Approaching the Ethics of Human Remains from a Medical History perspective. Report from the AAHM meetings.

May 11-14, I attended the annual meeting for the American Association for the History of Medicine at the University of Michigan in Ann Arbor. I chaired a roundtable entitled “Historical Medical Collections, Human Biomaterials and Remains” which explored the multiple ethical challenges surrounding historical medical collections, a category that is problematized also in Ethical Entanglements.

By historical collections the round table referred to the medical museums and anatomical and pathological cabinets that from the mid 18th century that all played a central role in medical research and pedagogy. At the time, and in the century and a half that followed, they functioned not only as reference points for medical knowledge production and reproduction, but also as shrines to medicine, the science, its men and their achievements. In the 20th and 21st centuries however, they are being perceived in new ways. Now the darker sides of their origin is coming into focus: unregulated trade, theft, and ethically dubious collection practices permeated the practice before institutional, professional and state governance and the development of professional ethics centered on bioethics and informed consent reshaped medical and anthropological practice. Nobody can contest the important contributions these collections made to our medical knowledge, our understanding of the human body, its biology, and the pathways to healing it. However, the dark past that looms over the legacy of these collections ties them to structures of classicm, racism, sexism, colonialism, and authoritarianism, that all facilitated their coming into being. 

It is – without a doubt – a troubling legacy. 

The Michigan Union at University of Michigan campus in Ann Arbor was the venue for the annual conference for the American Association for the history of Medicine, May 2023. Photo by Liv Nilsson Stutz.

Today, new methods and technical advances have made these collections less relevant for teaching medical students and for carrying out research on human biology, anatomy, and pathology. As their “value” for medicine has decreased, they have come under increased scrutiny and criticism with their troubling legacy casting longer and darker shadows, to the point of calling into question their continued existence. We are starting to hear more and more voices calling for their destruction, deaccessioning, and limitations in terms of both public access and research. 

While recognizing the importance of the criticism and the dark legacy, this panel problematized this development and asked: Are there multiple and competing ethical claims to consider when exploring the theoretical, political and practical challenges facing these collections and the institutions that care for them? What are the possible futures for these collections? What role should they play for medical professionals, for scholars, in education, and for the public? As these collections no longer hold the status of shrines, can their role be redefined in productive and ethical ways, for example as public facing centers of historical research and exhibition – and if they are, can these centers be imagined in a way that also considers their dark history to operate as democratic, inclusive institutions in a way that adhers to the contemporary role of museums (as defined by ICOM)? What are the best ethical policies and practices when we approach these complex issues? 

While recognizing the ongoing debate, which for the sake of simplification can be characterized as postcolonial debate, and that tends to be centered on specific categories of remains, and without trying to ignore or suppress it, the round table sought to explore additional questions around value, use and multiple ethics that tend to be marginalised in the current conversations. We came to this conversation from different experiences – from the fields of medicine, history and archaeology – all with various experiences of debating these issues on a theoretical level, carrying out research on human remains, and managing museum collections with human remains.

Speakers at the Roundtable on Historical Medical Collections, from the left, Mike Sappol, Olof Ljungström, and Rainer Brömer. Photo by Liv Nilsson Stutz.

The speakers at the roundtable were:

Mike Sappol – a medical historian based at Uppsala university with a significant experience as an exhibition curator and at the National Library of Medicine, and the author of several important books. His work focuses on the history of anatomy, death and the visual culture of medicine and science, the body, the history of museums and queer studies. His paper entitled “Endangered specimens. Historical Human remains and derivatives: competing claims, meanings, critiques, and practices” interrogated and explored the debates surrounding these historical collections and their different and complex values through the case of the Museo Morgagni di Anatomia in Padua: as materiality, artifacts, and perhaps even as a form of “relics of an extinct medical civilization.”

Olof Ljungström – a historian at Karolinska Institutet in Stockholm, where he oversees the anatomical collection. His work focuses on the history of medicine, including 19th century anatomy, race science and the history of research at KI. His paper The Body Politics in the Anatomy Collection: Where the politics of the past meets the politics of the present, contextualized the history of the Finnish crania at the KI collection and the contemporary claims surrounding them.

