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Equality after Death: The Dissection of the Female Body for Anatomical Education in Nineteenth-Century England.

Human dissection within the context of medical education has long been recognized as the best way to acquire anatomical knowledge (Lyser and Thomson 1740; Pole 1790; Vesalius 1543). In recent decades the skeletal remains of dissected individuals have been uncovered at archaeological sites located across Britain (Boston et al. 2008; Boulter et al. 1998; Chamberlain 2012; Cherryson 2010; Fowler and Powers 2012; Kausmally 2012; Mitchell 2012; Mitchell et al. 2011; Witkin 2011). Within these assemblages, evidence of human dissection is identified by the presence of surgical tool marks on skeletal elements. The location and pattern of these tool marks can be used to identify how and why a body was examined after death (Dittmar and Mitchell 2015, 2016a; Flies et al. 2017; Fowler and Powers 2012). The two main postmortem medical investigative procedures that were conducted during the eighteenth and nineteenth centuries were autopsies and human dissection. Although similarities existed between these procedures, the purpose of each and how they were conducted were very different. Autopsies were generally performed to determine cause of death. As such, evidence of an autopsy is generally restricted to the examination of the internal organs thought to be associated with the cause of death, usually the head along with the thoracic and abdominal cavities. Human dissection is undertaken to gain anatomical knowledge, a process that requires a thorough examination of all the structures of the body. As such, the destruction of the body was an inherent part of the dissection procedure. Tool marks resultant from dissection have been found on nearly every skeletal element, including the vertebrae, sacrum, the elements of the hands, and the facial bones (Fowler and Powers 2012; Kausmally 2012; Nystrom 2017).

Within the body of archaeological and historical research on anatomical education, an often-discussed phenomenon is the startling sex disparity of individuals who were dissected. At nearly every archaeological site across the United Kingdom at which dissected human skeletal remains were discovered, the bodies of men outnumbered those of women (Boston and Webb 2012; Cherryson 2010; Fowler and Powers 2012; Western and Kausmally 2014; Witkin 2011). At Royal London Hospital, three males were dissected for every female (Fowler and Powers 2012).

These archaeological findings are mirrored by the historical research conducted on the private papers of anatomists, burial records, and hospital dissection ledgers (Hurren 2004, 2012). At St. Bartholomew's Hospital in London between 1842 and 1905, men were dissected twice as often as women (Hurren 2012:160-61). At Cambridge between 1855 and 1920, the ratio of men to women given for dissection was three to one (Hurren 2004). This trend was not geographically limited to the UK, as men appear to have also been dissected more commonly in the United States (Nystrom et al. 2017; Richards et al. 2017).

This discrepancy has been explained as a preference for male bodies by anatomists (Wise 2005). The reason stated for this preference is that "male corpses were more highly prized than females, since they offered greater scope for the study of musculature" (Wise 2005:30). Indeed, many historical surgical texts did state preferences for certain types of bodies, often in the introduction to the text. For the dissection of the musculature, there was a preference for the bodies of adult men who were "fully developed" and had "died suddenly" (Tuson and Lewis 1844:viii). Yet the context of this statement should not be overlooked, as it does not imply a generalized preference for the bodies of adult men by anatomists. The selection of subjects was complex, and different types of bodies were preferred for different anatomical purposes. For example, if one desired to dissect the nerves, "the young are the proper subjects," while "lean, emaciated subjects are preferable" for making anatomical preparations (Tuson and Lewis 1844:viii).

The generalization of such a proclamation about the preference for male bodies is not unexpected, as men were at the center of anatomical education until the early twentieth century and the idealized male form has been widely depicted in the medical literature and within the dissection manuals since the early medieval period. However, the disparity in the sex of the dissected has resulted in the research conducted on anatomical education and the historical identity of medical cadavers to be skewed in favor of adult men, generally of low socioeconomic status. Although this sex imbalance has been identified in both the historical and archaeological literature, it is not known if the treatment of bodies differed by sex or how this treatment was affected by societal influences. Previous research has shown that the sociopolitical identity of fetuses and infants dictated how a body was treated by medical men (Dittmar and Mitchell 2016b). The aim of this research is to investigate if the postmortem treatment of medicalized bodies differed according to sex during the nineteenth century. This goal will be achieved through macro- and microscopically analyzing the surgical tool marks on the skeletal remains of dissected individuals from archaeological sites.

