a no-fuss final disposition.⁸⁷ “I wish to spare my family the barbarous racketeering practices of the morticians,” wrote a Californian to UCSF in 1956. Thankfulness for lifetimes of medical care inspired still others: “My action is not a great thing for me to do,” noted a Miami woman in 1961, “it is a gesture of admiration and gratitude for the expert services given me for 74 years.”⁸⁸ Yet another man stated that he wanted to give because he understood that “the University of Maryland Medical School would like to get the bodies of average people for scientific work, instead of the indigents.”⁸⁹

What relatively few donors expressed was awareness that their bodies were very likely going for medical students to dissect, with all the postmortem dismemberment that meant. A Florida man was one of this handful: “It would please me greatly,” he stated, “if I could give [my body] to the Medical School of the University of Miami, to be used by students for dissection or for whatever other use, or purpose, to which they should put it.”⁹⁰ Many more expressed this end with vague statements about hoping to contribute to medical education, although one added that he wanted his “skeleton to be utilized for teaching purposes,” which suggests he had a good idea of how bodies ended up.⁹¹ Even more vague were those who simply wanted to be useful, to benefit humanity in general. His gesture, a man hoped in 1966, might “help make this a better world.”⁹²

Indeed, one of the most common tropes in donor letters, as it had been in bequests and suicide notes reported in newspapers, was the intent to help “medical research” or “medical science.” Anatomists contributed to this altruistic vision in their correspondence with donors in the 1950s and 1960s, praising the offers individuals were making to benefit “medical science.”⁹³ In 1955, the NSMR surveyed American medical schools about their problems obtaining sufficient cadaveric material for anatomy teaching. In 1962, a group of anatomists worked with the NSMR to prepare a sample card for individuals who wanted to donate their bodies after their deaths. Intended to be carried on the person so there would be little delay once death occurred, the card featured a Bible text for inspiration: “The spirit of man is the candle of the Lord” (Proverbs 20:27). It went on to laud “the noble act of donating his or her body . . . for the advancement of medical science so that future generations may be more richly blessed by the great gift of health.”⁹⁴

Popular magazine articles reinforced the idea that body donation benefited medical science. “Every individual who bequeaths his remains to a medical school makes an important contribution to the advance of human knowledge,” wrote J. D. Ratcliff in the widely read Reader’s Digest in 1961.⁹⁵ That same year, Mildred Brooks recounted her experience with donating her husband’s body—“that was what he wanted”—in the face of surprise, uneasiness, and even disapproval. But she had no regrets because she had an opportunity to “help medical science and humanity.”⁹⁶ Three years after his death, she was finally speaking out about their decision “because of the importance of this subject to science.”⁹⁷

“Medical science” was a potent catchall for prospective donors. But some donors clearly thought that whole-body donation contributed to the therapeutic goals of eye, tissue, and organ donation. After having signed the forms to donate her eyes to an eye bank, for example, one Maryland donor wrote that she had been inspired to inquire about whole-body gifts after “read[ing] about donating one’s body to Medical Research, for grafting and transplanting parts, to others, injured, diseased, etc.”⁹⁸

Others unsurprisingly continued to conflate “medical research” with post-mortem examination. Several inquirers expected to receive autopsy reports from anatomists. Ingebord R. wrote to the funeral director who had handled her husband’s body asking for the autopsy results on her husband’s brain. “It means a great deal to my daughter Ava and me to get this autopsy report.”⁹⁹ The funeral director forwarded her letter to the Maryland Anatomical Board, which had to respond that no autopsy was done. “Inasmuch as a complete autopsy would defeat the purpose of the Anatomy Board in furthering medical education, we have not made a post mortem examination, however, we hasten to assure you that [Dr. R.’s] body will be most helpful in the instruction and training of many new doctors,” Vernon Krahl, head of the board, promised her.¹⁰⁰ While not explicitly saying that they expected their remains to be autopsied, quite a few prospective donors wrote that they intended their bodies to be studied to learn about the diseases they suffered from, including arthritis, “backaches and pain in the bladder region,” emphysema, cancer, and rheumatic heart trouble.¹⁰¹

In 1954, a woman wrote to the President of the University of Miami to complain that she understood her brother’s body had been given to the school for cancer research. “We assumed and understood that releasing the body for cancer research simply meant that there would be an autopsy to see if anything could be learned regarding cancer and that immediately following that, the body would be cremated.” After learning that the body could be used for any purpose for a year or more, the family wanted it back, even though his wife had authorized the gift. “This has completely disturbed us,” the sister explained, “and is definitely not what we intended.” The anatomy department released his body right away.¹⁰²