Rainer Brömer from the Institute for the history of Pharmacy and Medicine at the Phillips University in Marburg, where his research focuses on Anatomy and Pharmacy in the Ottoman Empire, Medical and research ethics, and the body, and where he has also been involved with the Marburg university anatomical collection, its Museum Anatomicum and the conception of a future museum in Marburg. His paper, Gazing at human bodies – epistemology, ethics, and aesthetics discussed the ethical challenges of this project.

After the presentation the room engaged in discussion that included voices form colleagues currently working with historical medical collections in museums across the United States who shared their perspectives and experiences.

“It is always more than one thing”

Lisa Harris in the opeing roundtable “Being a Public Scholar Now” on the subject of abortion

Personally I felt inspired as I made connections between what I was hearing in the room and what I had heard at the opening round table session for the entire conference earlier that day entitled “Being a Public Scholar Now: Obligations, Opportunities, and Dangers” chaired by Susan Reverby with Angela Dillard, Alice Dreger, and Lisa Harris. In her address Lisa Harris, who is an OBGYN, holds a PhD in American Culture, and is an activist for women’s reproductive rights, spoke about her role as a public intellectual and why it matters. Her thoughtful remarks were inspiring and, I believe, tie in with the conversation we were having hours later when discussing historical medical collections. She emphasised two dimensions that drive her work as a researcher and activist. First the presentism of history. “You learn from the past – about what was “bad” then, but you never distance yourself too much from the past, because the problems are still present.” She said, “you can biopsy any moment in American History and you can see similarities today.” The second dimension was her love of history and the ways in which its complexities reveal themselves through research. It is always more complicated than you think, she argued, and you need to embrace the complexity and hold the ambiguities. It is possible that something can be both good and bad, all at once – for example abortion: it is both a death and at the same time the opportunity for life and freedom for another person. “It is always more than one thing.” Given the subject of her research, it was also obvious that taking a stance that complicates the matters at first can be difficult, as many people who are engaged with a topic like reproductive rights may seek and want a more straight forward answer. But ultimately, the only way to really move forward and find the productive and real solutions requires a recognition of ambiguity and complexity. And here, in that recognition, the presentism of history comes back to enrich our sensitivities and our understanding of how phenomena like historic medical collections hold ambiguities and complexities that we need to embrace, not avoid, if we want to understand their potentials and their charge.

featured image: Baby Carraige” by Orin Zebest is licensed under CC BY-SA 2.0.

Reading Alexandra Ion: on ruins, nostalgia, and lonely specimens

Last week the project invited Alexandra Ion, formerly at the Institut de Antropologie Francisc I. Rainer, Academia Romana in Bucharest, to discuss her article “Anatomy Collections as “modern ruins”: The nostalgia of lonely specimens, published in 2021 in Science in Context.

This beautifully written paper explores a range of entangled issues relating to the collection and scientific handling of human remains. The piece departs from the discovery of a strange specimen – a preserved human face in a wooden crate – in the attic of the Francisc I. Rainer Institute of Anthropology in Bucharest in 2010. The face, extracted from a human cadaver at the turn of the last century, showcased a unique method to preserve human tissue developed by anthropologist and pathologist Francisc I. Rainer, a technology that very soon after its conception fell into oblivion, and with it, the scientific relevance of the face itself.

The face in anterior and posterior view.
Original published in Ion 2021. Intentionally blurred for this blog. Published with permission from Alexandra Ion.

The article explores the history of the specimen and contextualises it within the anatomy practice of the time. We can follow a sort of chaîne opératoire of the making of anatomical objects from human bodies, and how the process unfolds in space, in different parts of the building – from the intake on the ground floor, through different rooms of preparation and display. At some point in time as it becomes obsolete and forgotten, it moves out of the public eye into a closed crate in the attic, tucked away with other items from the past, including papers and photographs. An object among objects. Form here it then emerges at the time of its discovery in 2010. But it is changed. No longer a valuable piece to demonstrate technological skill and methodological progress, it has become an uncomfortable artifact of a problematic past. Like many liminal phenomena, by definition situated between categories, it causes discomfort. Ion describes how she moves it through the building to find a place for it that seems appropriate…the office, the lab….it no longer fits anywhere.