Materials and Methods

Materials

The skeletal remains of adult individuals (N=99) from two locations associated with anatomical training, the Royal London Hospital and the University of Cambridge, were assessed for this study (Table 1). All of the individuals within this study were noted to have evidence of surgical tool marks that suggested that human dissection was undertaken on the body (see Dittmar and Mitchell 2015).

The excavation of a previously unknown burial ground (RLP05) within the grounds of the Royal London Hospital, Whitechapel, East London, was undertaken between April 2006 and June 2007 by Museum of London Archaeology (MOLA) (Fowler and Powers 2012). The site was bounded by Whitechapel Road to the north, by Milward Street and Cavall Street to the east, by Newark Street to the south, and by the New Road to the west (OS National Grid reference 534700 181705). The excavated area lies south of the Grocer's Wing, which was the location of the hospital's medical college until 1854. This archaeological excavation comprised the entire area used for burials between the time the cemetery area was extended to the south, circa 1825, and when the larger burial ground was established, in 1841-42, and has yielded the largest body of evidence for anatomical training in London (Fowler and Powers 2012). For this study, the skeletal remains of 40 relatively complete adult individuals from area OA6 were selected for analysis.

The skeletal remains of 59 adult individuals selected for analysis from the University of Cambridge were retained from the dissecting room in the former Anatomy Department. By selecting elements known to have come from the dissecting room we ensured that the intended purpose of these cadavers was dissection, enabling us to examine the location of tool marks associated with human dissection accurately. Only skeletal material that could be verified by the pattern of the tool marks or with historical documentation as having been dissected were selected for this study. Two historical catalogs were consulted to provide a date for when the skeletal remains were entered into what is now known as the Duckworth Collection. First, the unpublished catalog of the Anatomical Museum collections at the University of Cambridge was used to determine the dates of the material that was acquired up until 1883 (Humphry, unpublished). Second, the Duckworth Catalogue (unpublished) was consulted to confirm the origin and dates of crania that were added to the collection from 1883 to 1913 (Duckworth, unpublished).

Methods

The skeletal remains were visually examined, and the location and orientation of all tool marks were recorded. The placement of the tool marks, the archaeological context, and the associated finds were the primary criteria used to classify the type of postmortem intervention performed on the body, being either autopsy or dissection (see Dittmar and Mitchell 2015). A problem often highlighted within the osteoarchaeological literature about postmortem medical procedures is that substantial overlap exists in the tool marks created during autopsy and those created during human dissection. However, human dissection is an exploratory process and requires the complete examination of the body, which often results in its fragmentation (Dittmar 2016; Fowler and Powers 2012). As this is the case, the distribution of tool marks has been found to be a key criterion to identify and differentiate autopsy from anatomical dissection. Only individuals that were classed as dissected based on the criteria outlined in Dittmar and Mitchell (2015) or those who could be verified as dissected through historical documentation were included in this study.

Due to the nature of this study, individuals were included only if biological sex was able to be established through the consultation of historical records or through the assessment of sexually dimorphic traits. The biological sex of each skeleton was determined by examining the morphological characteristics of the pelvis (if present) or cranial traits (Buikstra and Ubelaker 1994; Phenice 1969). Age at death was estimated using the degenerative changes observable at the pubic symphysis (Brooks and Suchey 1990), auricular surface (Buckberry and Chamberlain 2002; Lovejoy et al. 1985), and sternal rib ends (Iscan et al. 1984,1985). Due to the inherently destructive nature of human dissection, the skeletal material within this study is highly fragmentary. As a result, age-atdeath estimates were not possible for many individuals. For the material from the dissecting room at the University of Cambridge, two historical museum catalogs were consulted to acquire information about the dissected individuals (age, sex, and pathological conditions).

