All That Remains

by Sue Black

  When the jury returned a not guilty verdict we were more than a little surprised. What were the chances of someone else – and someone with a very similar superficial vein pattern on their hand and forearm – being in the teenager’s room at half-past four in the morning? But it is not our place as expert witnesses to convince a jury or question their findings: they are the triers of fact and the final decision is entirely theirs, on the direction of the judge.

  What we could do, and did, was ask the barrister if she thought there had been any problem with the science, or my communication of the science. Perhaps I had not been able to convey the information clearly to the jury? It transpired, somewhat bizarrely, that the barrister felt my evidence had probably not been a critical factor in their ultimate decision. Her impression had been that the jury simply had not believed the child. It was possible that they thought she was not sufficiently upset and that maybe her demeanour sowed doubts in their minds that she was telling the truth. And so the defendant was free to continue living, as an innocent man, in the very house where his own child had accused him of abuse.

  What became of the girl I will never know, but it worries me to this day that perhaps I could have done more. There is only one way to improve the quality of the evidence we can provide and its prominence in a case, and that is to increase the validity and robustness of the science, which was what we now set out to do. There was clearly some merit in Tamassia’s original research and we wanted to bring it into the modern world of the analysis of indecent images of children (IIOC).

  As well as being a barbaric betrayal of the trust our children place in adults, the taking and sharing of IIOC is one of the fastest-rising crimes of this millennium. We decided to follow in the footsteps of Vesalius and Tamassia by initially studying variation in the venous anatomy of the back of the human hand. This is the part of the perpetrator’s body that is most frequently captured in such images. It was serendipitous that between 2007 and 2009, the DVI training courses Dundee University was providing for police forces across the UK would bring over 550 officers to our campus. We asked if they were willing to assist us with the creation of a database so that we could investigate anatomical variation and virtually all of them agreed.

  We were not looking only at veins: we also started to consider scars and the patterns of moles, freckles and skin creasing at the knuckles – all regarded as ‘soft’ biometrics. We discovered that, when analysed in combination, these independent variables were extremely useful in assisting us to distinguish reliably between individuals. We photographed every officer in IR and visible light, recording their hands, forearms, arms, feet, legs and thighs. The result is a unique ground truth database which has proved to be of great value in the validation of our research.

  We got the grants, we did the research, we wrote the papers and we have now helped the police with over a hundred cases of alleged child sexual abuse, in which we have been able to help to exclude those wrongly accused and to supply evidence for the prosecution of the guilty. We have worked with most UK police forces, many across Europe and some as far away as Australia and the US. By the time a case comes to us, the police generally have a fairly strong idea of who the perpetrator might be and there is usually a significant amount of evidence to support the Crown case. However, in many instances the accused will either plead not guilty or, on the advice of their legal counsel, will present a ‘no comment’ response throughout the interview. In the cases that we have accepted, over 82 per cent of defendants have subsequently changed their plea to guilty as a result of the additional information our analysis has offered.

  This is incredibly important because it means a full court trial is no longer required. Not only does it save large sums of public money, but even more importantly, it means that the victim does not have to give evidence in court against their abuser, who may be their father, their mother’s boyfriend or someone else they know. It is enormously satisfying to have played a small part in cases where the courts have handed down sentences amounting to several hundred years of incarceration, including many life sentences, for those who commit what I consider to be one of the most despicable and heinous of crimes against the most vulnerable in our society. No adult has a right to steal the innocence of childhood.

  This success has been achieved in no small part thanks to anatomy, where the dead really do continue to teach the living – not only by lending us their bodies but, in the case of the lessons of Vesalius and Tamassia, through the legacy of their work.

  CHAPTER 13

  An ideal solution

  ‘I profess to learn and to teach anatomy not from books but from dissections, not from the tenets of Philosophers but from the fabric of Nature’

  William Harvey

  physician, De Motu Cordis (1628)

  A cartoon donated for our ‘Million for a Morgue’ campaign.

