Iconic autopsy: a response.

The article by Shannen Hill, "Iconic Autopsy: Postmortem Portraits of Bantu Stephen Biko," in African Arts 38 (3):14-25, explores the postmortem portraits of Bantu Stephen Biko and their impact on society and art. It is a stirring and critical examination of the autopsy report and its illustrations as interpreted through the lens of time and a changing world by artists, writers, and social philosophers. As such, it is an exploration related to the cultural interpretation of a martyr's death in South Africa. However, unlike the great works of art depicting the death of religious leaders, where no autopsies were performed by trained pathologists, an autopsy was carried out on Biko along with photographic evidence of the external body. It is necessary to clearly separate objective data from artistic license.

Hill states "[T]hese pictures [autopsy photos] sometimes accompanied reports on efforts to censure state pathologists for their handling of Biko's medical needs prior to his death." Pathologists are trained to be objective medical scientists investigating the causes of death and disease. For over 150 years, medical pathologists have served as part of a team with clinicians. However, to my knowledge--which includes South Africa--I am not aware of any forensic pathologists who would be involved with the medical treatment of a patient prior to death. All forensic autopsies have legal and public health consequences and importance. Did the pathologists in South Africa perform a "political autopsy" under government pressure? Hill presents no evidence that this is true, but it could be.

I would question Hill's assertion that "Since autopsies are performed when cause of death is questioned, abjection, in all its uncertainty, is inherent to the practice and its representation" (p. 14). The Webster dictionary definition of abjection is "a state of misery or degradation." To the pathologist, a dead body is to be treated with dignity at all times during the performance of an autopsy; I reject Hill's generalization as false and attribute it to the emotional tenor of her subject matter. Hill refers to William Kentridge, regarding Biko's case, that "little research has been published concerning associative effects of forensic imagery, and within that field, autopsy is hardly discussed" (p. 92, n. 2). I would refer Hill to papers, books, and monographs on this subject available at the the National Library of Medicine, the Armed Forces Institute of Pathology, and the National Museum of Health and Medicine which examine this subject. Associative effects of forensic imagery is not the domain of pathology. But, like all human beings, pathologists are concerned with the public perception of their work. However, due to coercive political pressure, doctors including pathologists may be forced to act against their moral and ethical values in order to survive.

How else do you explain the actions of doctors during the Nazi regime in Germany? I had the opportunity to review many of their documented reports of "medical research" as obtained by the US government after WWII. Holocaust museums around the world show photographs of human barbarism along with artists' interpretations of these acts. It is these "associative responses" which serve to keep our memories constant. Stephen Biko has ascended into the realm of historic figures because humanity convulsed and imploded. The perpetrators of his death cannot escape the judgement of history. Hill offers us the human dimensions of a significant social injustice with long-lasting images as the people of South Africa go forward.

Bernard M. Wagner, MD