The tool marks identified on dissected adult males (n = 74) and females (n = 25) were analyzed both macroscopically and microscopically. In order to assess variation in the treatment of medicalized bodies, the location of each tool mark was carefully recorded visually with the aid of a hand lens (10x magnification) if necessary. The pattern of the tool marks identified on each individual was compared with historical descriptions of human dissection (Ellis 1840; Holden 1868). Surgical texts from the mid- to late 1880s were also consulted to determine if any of the observed tool marks could have been created during life-prolonging surgical procedures (Fergusson 1845; Horsley 1886), as tool marks created during this process could potentially be mistaken for evidence of dissection.

Where skeletal elements had well-preserved cortex, silicone molds were made of the tool marks using Alec Tiranti RTV silicone putty based on the method outlined in Dittmar et al. (2015). Forty-one molds were made on the skeletal remains from the Royal London Hospital (n = 20) and the University of Cambridge (n = 21). Each mold was trimmed to remove any excess silicone using a scalpel blade and was fixed to a 25 mm aluminum SEM stub with double-sided tape. No conductivity-enhancing preparation methods (i.e., gold coating) were required prior to the examination of the molds. Each mold was analyzed using a Hitachi TM 3000 Tabletop SEM at 15kV, on topographic (topo) image mode. A morphological assessment of each tool mark was undertaken. The characteristics of each were recorded as described by Symes et al. (2010). When appropriate, chi-square or Fisher's exact tests were used to determine statistical significance.

Results

Examination of the head

Eighteen female skulls were present, and all but one had evidence of sawing. An axial craniotomy was performed in 16 of these individuals (Fig. 1). Two skulls were not sawed along the axial plane; one of these was bisected along the coronal plane, and the other did not have any evidence of sawing. The single skull in this sample that was not sawed open (CAM2555) was likely intentionally unharmed during the dissection procedure so that it could be placed on display, likely in the anatomical museum. Several drilled holes were present on the mandible of CAM 2555, indicating that the mandible was once attached to the cranium on springs. A total of 65 male individuals had cranial elements present. Of these, 89.2% (58/65), had evidence that the skull was opened and examined (Fig. 2). The majority of these individuals (75.9%; 44/58) had axial craniotomies. Six skulls were bisected along the sagittal plane, and one was bisected along the coronal plane The skulls of 15 male individuals, all from Cambridge, were unopened, but 86.7% (13/15) of these had evidence of defleshing in the form of knife marks on the cranial vault.

Knife marks were present on 61.4% (27/44) of the male skulls with craniotomies. Axially oriented incisions were most commonly found (n = 21), followed by incisions along the coronal plane (n = 17), and sagittal-oriented incisions were the least common (n = 6). More than half (15/27) of the male skulls with knife marks had incisions that were oriented along at least two planes. Knife marks were found on 62.5% (10/16) of female skulls with axial craniotomies. Axially oriented knife marks were also most commonly found on female skulls (n = 8), followed by those along the coronal plane (n = 4) and the sagittal plane (n = 3). Only three female skulls had knife marks on two or more planes. No significant difference was found between the presence of knife marks on the skulls of 63% (41/65) of males and 61% (11/18) of females [chi square] (2, N=83) = 0.02, p = 0.88.

Scanning electron microscopy (SEM) analysis of the majority of the molds of saw marks on the cranial vaults (female = 5/6, male = 12/18) revealed morphological characteristics consistent with a type of surgical saw that had teeth that were organized at opposing angles, with alternating teeth angled away from the midline. This type of saw produces kerfs with a pointed mound in the center with two V-shaped furrows on either side (Fig. 3). One mold made of a saw mark on a female cranial vault and four made on a male cranial vault did not have sufficiently distinctive characteristics to assess the kind of saw used. No discernible differences between knife marks present on the individuals were present in this sample. The assessment of molds of knife marks (n = 29) shows that all knife marks present on individuals in this study appear to have been created by a straight, single-bladed instrument with no evidence of serrated edges. The SEM analysis of the tool marks identified on the skull revealed that there was no statistically significant difference between the surgical tools used to perform a craniotomy on men and women (p = 0.628, Fisher's exact test).