The attic of the Francisc I. Rainer Institute of Anthropology. Published in Ion 2021.
Photo by Alexandra Ion. Published with permission from Alexandra Ion.

In many ways the journey described by Ion for this specimen, is typical for many anatomical collections today. They have become matter out of place (sensu Mary Douglas). No longer useful in the way they were once perceived and even made, they have transformed into something strange, historical, and perhaps, to some, upsetting. The transfer of many anatomical collections from medical spaces to history museums is a tangible expression on a larger scale of this redefinition.

The recurring question then becomes: What to do with them? This is a central question also for the Ethical Entanglements project. Ion offers an interesting approach when suggesting that we can view them, not only as archives (which they are), but also as ruins. Drawing inspiration from Thora Petursdottir’s and Bjornar Olsen’s writings on modern ruins, she views them as “caught between the past and present, between fascination and strangeness.” This opens up a venue to explore our own encounter with them as meaningful and important in new ways, drawing on scientific curiosity, but also emotion and nostalgia.

How do ethics relate to this? The paper centres on the multiple ethics entangled in the engagement with human remains – something that our discussion about the paper came to focus on:

“Alexandra’s inspiring approach to anatomy collections as “modern ruins” made me reflect about our responsibility towards human remains collections. As archaeologists, we work on the principle of preservation through documentation, and it would not occur to us to bury an archaeological site before investigation and documentation. Likewise, I believe it is our duty to engage with these legacies, however uneasy they may be.”

Rita Peyroteo Stjerna

“Alexandra’s paper was intelligent, thought-provoking and sophisticated. I was delighted that she was able to talk with us about it. In a wide-ranging discussion, we talked about how we can extend debates beyond the post-colonial critique, about multiple ethics and how we manage the tension between object and person that human remains present, among other things. We talked about circumstances in which displaying human remains might be a more appropriate solution than concealing them. We went on talking well past our scheduled hour of discussion, which is testament to how rich and engaging Alexandra’s work is. I hope that we will find ways to include her in some future discussions.”

Sarah Tarlow

I too congratulate Ion on this important and beautiful paper. The metaphor of the ruin is interesting and captures an important dimension in the engagement with human remains of the past, emphasising the emotional and affective in this encounter, adding an important dimension to the scientific and historical values often mentioned in the debate. But it also has limitations.

“…to me, as ruins these human remains from the past remain inhabited, if not necessarily haunted”

Liv Nilsson Stutz

To me it remains a metaphor that captures an encounter between a subject in the presence of an object from the past. But human remains are not neutral objects, something Ion also discusses. I want to embrace the liminality of the category fully, and recognise, as a point of departure, that human remains from the past always retain a certain level of their subjectivity, also in the present. To build on the metaphor: to me, as ruins these human remains from the past remain inhabited, if not necessarily haunted.

Addressing dark heritage in exhibitions. The University Museum in Groningen.

After our visit in Amsterdam I continued to Groningen which aslo has an anatomical collection on display in its University Museum. Here, the anatomical collection is part of the exhibition on the history of the university and its scholars, and it is thus clearly inscribed in the broader history of research and scholarship. A separate room is dedicated for this purpose. The anatomical display is arranged on stepped shelves organised in a semi-circle, with mounted skeletons on top and with preparations of body parts and organs on the lower shelves. The room has a claire-obscure quality with dimmed lights and spots illuminating the white bones, and the body parts almost glowing through the amber coloured liquid of the old preparations. The display is accompanied by an interactive screen where visitors can see close-up photographs of each displayed specimen and read descriptions about pathologies and preparations. The exhibition is extremely interesting, quite moving, and, I must admit, very aesthetic. 

The anatomical collection arranged on stepped semi shelves organised in a semi-circle. Photo by Liv Nilsson Stutz (intentionally manipulated)

On the opposite side in the same room, an exhibition is devoted to the contribution of Petrus Camper (1722-1789). Camper was Professor Medicinae Theoreticae, Anatomiae, Chirurgiae et Botanicae at the University of Groningen from 1763 and to his death. He was an academic celebrity of his time and a leading scholar in many fields, including comparative anatomy.

Tibout Regters – De anatomische les van Petrus Camper. Amsterdam Museum, Public Domain.

