1784: When Universal Health Care Was as Simple as Donating Your Body to Science

Colin Dickey is the author of Cranioklepty: Grave Robbing and the Search for Genius and the co-editor (with Nicole Antebi and Robby Herbst) of Failure! Experiments in Aesthetic and Social Practices. He lives in Los Angeles. For more from Lapham's Quarterly, please visit www.laphamsquarterly.org.

One of the earliest experiments of universal health care for the poor could be found in eighteenth-century Vienna. Founded in 1784 by Joseph II, the massive General Hospital provided free health care to thousands of the sick poor well into the nineteenth century. A sprawling complex that at its height admitted tens of thousands of patients a year, it was the largest hospital in a city that, by 1850, had surpassed Paris as the capital of clinical education. It was here that Karl Landsteiner discovered blood types, and where Ignaz Semmelweiss first proposed hand-washing as a means of stopping bacterial infections. The poor who came to its halls could be assured that they were receiving the finest medical treatment Europe had to offer. The price for this service was simple: if things didn't turn out well and you didn't make it, the hospital kept your body. Joseph II felt that the use of one's body after death was a fair price for the free medical attention given in life.

This simple system made Vienna a substantially different place for medicine than anywhere else in Europe. Since the sixteenth century, medical students had realized that the best way to get practical knowledge of the human body was through dissection, but religious authorities would not permit such a desecration of a human corpse. The only legally obtainable bodies in most countries belonged to criminals, such as the bank-robber Aris Kindt, pictured in Rembrandt's The Anatomy Lesson of Dr. Nicolaes Tulp. Particularly in places like England, one's intact body was seen as necessary for resurrection, and the dissection of one's corpse was equivalent to a punishment literally worse than death. As a result, it was reserved exclusively for criminals, where it became an added punishment that followed execution.

The problem, of course, was that there were far less murderers than there were medical students. Sixteenth-century medical students like Felix Platter, anxious to understand the workings of the human body, were obliged to steal recently deceased bodies from local graveyards and dissect them in secrecy. In his journals Platter describes how, in 1554, he made repeated trips into the graveyard of Saint-Denis to take bodies, his nocturnal forays ultimately leading to the monks arming themselves with crossbows to keep grave robbers at bay. But that didn't stop the ever-growing need for bodies: over the next three hundred years an entire industry evolved from the early endeavors of men like Platter who were subcontracted from medical students to professional grave robbers known as "resurrectionists," thieves that plundered graveyards specifically for medical schools.

But in Vienna the situation had always been quite different. By 1537, the city was already performing limited autopsies for doctors and medical students, far earlier than other European countries: usually once a year, though this number gradually expanded. They were using executed criminals as well, but in 1748 only three criminals were executed in Vienna, and it was this dearth of ne'er-do-wells that led the city to expand its criteria for who could fall under the knife. In 1749, the Empress Maria Theresa allowed the bodies of the women who died in the maternity hospital at St. Marx to be used to help train midwives. Unlike England or France, Austrian culture seemed not to have the same qualms about this particular violation of one's body -- religious friendship societies, such as the Society of St. Joseph of Arimathaea, arranged to have the bodies of those dissected collected post-autopsy and given a proper burial, suggesting that the Austrians felt that one could undergo dissection and still return to the ground to await the Second Coming. (Cadavers readied for dissection thus came to be known, among their many other names, as "Arimathaea corpses.")

This opened the door for the policy that governed the General Hospital when it opened in 1784, which would lead to the massive amounts of bodies that flowed through Viennese dissection labs. In the mid-nineteenth century, the General Hospital produced in excess of 2,000 bodies per year.

Vienna was a novelty for Christian Europe in that it had a ready supply of corpses available for autopsy. At a time when a medical student might see a few dozen dissections, and participate in perhaps one if extremely fortunate, the chief prosecutor of the Vienna General Hospital, Dr. Karl Rokitansky, personally performed 59,786 dissections in his career.

As a result, medical tourists flocked from all over the continent where Arimathaea corpses (also known as "study corpses," "free-of-charge corpses," and "failed corpses") went under the knife by the thousands. Particularly from Germany and England, these students took intensive six-week courses in Vienna that offered the promise of hands-on work with actual cadavers. Sir William Wilde (father of Oscar) took one of these courses, and later wrote of Vienna that there "are many opportunities to gain knowledge" in the field of anatomy "as the supply with dissectible bodies is plentiful."

These medical tourists became so plentiful that eventually they threatened to exhaust even Vienna's rich supply of cadavers, leading some doctors to complain that there were no longer sufficient bodies for the Viennese students, but they continued to pay, and pay handsomely, for the privilege of working with a dead body. It was this influx of paying medical tourists that helped support the General Hospital, buoyed by its deserved reputation as the center for anatomical learning in all of Europe.

It was a particular moment in history where the poor still had something valuable to offer: the raw matter of their own bodies. Universal health care in nineteenth-century Vienna, in other words, was paid for by those it could not save. With the medical reforms of the twentieth century, and the destigmatization of donating one's body to science, all this vanished, and once again the poor have nothing to offer to entice others to save their lives.

 

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Comments

[Zenith1959]

Saw show on it once, sometimes when you donate your body to science, it just gets put out in a field or shallow grave, so they can study decomposition. That is important so police can tell how long a body has been dead, but probably not what most people expect will happen, not that it really matters.

[Martin 27514]

Rokitansky worked hard and has 17 eponymous contributions. Many of his original contributions still defy explanation though the gynaecologists have made some progress with adenomyosis.

Semmelweiss was remarkable. He identified the possibility of micro-organisms, then did a serious randomised trial - and then was thrown into a mental hospital for his trouble. Plus ca change.

Interestingly, one of the decisive problems in understanding chronic diseases has been the "loss" of the autonomic nerves. In C19, when Lee and Gray were in action, they stored cadavers in alcohol; in C20 they stored them in formalin which destroyed the fine branches of the autonomic nerves. Some forms of many Western diseases result from injuries to autonomic nerves through straining during defecation, straining during labor and surgery. Drugs, alcohol, smoking, infection make them worse.

Autonomic denervation causes changes in visceral form and function, susceptibility to infection, aberrant reinnervation and CNS sensitisation creating diverse and cumulative mechanisms for chronic disease at different times of life. Straining in infancy injures coeliac nerves and results in T1DM; straining in elderly women (after 2 children and a hysterectomy) causes "autoimmune" disease where CD4 and CD8's may simply be the histopathological signature of autonomic denervation.

[kimleehan]

Would you donate your resources to a organization that would refuse you those same resources if you ever had a need for those same resources.­? Its done hundreds of times a day in hospitals in this county, If you cannot show the ability to pay for a organ donor transplant than you would not be considered a good candidate for a organ transplant, and would not be added onto the organ donor waiting list, but you would be considered a good candidate to be a organ donor.

[bannorhill]

Now I understand the goals of Universal Health Care.

Invasion of the body snatchers.

[mydwyf]

Actually, the way medical students went from cadavers to patients without even wiping off their hands
pretty much guaranteed that this would become a self-perpetuating system. There are several very
good books out about Ignaz Semmelweis, even his own book (fascinating !) has been reprinted and
is available at Amazon.

The worst part of his story is that no one would believe him and he died tormented by the thought of all the lives he himself had unwittingly taken and all the further lives he was unable to save due to the deaf doctors all around him.

[Martin 27514]

Nothing new with Semmelweiss, medicine keeps doing it to anyone that thinks differently.

www.semmelweisssociety.com

[mydwyf]

Agreed. Thanks for link !