It was possible to determine the location of the origin of sawing in 25 individuals. In 73.5% of craniotomies in both males and females, sawing was initiated on the left side of the skull (female = 5/9, male = 20/25). In males, the origin of sawing was most commonly found to be on the left aspect of the frontal bone (n = 17) but sawing also commenced at other areas of the frontal (n = 4), on the left parietal (n = 2), and on the left temporal (n = 1). Similarly, sawing was originated on the female skulls on the left aspect of the frontal bone (n = 3), followed by other areas of the frontal (n = 4) and the left parietal (n = 2). When analyzed statistically, no relationship was found between biological sex and the location of the sawing origin, [chi square] (2,N=34) = 2.03,p = 0.15.

In 60% (15/25) of individuals with craniotomies, sawing initially commenced clockwise until reaching a location on the posterior or the right side of the skull, usually the posterior aspect of the parietal, before the saw was removed and repositioned at the origin of sawing and then moved counterclockwise to complete the incision. Evidence that a chisel was used to pry away the sawed calvaria was identified on 47.5% (19/40) of male skulls and on 60.0% (9/15) of female skulls where this information could be gleaned. A chi-square test indicated that the likelihood of using a chisel to open the skull was not significantly different between males and females, [chi square] (2, N= 55) = 0.68, p = 0.41.

Evidence that the face was dissected was found on 66.6% (24/36) of males and 46.6% (7/15) of females that had facial bones present. This evidence included the dissection of the eyes, identified by the presence of sagittally oriented sawing on either side of orbit. Of the individuals with axial craniotomies who had facial bones present (n = 51; 15 females, 36 males), no relationship between the biological sex and the dissection of the face was found, [chi square] (2, iV=51) = 1.19, p = 0.27

Examination of the body

Of the individuals with the axial elements present that would have been affected if a thoracotomy was undertaken (i.e., ribs, clavicles, sternum), all (n = 23; 8 females, 15 males) had evidence that this procedure was conducted (Fig. 4). Nearly all the females (7/8) and the majority of the males (11/15) had saw marks present on the ribs. Knife marks were much less common in both males (n = 2) and females (n = 2). Of the thoracotomies examined, 39.1% (9/23) had a combination of sawed and snapped ribs. Two individuals, one male and one female, only had evidence of snapped ribs and no evidence of tool marks. The location of the severing of the ribs by either sawing or breaking was generally found at one of three locations: the sternal end of the rib, the midshaft, and the vertebral end. The majority of thoracotomies performed on both males and females had evidence of severing by either sawing or snapping the ribs on the sternal aspect (14/23). Severing located on the vertebral aspect of the rib was identified on 30% (7/23) of individuals. Of the seven individuals who had ribs severed on the vertebral aspect of the rib, five were females. The sternum was bisected in 60% (3/5) of female individuals and in 54.5% (6/11) of male individuals who had this element present. Sawed clavicles were present on 40% (2/5) of the female individuals who had clavicles present and on 71% (10/14) of male individuals who had clavicles present.

Of the 39 individuals who had postcranial elements present, all had evidence of tool marks on at least one skeletal element. Multiple individuals had evidence that the body was divided into sections, and no difference was found in the locations that a body was divided between men and women (Table 2). The most common location that the body was divided in both males and females was through the vertebral column. Of the men that had vertebral elements present, 35.7% (10/28) had axial saw marks that severed the vertebral column, while 61.5% (8/13) of women with vertebral elements had severed vertebral columns. For both men and women, most (female = 5/8; male = 9/10) of these individuals were divided through the lumbar region. In addition, three men and three women had their heads removed by sawing through the cervical vertebrae.

On the appendicular elements, six women had transected long bones. The placement of the sawing was located on either side of the joint, never through the joint surface (Fig. 5). In women with lower limb bones (n = 11), the midshaft to the distal region of the shaft was most commonly severed (5/11). In female individuals with upper limb elements (n = 5), sawing was also seen in the long bones of the upper limbs, primarily surrounding the elbow joint (2/5), and in one case the radius and ulna were severed just above the left wrist. Three male individuals had evidence of transected long bones. Eleven male individuals had upper limb long bones; of these, two individuals had severed radii and ulnae. Thirteen men had at least partial lower limbs present, and two of them had axially sawed femora.

