Skeletal Evidence of Medical Education at the Blockley Almshouse

The thousands of commingled human bones excavated from the burial clusters in the Blockley Almshouse Cemetery represent the remains of the residents who had been autopsied, dissected, and used for surgical practice over a period of about 30

Excavation of boxes in Cluster 3 containing commingled human remains and laboratory garbage. Note autopsied cranium and bottle at upper right

Fig. 12.4 Excavation of boxes in Cluster 3 containing commingled human remains and laboratory garbage. Note autopsied cranium and bottle at upper right

years. The extent of these practices is reflected in Dr. Jefferson H. Clark’s comment that over 25,000 postmortems had been recorded between 1867 and 1932 in Blockley’s official register (Clark 1933). Analyses of the bones and bone fragments over the past decade have included estimation of the demographic profiles of the individuals represented by crania and mandibles, documentation of patterns of autopsy and dissection incisions, and studies of the pathological conditions that interested the almshouse physicians and their students.

A demographic study of the Blockley Almshouse skeletal collection indicates that most of the individuals whose remains could be analyzed were older men of European descent. Following standard anthropological methods (Buikstra and Ubelaker 1994; Moore-Jansen et al. 1994; Paleopathology Association 1991), in this study all intact and partial adult crania and mandibles from the clusters of commingled anatomical specimens were examined to determine each person’s sex, ancestry, and age range at death (Baldwin et al. 2014). Each of the non-mending intact and fragmentary crania and mandibles was presumed to represent a unique individual, although it was possible that some of them had originated from the same person. There were no cranial remains of infants or children in the assemblage.

Of the resulting 248 individuals, 67 % were males, 30 % were females, and 3 % were indeterminate. Among this group 62 % were older than about 35 years when they died. Sixty-five percent of the males and 57 % of the females were older than 35 years at death. Although the ancestry of 71 % of the group was indeterminate, 24 % of the remaining 72 people were estimated to be of European descent, 4 % of African descent, and 2 individuals (1 %) presented morphological features most typical of Asian/Native American ancestry. Men and women were almost equally represented among the individuals who had been autopsied or dissected. Of the 248 individuals, 67 % exhibited evidence of autopsy, dissection, or surgical practice. Four of the specimens had been trephined and 16 others displayed trephination holes together with one or more cuts including bisections, transverse or coronal separations, or inverted V-cuts through the cranial vault bones (Figs. 12.5 and 12.6). No differential patterns of autopsy, dissection, or surgical practice were observed among the demographic subgroups that comprised the study sample. The data suggest that the almshouse physicians and medical students chose to perform their postmortem work on whichever bodies were available and that they often cut into the heads and jaws of the patients to explore and demonstrate specific anatomical structures.

To document which parts of the patients’ bodies were most commonly dissected in the almshouse dead room, Hynes et al. (2005) studied the commingled remains from Clusters 4, 6, and 11, which were chosen because they were found in three different sections of the cemetery and possibly reflect temporal differences. After sorting 2534 bones and bone fragments into groups based on bodily regions, Hynes

Right lateral aspect of a cranium from Cluster 8 presenting an inverted-V autopsy cut

Fig. 12.5 Right lateral aspect of a cranium from Cluster 8 presenting an inverted-V autopsy cut

Fig. 12.6 Anterior aspect of the same autopsied cranium from Cluster 8 depicting two perimortem or postmortem trephination holes drilled into the forehead

Anterior aspect of the same autopsied cranium from Cluster 8 depicting two perimortem or postmortem trephination holes drilled into the forehead

et al. (2005) found that ribs (44.5 %) and vertebrae (13.5 %) together constituted the highest proportion of bone types. Collectively, lower limb bones (femora, tibiae, and fibulae) accounted for 5.9 % of the sample while the bones of the upper extremity (humeri, radii, and ulnae) represented 4.7 %. Twenty-eight crania (1.1 % of the sample), 11 mandibles (0.4 %), and 45 os coxae (1.8 %) were also present among these three burial clusters. Among this sample, 147 bones (5.8 %) presented evidence of postmortem modification resulting from dissection , autopsy, or surgical experimentation. Although ribs and rib fragments comprised the largest proportion of the skeletal sample, none of these bones presented cut marks. Evidence of cut marks was most prevalent among bones of the head: of the 28 crania in the sample, 23 (82.1 %) had been bisected or sawn through transversely. Five of the 11 mandibles (45.5 %) also had been cut, typically bisected at the chin. No pathologic lesions were present among these bones. Among the 341 vertebrae, 19 (13.2 %) had been cut or sawn, the majority of which were from the thoracic region. Most of the appendicular bones had also been dissected or used for surgical practice. When analyzed by bone, 26 % of the 43 humeri, 37 % of the 35 radii, and 40 % of the 40 ulnae had been sawn, all transversely. Similarly, 40 % of the 60 femora, 39 % of the 44 tibiae, and 39 % of the 46 fibulae were cut transversely. The transverse cuts almost certainly represent practice amputations or removal of hands and feet for use as anatomical specimens. The thoracic cage, shoulders, and pelvic girdles do not appear to have been commonly dissected or used for surgical experimentation; only 1 of 14 sterna (7.1 %) had been bisected.

Two studies have documented the extent and nature of the pathological specimens in the Blockley Almshouse Skeletal Collection. Curri et al. (2008) looked at

Fig. 12.7 Anterior aspect of an adult’s right proximal tibia and fibula resulting from a healed trans-tibial amputation

Anterior aspect of an adult’s right proximal tibia and fibula resulting from a healed trans-tibial amputation

the commingled remains found in 42 wooden boxes buried in Cluster 3. Spinal disorders were the most common pathological lesions identified among the thousands of adult remains from this cluster. These disorders were indicated by osteophytes, laminal spurs, fused vertebral bodies, and healed fractures. Five separate examples of vertebrae most likely modified by ankylosing spondylitis (a rheumatic inflammatory disease of genetic origin) were identified in the sample. Examination of the remains from the other 8 burial clusters documented 7 examples of appendicular osteomyelitis, 21 cases of spondyloarthropathy (joint diseases of the spinal column), and 8 cases of healed proximal femoral trauma (Fus Jr. et al. 2006).

Thousands of amputated long bones and fragments were also present in the assemblage from Cluster 3. Virtually all of these long bones presented saw marks with no evidence of healing; they had been either removed from the living Blockley Almshouse patients around their times of death (perimortem amputations) or sawn off after death for surgical practice or to generate anatomical specimens of the various joints. The vast majority of the long bones were cut transversely, with some bisected to reveal their internal structure. Cluster 3 also produced the only sawn specimen in the Blockley Almshouse Skeletal Collection that was healed. This specimen was an adult’s proximal right tibia and fibula that had been subjected to a trans-tibial amputation of the leg (Fig. 12.7). In addition to the postcranial evidence of autopsy, dissection, and surgical practice, three crania from Cluster 3 presented trephination holes, none of which were healed. None of the cranial bones presented pathological lesions, suggesting that these holes resulted from surgical practice or experimentation.

 
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