  THE DEAD MUST have somewhere to reside until they move on to their final resting place and those who bequeath their remains to our anatomy department have chosen a calm waiting room full of people who care. To demonstrate their belief in our job, many staff in anatomy departments sign bequeathal forms so that when their time comes – we hope after a long and happy retirement – they will return to their workplaces to resume their role as teachers. It is somehow in keeping with the discipline that their life’s work also becomes their death’s work.

  The trade we ply in this place of death may seem macabre to some but in reality it is anything but. Our donors often have the most wonderful sense of humour. The elderly gentleman tickled by the fact that ‘a young lassie like you still wants my old body’ was not untypical. And many feel quite strongly that their remains should be put to worthwhile use. Allow me to share the words of Tessa Dunlop, who wrote to us about her father, a no-nonsense Perthshire farmer.

  My father, Donald, has been terminally ill with a bone marrow cancer for more than four years – his once enormous frame is now ravaged. I couldn’t imagine that science would have much use for him. In fact, I wasn’t at all sure that science still needed bodies. No one ever seemed to talk about a shortage. Hadn’t computers replaced the role of the cadaver? But Dad was adamant. ‘A dead body is a very unattractive thing. You won’t want mine hanging around, and I can’t stand funerals. Surely a medical school will take me?’ A couple of forms, a witness signature and a week later he got the answer he was hoping for. The University of Dundee … accepted his ‘generous offer’. He was grinning from ear to ear.

  Mr Dunlop had worked hard all his life and to him it seemed only fitting that he should carry on working after his death. But while our donors might be fully at ease with their decision, sometimes it is not so easy for those left behind. A widow whose husband had bequeathed his body to my department once pleaded with me to ‘look after’ him as she did not fully understand his decision or his wishes.

  To hand over the remains of the person you have loved all your life to a stranger must be a hard thing to do and we take our duty of care very seriously. Indeed, since human anatomy and the world of the corpse are at the core of everything we do, it is our priority every single day to guard and protect zealously those who have chosen to continue to be of value to society after their death by helping us all to learn more about the human body. That widow must have been won over by her experience of our department, because by the time of her husband’s funeral service she, too, had signed her forms to donate her body to anatomy. This is something that, encouragingly, happens quite often.

  When I moved to the University of Dundee it was on the guarantee that full body dissection would be retained for all our students. In the eyes of most university deans, anatomy is a dead subject from which there is no further financial return to be gained and is therefore an expensive luxury. As a result, it has become a focus for disinvestment in many medical schools. Administrators may be seduced by the augmented or virtual reality options modern technology can offer, which they believe suit the short attention span associated with education today.
But to assume that there is nothing new to learn, and no operational processes to be amended or developed, in the study of anatomy is to misunderstand its importance to so many disciplines. In a lazy world, it is much less trouble to pronounce a subject dead than to look at what is required to rejuvenate and expand it.

  No computer, book, model or simulation could ever replace the multisensory impact of learning from the gold standard. To go down the road, as so many anatomy departments have done, of depriving students of the opportunity to explore a real human body is, in my opinion, detrimental to their university experience and simply sets up problems for the doctors, dentists and scientists of the future who, to become experts in their field, surely deserve to be able to study through the best medium. The one thing every student learns in a dissecting room is that no two bodies have identical anatomy. There are so many possible variations and if these are not learned and understood, the people who will suffer are the unsuspecting patients of these future practitioners. Approximately 10 per cent of all legal cases involving surgical malpractice are believed to be due to ignorance of anatomical variation.

  Anatomy has been governed by an Act of Parliament since 1832. The first legislation was introduced principally in a knee-jerk reaction by Earl Grey’s Whig government to the murders committed by Burke and Hare in the West Port district of Edinburgh. In an attempt to halt the illegal trade in corpses and to raise the ethical standards of the profession, the law permitted teachers of anatomy to dissect the bodies of both the criminal and the unclaimed poor and to accept bequeathals and donations.

  Before recent amendments to the Anatomy Act – in 2004 in England and 2006 in Scotland – an old clause persisted which, paradoxically, made it illegal for surgeons to practise or test procedures on a dead body. They could come into a dissecting room, they could cut a cadaver’s skin, move the muscle or saw out the femur, but they could not replace the bone with a prosthesis, as that was categorised as a ‘procedure’. This restriction was a long-lasting and pointed reminder of the historical relationship between surgeons and anatomists. Good old Burke and Hare still have a great deal to answer for.

