The University of Southampton

Author: Amy Sturgeon

Medical Cadavers Throughout History

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As someone who is very interested in biological fiction, I am currently reading ‘The Body’ by Bill Bryson. I came to the chapter, ‘In the Dissecting Room: The Skeleton,’ and was intrigued to hear that medical cadavers have been the topic of various controversies throughout history. Soon after reading this, I also attended the ethics and law lecture, which led me to delve deeper into the issues and history of acquiring medical cadavers for teaching.

‘The body’ by Bill Bryson. The book that sparked my curiosity of medical cadavers. https://www.waterstones.com/book/the-body/bill-bryson/9780552779906

Where did medical cadavers previously come from?

Public opinion of dissection around the 18th and 19th century, even for the benefit of science, was seen as sickening and disrespectful. Fitting with the questionable ethos of the time, only hung criminals were seen to warrant this brutal fate. I was appalled to discover that this was justified by judges who believed murderers deserved further prosecution after their execution, so offered their bodies up for dissection without choice.

Why did this need to change?

Still, there never seemed to be enough cadavers to distribute between medical schools. Bryson mentions in his book that in 1831, London had 900 medical students with only 11 cadavers. This ultimately led doctors to turn to grave robbing. These hellish actions were not a punishable offence at the time, which only encouraged them to continue. I was shocked to hear this, but it made me realise that legal enforcement was the only way forward to put a stop to the clearly desperate thievery. My research led me to find that the Anatomy Act of 1832 was enforced because grave robbing had gotten too out of hand. This allowed medical institutions to also take ownership of the bodies of unclaimed poor persons.

Cadavers are dead human bodies that are preserved and used by medical schools to aid the teaching of anatomy to students. https://en.wikipedia.org/wiki/Cadaver

While this seemed to fix the shortage and improve standards of anatomy textbooks, I found it shocking to believe that the financial status of a person upon their death should determine the fate of their body. Can the sacrifice of convicts and the poor be justified for the greater good of science? Rather than discarding abandoned bodies, should they be put to better use? I can see balance in this argument, but it is hard to believe doctors had free license to dissect unclaimed bodies. This opinion was shared by many.

“They tell us it was necessary for science. Science? Why, who is science for? Not for poor people. Then if it is necessary for science, let them have the bodies of the rich, for whose benefit science is cultivated.” – William Cobbett (1763-1835, advocate for English poor and working-class)

Where do medical cadavers come from now?

Under the Human Tissue Act 2004, written and witnessed consent for anatomical examination is required prior to death, it cannot be made by anyone else after a person has died. In the UK, It is illegal to buy and sell human remains, therefore modern medical schools rely entirely on donations of those willing to give their bodies for science. I was even pleasantly surprised to hear that some schools are positively overwhelmed by donations that they must turn away excess offerings.

A current perspective:

I was intrigued to see what current medical students thought about cadavers and the regulations implemented by Southampton University. I consequently conducted a short interview with a student which I found very insightful, as shown below.

Video of the short interview I conducted with a current medical student at the University of Southampton.

A real-life nightmare:

News article describing the incident of a Nigerian medical student that attended an anatomy lesson which used the dead body of his former friend that had been shot, killed and unclaimed. https://www.bbc.co.uk/news/world-africa-57748122

Unfortunately, I was devastated to find that some countries still use unclaimed bodies for teaching. I found a truly awful news article where a student from the University of Calabar in Nigeria was traumatized by an anatomy class that used the dead body of his friend. I discovered that 90% of Nigerian medical cadavers are criminals killed in shootings. Whilst this story truly horrified me, it shows that there is still a global shortage of legitimate cadavers .

I believe there should be tighter universal regulations that limit the distribution of unclaimed bodies for science, but similarly increase international positive awareness to encourage more people to donate their bodies. This may be the only solution to permanently fix shortages without overstepping ethical practice.

Reduce, Re-use, Recycle – Environmentally Friendly Prosthetics?

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Following both prosthetic workshops and after hearing about the ZeroThirty initiative hoping to see the NHS carbon neutral by 2030, I began to wonder whether the conventional plastic used in prosthetic components could be sustainably sourced or even recycled. Being someone who is passionate about developing a greener future and currently conducting a research project in sustainable land management, this led me to wonder whether environmentally friendly prosthetic limbs already exist via the creation of new prosthetics re-using wasted materials or recycling those that no longer serve their owner purpose.

By prolonging the working lifespan of such a persistent material, could this reduce the unnecessary contribution of yet another source of plastic to the growing waste accumulation and help keep the NHS on track towards its target?