As part of his research, Camper studied the anatomical differences between humans and apes, in particular crania and larynxes. To address the context of this research, the museum signage both celebrates and problematises his legacy. The exhibition called “Bitterzoet Erfgoed” (Bittersweet Heritage) informs us that while Camper lived in a time of colonialism and slavery, he “did not accept this worldview” (i.e. slavery). That being said, the text continues “Camper’s work cannot be separated from colonial history,” as “he collected specimens (human and animal) from colonised regions including the skulls and skin specimens on display in this exhibition.” The next sentence sums up the central dilemma:

“This raises complex questions. We want to tell the story of Petrus Camper, but also treat the remains of people who did not choose to become subjects of scientific research with respect”

Text in the exhibition about Petrus Camper at the University Museum in Groningen.

Several human crania are on display in this part of the exhibition, and a color coded map indicates their provenance including Madagascar, Europe, Java, Russian Republic of Kalmykia, Angola, China, Jakarta, and Mongolia.

Display of skulls from different parts of the world. The crania wee collected by Camper for his research into comparative anatomy. Photo: Liv Nilsson Stutz, intentionally blurred.

The transparent and honest way in which the exhibition communicates about the content of the collections and their problematic history, is interesting and quite admirable. The display of remains such as skin samples brings the hot button topic of racism into focus. The exhibition strikes the balance between communicating that while Camper’s research was not seeking to support racism as an ideology and a “scientific” concept, he still worked within a context of colonialism and othering. And while not explicitly stated, the knowledgeable visitor can probably fill in the blanks as to how this research tradition came to be enmeshed with race science only a few generations later. While taking risk with this display, the museum paradoxically takes responsibility for its collections as it does not try to avoid confronting difficult issues or hide its collections.

Skin samples on display in the museum. To the left, skin samples form humans from different parts of the world, displayed in the Bittersweet Heritage exhibition. The samples were used by Camper to understand human variation between white and black skin. To the right, human tattooed skin (the face of a woman and the British and Norwegian flags) exhibited with the skin of whale to illustrate Camper’s work in comparative anatomy. Photos by Liv Nilsson Stutz, intentionally blurred.

Interestingly (and typically) the problematisation is limited to the anthropological research and exhibition, and does not discuss the medical collection displayed only a few meters away in the same room. The context of the “bitter sweet heritage” is not extended to include collection practices from other contexts (such as, presumably, maternity wards and other care facilities). This relates to a more general pattern that we can see in how different categories of human remains sometimes are treated with different consideration and levels of problematisation.

Museum Vrolik and Body Worlds Amsterdam: reflecting on two exhibitions of human remains

In early November, we (Sarah Tarlow and Liv Nilsson Stutz) visited the Netherlands with the objective of viewing two different exhibitions of human remains: Museum Vrolik and Body Worlds, The Happiness Project, Amsterdam. While we realised it would be two distinct experiences, we were not quite prepared for just how radically different these two exhibitions would be, and how entangled the ethics of it all would appear at the end of the day.

The signage to the museum in the hospital foyer underscores the medical context of the collection. Photo by Liv Nilsson Stutz.

The Museum Vrolik is located on the bottom floor of the Amsterdam University Medical Center. As you enter the building you find yourself in a contemporary hospital, but as you turn left and enter the dark space of the museum you take a step into the past. A sign at the entrance cautions you that the exhibition contains human remains and may not be suitable for sensitive visitors. Photography is not allowed. The Museum website states:

“You should compare your position as a visitor to the Museum Vrolik with students of medicine during a practical anatomy session in the dissecting room. They observe and dissect mortal remains, but do so with proper respect and they are not allowed to take photographs of whatever they see in the room”

Museum Vrolik has an impressive collection. The remains were collected between 1750 and 1950. It contains 3300 human bones, skulls, and complete skeletons, 840 anatomical preparations with congenital defects, 1230 human anatomy preparations, 7400 glass negatives, 600 preparations related to dentistry, 530 plaster models and casts, 1760 drawers of brain slices, and 410 wax models. In addition the museum also contains animal bones and preparations. Only a small sample of this impressive collection is exhibited.

Cover of the catalogue of the Museum Vrolik “Forces of Form,” for sale in the museum shop. While I do not want to link to any online content of the displays, I show the cover of this book to provide an impression of the kind of specimens exhibited in the museum.