The analysis of the tool marks (n=7) from these individuals revealed transverse sawing consistent with limb removal (n=5). The SEM micrographs of the tool marks identified on two molds showed cut marks that were previously unobservable located between the two false start kerfs, suggesting that the skin and muscles were dissected away from the bone prior to the sawing event.

Wax injection

Evidence of wax injection in the form of red dye was found on the skeletal elements of both male (n = 2) and female bodies (n = 3). In both males and females, the dye was found on the axial skeleton, primarily the vertebrae and the ribs. In each of these cases, the body had been divided by an axial cut through the vertebral column, the majority of which had the body was sectioned in a way that suggests it was intentionally divided as part of cadaver sharing.

Discussion

Treatment of the body and equality after death

In both men and women, evidence of a craniotomy was the most commonly identified postmortem surgical procedure. The skull was most often opened along the axial plane, and very few differences were identified in the way that craniotomies were performed between men and women. In both men and women, the left side of the skull, either the left frontal or the left parietal, was identified as the most common location as which sawing was initiated. There is also evidence that certain facial features (eyes, ears, mouth) were sometimes examined more extensively on both men and women, often resulting in substantial fragmentation and disfiguration of the corpse.

Evidence of opening the thoracic cavity via a thoracotomy was much less common than evidence of craniotomy, even though there are many more bones that could be affected during this procedure (clavicles, ribs, sternum). However, the lack of skeletal evidence that the thoracic cavities of these individuals was examined may not indicate that this procedure was less common, as the internal organs could potentially have been accessed via the diaphragm without causing damage to the skeletal structures. Such an approach would, therefore, be invisible in the skeletal record. When tool marks were present, saw marks were much more commonly found than knife marks on axial skeletal elements. Interestingly, the combination of sawed ribs and those that were broken by hand to open the thoracic cavity was found in both males and females.

The bodies of both males and females had evidence of cadaver sharing, and no differences were identified in the locations where the body was divided. The evidence of cadaver sharing on female skeletal remains provides convincing support for equitable treatment of the bodies of the dissected. The routine act of dividing a body into several segments for dissection contrasts the view of the dead body as "vulnerable" and in need of protection in a similar way femininity required protection (Sappol 2002). The inherently violent act of cadaver sharing is a transgression against the integrity of body. As such, the intact body was likely perceived differently than an isolated fragment produced through the division of the corpse. Dividing the body into multiple sections by removing the head and limbs from the torso results in the de-gendering of a body. By dividing the body into parts, educators and anatomists created a situation in which sections of the body could be divorced from their antemortem gendered identities. An isolated body portion that lacks sexually dimorphic characteristics can be treated as either male or female depending on the reassignment of gender that occurs by the practitioner who is engaging with that particular segment. The similarity in the tool-mark patterns identified on the skeletal remains revealed that the treatment and dissection of adult bodies did not vary according to biological sex. These findings were mirrored at the Blockley Almshouse in Philadelphia (Crist et al. 2016).

This is not to say that there were not differences in the way the soft tissues were examined. The assessment of historical dissection manuals shows that the main difference between the dissection of men and women was the examination of the sexual organs, which leaves no evidence on the skeletal remains. However, the organs in the lower abdominal cavity, including the rectum, bladder, and reproductive organs, could only be properly examined if the skeletal elements were removed as described by Ellis (1840). He states that "these organs (organs of regeneration) are best examined in the lateral view obtained by taking away the os innominatum of one side" (Ellis 1840:571). This recommendation was made for both men and women and is illustrated in the skeletal evidence.

The lack of differences identified in the historical and archaeological record suggests that the bodies of women were not given any special or protective treatment by the dissectors, who were almost certainly exclusively male. It appears that the bodies of women, unlike the bodies of infants, were not treated differently during dissection as a result of their sociopolitical status (see Dittmar and Mitchell 2016b). This examination of the dissected female body illustrates that, within the specific confines of the dissection room, the inequality of the sexes experienced during life ended at death. However, the fact that the bodies of men and women were dissected in the same way does not explain the skewed male-to-female ratio observed within the archaeological assemblages and the historical record.