Recycled Plastic Prosthetics:

Prosthetic leg structure. https://www.physio-pedia.com/File:AKparts-of-a-prosthesis-268×300.jpg

While you wouldn’t expect false limbs to make up a large portion of landfills, the materials used to make prosthetic sockets and implant components, include high density molecular weight polyethylene (UHMWPE) and other thermoplastic polyethylene. UHMWPE has a very high strength to density ratio needed to withstand large amounts of stress while being relatively lightweight compared to titanium or ceramic materials that have also been used. One key feature of UHMWPE is its longer chain structure which is able to resist heavy loads more effectively resulting in being a high impact strength. However, thermoplastics do not biodegrade and will therefore persist in the environment.

UHMWPE components used in artificial joints. http://article.sapub.org/10.5923.j.ijbe.20110101.02.htm

This only becomes an issue when prosthetics are no longer required by a person, due to outgrowing replacements, gaining upgrades or eventual death. In 2019, researchers from De Montfort University (DMU), developed a recycled prosthetic limb by pulverizing plastic bottles and spinning them into polyester yarns that were moulded upon heating. Dr Kandan stated that, “Upcycling of recycled plastics and offering affordable prosthesis are two major global issues that we need to tackle.” Not only is this solution more cost-effective, but it is also more durable. The DMU team claimed that price per socket could be reduced from £5000 to only £10.

Evolution of recycled plastic prosthetic development. From discarded plastic bottle, to polyester yarns and finally moulded prosthetic limbs. https://www.weforum.org/agenda/2019/10/plastic-bottles-waste-prosthetic-limbs/

In 2015, the World Health Organisation estimated there were 40 million amputees in the developing world with only 5% having access to prosthetic care. Due to the staggering cost reduction, the largest beneficiaries of the recycled prosthetic limb are presumed to be amputees in developing counties, bringing a more financially accessible option to areas with limited resources and narrowing the inequality treatment gap. Although, there is little long-term evidence that this creation performs the same quality of function as modern prosthetics, so it is difficult to assess long-term benefits (or possible disadvantages) of using a prosthetic limb that is so different from all that came before it. Another issue is the weakened chemical structure of the plastics and questionable longevity once in use again. Are these unknown risks going to do more damage? Only time will tell …

Re-using prosthetics:

After further research into solutions to tackle the barriers of cost, supply and demand of prosthetics for amputees in developing countries, I discovered the Legs4Africa charity which does exactly that. Relying on public donations, recycled prosthetic legs are shipped worldwide to Africa. Since 2014, over 12,000 prosthetic legs have been collected, allowing amputees to return to work and regain a higher quality of life.

Pie chart showing the proportion of prosthetic leg donations from each country involved in Legs4Africa. UK has the highest number of donations of all participating countries. https://www.legs4africa.org/recycling/

The short video below demonstrates the incredible work Legs4Africa has achieved making a huge difference to the lives of so many.

Final thoughts:

Though both aspects explored in this blog are small contributions, they are headed in the right direction. Extending the life of prosthetics to fulfil pressures of demand and repurpose existing materials to limit consumption and waste generation could become revolutionary. There is a long way to go, and I believe that with a scrupulous trial of performance, recycled prosthetics could really take off. This topic is so important and I find it fascinating that large prosthetic manufacturers have not yet made the link between sustainable regeneration of plastics in prosthetics. What does this suggest about its reality?

Engineering Replacement Body Parts practice Blog

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As a natural scientist, my interests remain very broad, however, I mainly focus on organic chemistry and aspects on immunology and pharmacology. I began studying cellular biology in my first years at University, but have since diverted my interest along the immunotherapy pathway focusing on selective toxicity.

This module will allow me to extend my understanding of real-life applications and ethics behind the closed doors of engineering replacement body parts. I am particularly intrigued to look closer at the medical ethics aspect of the module, as a future in ethics or patent law is something I am considering. Equipping myself with the knowledge and reasoning behind the implications of stem cells and medical devices, will help me to learn the foundation of assembling scientific reasoning which I can apply to further and current examples in the medical industry and impact such inventions will have on society.

I am excited to explore prosthesis and the mechanics involved in installing false limbs, something which I have never looked into before. This module is very significant and I believe it is important to spread the awareness behind new and technological advancements.

In line with the ethos of the Natural Sciences course, this interdisciplinary module focuses on improving student skill set beyond written exams, via reflective learning and interactive discussions.

A short video describing the key aspects of medical ethics.

Amy Sturgeon