While central to medical work, anatomy was viewed with suspicion by the public for various social, cultural, and religious reasons. In Britain, the Murder Act (1752) enshrined post-mortem punishment as a deterrent for murder in law, with dissection a common fate for murderers. As a result, anatomists and medical students struggled to obtain enough bodies for their work, which led to an underground trade in bodies stolen from the grave for dissection.
But consent was sometimes given by individuals—it became something of a fashion for the rich to have a post-mortem, for example, whilst surgical patients might have some of the costs of surgery defrayed on the understanding that their body could be preserved for medical education on the event of their death.
Before the inventions of anaesthesia and antisepsis, undergoing any kind of internal surgery was an extremely dangerous business. Patients were in grave danger from succumbing to shock, haemorrhage, or infection either during their operation or after it. Thus, operations viewed as routine today—such as caesarean sections—were very rarely attempted.
The object pictured is a preservation of the skeleton of a woman who underwent an early caesarean operation. Likely having been malnourished in life, she may have suffered from rickets, and her skeleton shows signs of puerperal osteomalaica. The woman had been pregnant six times and, unable to deliver naturally, an attending surgeon had had to deliver the baby with a ‘crotchet’. This was a single hook that would be used to free a dead baby from an obstructed birth canal in order to save the life of the mother (who would die from infection otherwise). Whilst this seems cruel, it was done for compassionate reasons.
Despite the extreme danger, the woman wanted to give birth to a living child and so underwent a caesarean performed by John Bell, Charles Bell, and James Renton in Edinburgh in January 1800. All knew the likely outcome. Afterwards, Charles Bell described the operation in a paper published in Medico-Chirurgical Transactions (now Journal of the Royal Society of Medicine) in 1813. In what follows note the attention he paid to cutting into the living tissue of the uterus—something he had only done in cadavers before:
Through I moved my hands, which were spread upon the belly of the woman, so as to make the walls of the abdomen glide on the smooth surface of the uterus. The very great distension of the integuments, and their consequent thinness, made this necessary, to inform those who looked on that the abdomen was actually cut into; and indeed the surface, which now presented of a pale rosy hue, was not even what an anatomical student might have expected. It was matter of wonder to me, that no small vessels were perceptible on the living surface of the uterus, and no sinuses tinged with blood, considering that those vessels make so great an exhibition in dissection. But it was more a matter of admiration to me to observe the effect of the first touch of the knife upon the uterus; for instead of the form of a cut remaining for a moment, the fibres were excited to retract what would otherwise have formed the edges of the incision, and instead of a cut being perceptible, there was, in its place, a circular space, with concentric circles of fibres. Another thing remarkable was, that although the integuments and rectus muscle and sub¬stances of the womb were cut, yet there was not as yet a drop of blood to flow over the edges of the wound, no large veins were to be seen in the substances of the womb; and in this we thought ourselves particularly fortunate. But presently it appeared how much we have been deceived; for the substance of the womb being cut through, the lobes of the placenta rolled out. The placenta was unfortunately attached to the fore and lower part of the womb, and now, notwithstanding that no blood jetted from the womb, I was convinced that the incision must be through the larger blood-vessels, and I already despaired of the woman's recovery.
Mr Renton, Surgeon of Pennycuik (who had, in a manner deserving the highest praise, delivered the woman on former occasions with the crotchet, in very difficult circumstances), was prepared to break the membranes; to pass his naked arm into the uterus; to seize the child by the feet; and deliver it. This was done rapidly and dextrously by Mr Renton passing his hand in a conical form below the lower edge of the placenta: the child was delivered safely, and is now alive. After the delivery of the child, the placenta was thrown out by the action of the uterus. The instant the operation was performed, the mother was seized with violent vomiting; and now it required all my strength to compress the abdomen, and retain the parts against the operation of the diaphragm and abdominal muscles. For twenty minutes I continued pressing the belly, and compressing the uterus betwixt my hands. The wound of the integuments was dressed; stitches were introduced, and the intervals strengthened by adhesive straps; compresses were put on the abdomen, and the belly swathed. But what happened which I foresaw would be the consequence of ceasing to compress the uterus: the woman became more faint, and at last insensible; she lived only to the gratification of her wish, to become, at all hazards, the mother of a living child.
The child was named Caesar.
What is perhaps most striking about this story is how the woman chose to undergo surgery that would almost certainly result in her death in order to give birth to Caesar. We might reflect on how this makes us feel, and about what might have motivated her to sacrifice her own life for that of a child that she would never know. We might also reflect on whether it was a good decision to make, and what kinds of ethical issues arise from it.
Articulating a skeleton was a standard process that involved first dissecting tissue from the bones before boiling them with alum to disarticulate and bleach them. Once all the tissue was removed, the dry bones would be carefully drilled in order to attach metal wiring where necessary. The resultant preparation is thus both a natural object and an artificial one, made through a series of craft processes.
This skeleton became part of the Extra Mural Anatomy School at Great Windmill Street in London (run by Charles Bell) and then sold to the Royal College of Surgeons of Edinburgh in 1825 as part of the sale of Bell’s collection to the college.
The specimen is from the Bell Collection, GC.13689 – OSTEOMALACIA. You can search the catalogue here: https://museum.rcsed.ac.uk/the-collection/search-the-museum-collections-adlib
The images of the skeleton are shared with the kind permission of the Royal College of Surgeons of Edinburgh. The images are not to be shared or distributed on social media, or for any other purpose than as educational material in line with the aims and goals of the ALCMAEON project.