Legislation, sociopolitical identity, and biological sex imbalance in anatomical education

It is tempting to assign the sex discrepancy in the bodies of the dissected to a choice made by members of the medical community. Although it appears that more men were dissected, there is no evidence to suggest that anatomists themselves only sought male bodies for dissection. In truth, a variety of different types of bodies were required for anatomical purposes, and each of these bodies was highly valued for the unique learning opportunities it could provide. However, the scarcity of female cadavers severely limited the routine dissection of individuals of both sexes. This problem was widely acknowledged within medical education, and students were encouraged to seize any opportunity to dissect the body of a woman, even if it arose during an undesirable time of the year for dissection. Lyser and Thomson (1740:11) state that if "you have an opportunity of dissecting a female subject in Summer, you must not then refuse it because this does not so often come under your hands as a male." Their assertion that students study both male and female bodies and their recognition of the dearth of opportunities to do so indicate a desire for students to study female cadavers.

Further support for the lack of a preference for male cadavers by the medical community is illustrated by resurrectionist activity. The high demand for bodies to dissect gave rise to gangs, sometimes called resurrectionists, who would acquire bodies through illicit means such as grave robbing. Because monetary gain was the primary objective for grave robbers, if a preference existed within the medical community, evidence of this preference for one sex or the other should be reflected in the price of illegally acquired bodies. As grave robbing was illegal throughout the eighteenth and nineteenth centuries, acquiring the financial records of either those selling or purchasing bodies for dissection is particularly challenging. In the only known firsthand account of resurrectionist activity, titled The Diary of a Resurrectionist, it appears that bodies were valued based only on size (Bailey 1896). This documentation indicates that in the early nineteenth century, a group of resurrectionists working in London were marketing bodies at rates that were directly linked to body size and maturity, using the monikers "large" and "small." As there is a substantial difference in price between large and small but no documented difference between the costs of male and female bodies, we can assume that there was no specific demand substantial enough to affect the market rate between male and female bodies, indicating that if a preference for a body of a specific sex existed, it was limited.

It is much more likely that the imbalance in the demographics of individuals dissected from the seventeenth to the end of the nineteenth century is linked to the legal history of the practice. In the early years of practicing human dissection in England, the only legal avenue to acquire bodies to examine was the gallows. In 1540, Henry VIII granted four hanged felons to the United Companies of Barbers and Surgeons for dissection (Anonymous 1540), perhaps unintentionally, establishing a tradition of dissecting men. The dissection of the condemned, who were almost exclusively male, was further reinforced with the passage of the Charter for Anatomies in 1565, which granted the College of Physicians the bodies of four criminals per annum for dissection (Anonymous 1565). These eight hanged felons comprised the entire legal supply of bodies for anatomical education until the mid-eighteenth century, when An Act for Better Preventing the Horrid Crime of Murder, also known as the Murder Act (25 Geo. 2, c.37,1752), was passed (Anonymous 1752). The Murder Act sanctioned dissection as a form of eternal punishment that was reserved for the most heinous crime of murder, for which women were rarely convicted. Although some women were convicted as felons in England from the seventeenth to the nineteenth century, very few were sentenced to death, thus severely limiting the availability of female cadavers through early legal channels.

The passage of the Murder Act did very little to alleviate the demand for bodies to dissect. Substantial research elaborates on the difficulty anatomists continued to face in securing sufficient numbers of cadavers and the ways in which they tried to overcome this shortage (Hurren 2012; Hutton 2013; MacDonald 2009). It was not until 1832, with the introduction of new legislation titled An Act for Regulating Schools of Anatomy (2&3 Will. IV c.75, 1832), or the Anatomy Act, that legal access to bodies increased and included women more regularly. The Anatomy Act permitted the workhouse masters, hospital or asylum managers, and Poor Law guardians to donate unclaimed bodies of the poor to anatomists (Anonymous 1832). The inception, legislative process, and the ultimate ineffectiveness of the Anatomy Act has been extensively researched (Richardson 1987). The intention of this act was to prevent grave robbing and other deceitful methods of obtaining bodies, but it was largely unsuccessful. Even after 1832, bodies continued to be obtained through nefarious means, as the individuals employed to enforce compliance to this legislation did not have the power to do so effectively (Hurren 2012; MacDonald 2009). In reality, the Anatomy Act resulted in a small and ultimately insignificant increase in the number of female bodies available for dissection. This change was due in no small part to the increased numbers of men within institutions such as charitable hospitals and workhouses who would donate or sell the bodies of the unclaimed to anatomists.