There were times, too, that anatomists felt pressured to accept a donated body even when it was not suitable for dissection. As he was dying, John R. Wheaton, a nineteen-year-old student at the University of Miami, told his roommate that he wanted to give his body to the medical school; this human-interest story appeared in the Miami Herald on May 2, 1963. But by that time, the anatomy department had rejected the remains because he had undergone many abdominal operations. There was much confusion about the status of the body when relatives complained to the president of the university that the donation meant a great deal to the “grief-stricken parents.”¹⁰³ The medical school reversed its decision and the parents eventually received a very kind letter from John Finerty, professor of anatomy, who assured them that “everything is being done to ensure that John’s last wishes will be carried out.”¹⁰⁴

These examples from donors’ letters and forms of course confirm Americans’ postwar enthusiasm for medical research after the astonishing therapeutic successes of previous decades, especially blood transfusion, corneal transplants, antibiotics, and, in 1955, the first effective polio vaccine. To contribute to such noble pursuits inspired ordinary citizens to donate their money to research cancer, heart disease, lung diseases, and many other disabling and deadly conditions. But corporeal philanthropy, giving the whole body, marked a new dimension in altruism, one that reversed centuries of disgust at the very idea of ending up dead in a medical school. Ironically, even a few individuals who identified themselves as “indigent” chose to donate their bodies.¹⁰⁵

Framing whole-body donation as a contribution to newly efficacious medical research and medical science gradually erased the profaneness of dissection and dismemberment for many Americans. Anatomists deliberately used “medical science” and “medical research” to obscure the grim realities that had titillated audiences of nineteenth-century gothic fiction, newspaper stories about the horrors of dead bodies floating in tanks at medical schools, and tragic accounts of loved ones rescued from dim dissecting rooms and cavorting students. New images of medical students, like those in the Life spread in 1950, reinforced the reputations of young doctors-to-be as serious, hardworking medical protégées. The photograph of Tom Peterson holding the hand of his shrouded cadaver at the University of Michigan (Figure 5), for instance, promoted a vision of the modern, science-oriented student respectfully approaching a delicate task.

By the 1950s, moreover, nearly all popular museums showing human anatomical specimens (other than bones) had closed. (Their twenty-first-century return in Body Worlds exhibits of plastinated bodies belongs to quite a different narrative.) So, too, had dissecting room photographs disappeared as a popular genre for medical students’ self-expression, although they no doubt surreptitiously survived long after as private mementos.¹⁰⁶ As donated bodies became a new norm, moreover, anato-mists consciously proclaimed that they were treated with “great care” and “reverence” by students and researchers.¹⁰⁷ While claims that students treated bodies respectfully can be found in the 1930s, whole-body

Figure 5.

Medical student Tom Peterson in the anatomy lab. Note the solemnity and reverence of the student’s gaze, a world away from the nineteenth-century irreverence associated with anatomy students. “Medical School: Four Hard Years Turn Michigan Students into Doctors,” Life, May 1, 1950, 95./Shutterstock.com.

donation gradually transformed the dissecting room. Certainly, by the 1980s, anatomists demanded that students behave with decorum and discretion.

Our evaluation of the changed fortunes of body donation—from eccentric and occasional report to a well-established and respected form of disposition of the dead body—has benefitted from studies of the anthropology and history of death in America that focus on the funeral industry and organized religion. As we noted earlier, death studies scholars have signaled the increasing centrality of the hospital to profound changes in American deathways. Much more than the spatial displacement of death from the home to the hospital animated Americans to consider the radical step of requesting that their remains be sent to the medical school. Here historians of medicine have much to contribute to the field of death studies by fleshing out the myriad ways in which the cultural authority of physicians and medical institutions rested on changing expectations about the role of medical science in delivering powerful new technologies and therapeutic interventions, about the role of the doctor to intervene meaningfully in the dying process, and the place of new conventions in medical education and medical identity that beatified physicians at the bedside. Parsing the many meanings of such potent signifiers as medical science and “to advance medical science and humanity”—using the words and phrases of potential body donors themselves—thickens our understanding of the historically contingent and increasingly medicalized cultural attitudes toward the dead body.

As Alma Merrick Helms recounted in 1956, she hoped that donating her body to Stanford Medical School might well be “the most generous act of her career.” Just as Helms and generations of Americans retreated from intimately experiencing others’ deaths, and embalming protected them from experiencing decay, medical science created an uplifting final disposition, a new narrative for the social death that eased individuals out of this world. Because the ultimate end for bodily remains used in medical schools was usually cremation, moreover, those who already welcomed this replacement for whole-body earth burial could imagine resting as ashes and slide over what happened to the body between death and the fire. They could imagine white-coated acolytes treasuring this new, voluntary sacrifice of human flesh and bones behind the closed doors of the medical school, as they, for a while, rested in pieces.