The exhibition consists of one square shaped room with dimmed lights and aesthetically illuminated glass display cases forming four areas in the center of the room displaying anatomical and pathological specimens, and along the perimeter of the room, a series of display cases that chronicles the history of the collection. It is breathtaking.

The collected are categorized as “objects of science” – but the display invites us to see people who once lived with pain, disability and strength to survive many years under difficult circumstances. It is moving and unsettling all at the same time.

In the historic overview the collection is contextualised with a focus on the collectors and their roles in the history of research. The presentation is honest and transparent and mentions collections from cemeteries and medical wards. In contrast to the matter of fact tone in the texts, the actual exhibition in this part of the museum is sometimes very moving – especially the mounted skeletons of physically disabled individuals, one of which is still leaning on their cane. The juxtaposition between the factual narrative on the signs with the emotional displays is interesting. While only the collectors are visible as agents in the narrative, the collected demand our attention in the display. It suddenly dawns on us that there is contextualisation but no problematisation. The collected are categorised as “objects of science” – but the display invites us to see actual people who once lived with pain, disability and the strength and support to survive many years under difficult circumstances. It is moving and unsettling all at the same time.

The main part of the exhibition focuses on anatomy and pathology. Here there is very little contextualisation of the collection beyond that of the human body itself, which presents itself as a timeless medical fact. The preparations of fetuses and new borns, or of more complete body parts, add a dimension of subjectivity to the exhibition, bringing to the fore a shadow of individual lives – viable or not. But in the end, these remains are exhibited as objects of science.

While an explicit reflection on the ethics of collection is absent from the exhibition, the museum webpage includes a statement that recognises that collection practices in the past were very different to contemporary medical practices, and that it is not possible to know if the deceased or their relatives consented to, or were even aware of the fact that the remains were collected. Just like in the exhibition itself, it is in the voids between what is explicitly stated and what is implicitly felt, that the ethical entanglements emerge for us to reflect on. It is interesting and moving.

Entrance to Body Worlds in Amsterdam, advertising the exhibition of “over 200 real human specimens” in the midst of the Amsterdam tourist district. Photo by Liv Nilsson Stutz.

Later the same day we visited Body Worlds, The Happiness Project, Amsterdam, located in the tourist area of the city center, and marketed at the entrance by a man who, like in a manner that reminded us of old time fair ground exhibitions or freakshow, enthusiastically invited us in.

Three separate displays of plastinated human bodies at Body Worlds Amsterdam. Note the sexualised position of the woman (left), the active position of the male (center). To the right an arrangement of sexual intercourse. Photos by Liv Nilsson Stutz.

Body Worlds has become a world wide sensation and a lucrative private enterprise. Günter Hagen who developed the plastination process which makes it possible to display the anatomical structures of the human body like sculptures, has marketed the venture as a mission to educate lay people about anatomy and health. Body Worlds has been criticised for using unethically sourced bodies, but today claims that all bodies on display are of people who have given their informed consent.

The Amsterdam exhibition mixed the exhibition of plastinated bodies staged in evocative poses with the display of individual organs. The whole bodies were positioned in a way that was always gendered and sometimes even sexualised, with female bodies placed lifted, lying down or leaning to the side with their legs apart, and with male bodies jumping a fence, playing a saxophone and steering a ship. One room was devoted to sexual intercourse. The theme chosen to frame the exhibition was happiness, and it was communicated through basic educational texts about health and well being, and through inspirational quotes. Despite the unique selling point of Body Worlds – the display of actual human bodies (in the middle of the tourist district no less) – the experience seemed artificial. It was difficult to connect to the material/humans on display. The commercialisation of the venture added to the confusion. Was the purpose of the exhibition to provide education, and the plastinated bodies were used as a way to lure people to pay over 20 Euros for a mediocre learning experience? Or, was the educational theme just added on as a justification to show dead human bodies? It was impossible to say.

The contrast between the two exhibitions could not be greater. Museum Vrolik showed old and admittedly sometimes problematic collections, but managed to inspire compassion and emotion, while Body Worlds felt like a commercial carnivalesque display trying to pass as education. Even if these bodies were displayed with consent, the ethics seemed more muddled than ever.