Hospitals

Access to hospital wards was essential to acquiring cadavers to dissect, both before and after the Anatomy Act (Richardson 1987), partly due to the increased number of individuals who were dying in hospitals during the second half of the nineteenth century. In London, 5.7% of the population passed away in a hospital in 1851, a figure that nearly doubled, to 9.8%, by 1881 (Mooney et al. 1999). The unclaimed bodies of patients who died while in the hospital were routinely provided to students to dissect. As such, the composition of these hospitals had a significant impact on the kinds of bodies that were dissected as part of medical education. Often in charitable hospitals, the biological sex of patients was largely dictated by the entrance requirements of the institution. During the eighteenth century, the majority of the charitable hospitals in England were built as a result of donations from wealthy patrons and were designed to care for the working poor, a group that was dependent on wage labor and could not afford to pay for medical treatment (Dyson 2014). These institutions were dependent on donations, subscriptions, and fund-raising to provide charitable care. Many had strict entrance requirements that prohibited the admittance of those with certain ailments, pregnant women, and children under a certain age. In order to ensure the adherence of these restrictions, at many locations, prospective patients were required to obtain a letter of recommendation from either a hospital governor or a donor. As a result, at many of these institutions, such as the Royal London Hospital, significantly more men than women were admitted and subsequently died within hospitals (Fowler and Powers 2012).

Workhouses

Less straightforward is the association between workhouse inmates and the dissection room. During the eighteenth century, widespread poverty within many parishes increased the demand for financial assistance. This situation led to the proliferation of institutionalized care in workhouses from the 1720s onward (Siena 2010). The passage, in 1834, of An Act for the Amendment and better Administration of the Laws relating to the Poor in England and Wales (4 & 5 Will. IV cap. 76, 1834), or the New Poor Law, officially ended outdoor relief and mandated that able-bodied individuals could only receive state aid inside a workhouse (Anonymous 1834). The aim of this legislation was to reduce poverty by encouraging men to find work, as most unemployment was viewed as voluntary (Thane 1978). The historical research on the New Poor Law shows that the changes made for the admission requirements for workhouses propagated gender norms that associated manliness with independence and femininity with dependence (Rose 1992; Tilt 1853). It was believed that poverty of women and children would be solved by increasing the employment of men as the New Poor Law authorities assumed that a family had a male figure who provided financial support (Levine-Clark 2000). As a result, a woman's relationship with a man, either a husband or her father, was critically assessed. A woman could be disqualified from assistance based on how able-bodied that man was, regardless of her own physical and mental state (Levine-Clark 2000; Rose 1992). Alternatively, if a male pauper was classified as "not able-bodied," his wife was also labeled as such. If he then entered into a workhouse, she had to no choice but to follow (Thane 1978). As a result, within this legislative framework, women occupied a contradictory space that straddled the inherent feminine identity of women and "the worker" (Rose 1992). This category included women who were financially responsible for themselves and their children, such as abandoned wives, the wives of absentee soldiers, and widows. The sociopolitical climate made these women particularly vulnerable and, although their plight was not expressly discussed in the New Poor Law, women came to comprise a substantial portion of adult recipients of relief (Thane 1978).

Yet the archaeological and historical evidence suggests that the bodies of men were more likely to be taken from workhouses for dissection. As this procurement was only supposed to occur if a body was unclaimed, this evidence may indicate that the bodies of men were less likely to be claimed than those of women. Alternatively, it may indicate that the masters of workhouses were less inclined to give the bodies of women over for dissection. This reluctance may have been the result of the Georgian and Victorian period perceptions of gendered difference, which existed across class divides. Men and women were believed to possess differing qualities and physical attributes that dictated the roles that members of each gender were allowed to occupy. As a result, women occupied a different role within the family structure than men. Societally, men were commonly viewed as the stronger, more intelligent sex, who possessed reason and courage and were more able to withstand the stressors of the workplace. Women, conversely, were considered weak and frail and were regarded as suited for the protected domestic sphere. The traits that women embodied were considered worthy of societal protection; as a result, women who died in workhouses may have been more likely than their male counterparts to be collected after their demise by a family member. The fragility and protected status of women also may have contributed to the view by the populace that it was inappropriate to dissect the bodies of women. If so, this view was not shared by members of the medical profession, as dissection was performed in the same way on both male and female bodies.

Conclusion

The vast majority of the available archaeological evidence of anatomical dissection reveals that men were far more likely to be dissected than women. However, there is no evidence to suggest that anatomists themselves preferentially sought male bodies for dissection. Although the bodies of women were less likely to be obtained by anatomists, there appears to be no difference in the dissection procedure between the sexes. Within this sample, women and men were found to have nearly identical patterns of tool marks. The bodies of women were also divided and distributed among multiple students in the same way as the bodies of men. The substantial fragmentation of the body during dissection and cadaver sharing illustrates that within the confines of the dissection room, the inequality between the sexes that existed during life ended at death.

The smaller number of dissected women discovered in archaeological excavations is likely a consequence of the sociopolitical identity of women during the eighteenth and nineteenth centuries. The perceived physical attributes of women, which dictated their suitability for the domestic sphere, may have decreased their likelihood of entering into, and thus dying inside, a hospital, and increased the likelihood that a woman's body would be collected from a workhouse by a family member after her demise. However, the unclaimed bodies of women that ended up on the dissecting table were not viewed as fragile or afforded protected status by anatomists, as they were dissected in the same manner as the bodies of men.

Acknowledgments

The authors would like to thank Jelena Bekvalac and Rebecca Redfern at the Museum of London, as well as Don Walker and Natasha Powers (formerly of Museum of London Archaeology) and Maggie Bellatti (formerly of the University of Cambridge), for their help sourcing and contextualizing skeletal material. We would also like to thank Dave Errickson of Teesside University for consulting on the tool-mark analysis.

References Cited

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Jenna M. Dittmar (a*) and Piers D. Mitchell (b)

(a) McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, CB2 3ER, UK

(b) Department of Archaeology, University of Cambridge, Fitzwilliam Street, Cambridge, CB2 1QH, UK

(*) Correspondence to: Jenna M. Dittmar, McDonald Institute for Archaeological Research, Downing Street, Cambridge, CB2 3ER, UK

e-mail: jjdd2@cam.ac.uk

Received 2 August 2018

Revisied 4 November 2018

Accepted 18 November 2018

DOI: 10.5744/bi.2019.1002
Table 1. Sex Distribution of Adult Individuals from Each Site.

Site                              Male  Female  Total

University of Cambridge           50     9      59
Royal London Hospital (Area OA6)  24    16      40
Total                             74    25      99

Table 2. Count and Statistical Comparison of Locations Where Male and
Female Bodies Were Divided.

Location of Division  Female    Male

Vertebral column      n = 8/13  n = 10/28
Cervical vertebrae    n = 3/8   n = 3/10
Thoracic vertebrae    n = 0     n = 0
Lumbar vertebrae      n = 5/8   n = 9/10
Upper limb            n = 2/5   n = 2/11
Lower limb            n = 5/11  n = 3/13

Location of Division  Result of Fisher's Exact Test (*)

Vertebral column      Not significant (FET statistic value = 0.179)
Cervical vertebrae    Not significant (FET statistic value = 1)
Thoracic vertebrae    NA
Lumbar vertebrae      Not significant (FET statistic value = 0.274)
Upper limb            Not significant (FET statistic value = 0.546)
Lower limb            Not significant (FET statistic value = 0.390)

(*) Significance level p < 0.01.
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Date:Sep 22, 2018
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