  Many anatomists, surgeons and clinical practitioners gave evidence to government committees to reassure them that the nefarious commercial association behind this 170-year-old ban was no longer relevant – surgeons could be trusted and should be allowed to hone their skills on the human cadaver rather than on the hapless patient. The age-old partnership between surgery and anatomy began to blossom once again but there was a minor hurdle to be overcome first. Surgeons turned their backs on anatomy very soon after the legislation was changed because they found that the formalin we used to embalm our cadavers rendered the body too stiff and inflexible for their purposes. They wanted something that more closely resembled the feel and tissue response of a live patient and decided that they would instead prefer to pursue the option of using ‘fresh/frozen’ cadavers.

  I had more than a passing objection to anatomy being driven in this direction. Let me explain. To comply with the surgeons’ preferred approach, when a bequeathed body is received fresh from the hospice, hospital or wherever the donor has died, it needs to be sectioned into relevant pieces (shoulder region, head, limbs and so on) in a manner fairly reminiscent of dismemberment, which criminal law views as an aggravated insult to a corpse. The parts are then frozen and, when required for surgical courses, recovered from the freezer, defrosted and worked on by the students, surgeons in training and other groups. Because, once defrosted, these sections are to all intents and purposes ‘fresh’, after a couple of days they will no longer smell quite so fresh and, like any organic matter, will not respond well to repeated freezing and thawing. They will therefore be of limited, if any, value for others to study after the first group has finished with them. Furthermore, many pathogens are known to be able to survive freezing and can merely lie dormant before regenerating when the tissues begin to warm up again. The likelihood of transfer and infection then rises and great care must be taken by those learning their trade not to cut themselves as well as to ensure that all their inoculations are up to date.

  The change in the law also made it legal for us to import body parts into the UK from overseas. Now, this made me very nervous. The fact that you could place an order with a company in America for, say, eight legs, all carrying an alleged clean bill of health, was bad enough; the fact that after use these body parts would then be incinerated as clinical waste I personally found disrespectful and unacceptable. It felt to me as if these remains were being treated more as disposable commodities than with the consideration due to people who had died.

  So for me, the fresh/frozen system as administered in some institutions appeared not only wasteful of a precious resource but also morally questionable. Neither was I prepared to take the inherent health-and-safety risk. I could imagine the possible consequences: if a surgeon or a student cut themselves and contracted an infection, we could be facing a lawsuit claiming that the injury had ended their medical career. Our university undertook a feasibility study, led by a member of the senior management, and I was delighted and relieved when this produced the recommendation that Dundee should not adopt the fresh/frozen method. If it had, I would have left.

  It was clear, though, that continuing with formalin was a problem for a number of reasons. For a start, there was the cost. We had seen from the experience of the trainee surgeons that human tissue embalmed in formalin was not ideally suited to all the procedures they needed to practise. And the critical issue of health and safety was paramount to medical and reputational security. It is important that tissue should be sterile, and while formalin does satisfy this criterion to a greater or lesser extent, we also knew that, in concentration, it is a potential carcinogen. Indeed, formalin was already coming under some scrutiny in many countries and its use was beginning to be discouraged in the wake of a 2007 EU ruling under which a reduction in the approved concentration was being considered. If further dilution became a legal requirement, formalin’s role in the field of anatomy could become redundant. We would have to get our clever heads on and find a solution that would meet everyone’s needs.

  I remembered hearing about a technique being used in Austria, developed by a charismatic and inspirational anatomist and teacher named Walter Thiel, and started to wonder whether maybe this could provide an answer. Professor Thiel, head of the Graz Anatomical Institute, had been a medical student in Prague when he was called up for active service in the Second World War. After being invalided out of the army with a gunshot wound to his face, he overcame his injuries and resumed his medical studies. After the war, he dedicated fifty years of his professional career to the Graz institute where, in the early 1960s, he recognised the very problem we were wrestling with and made it his life’s work to solve it.

  Thiel’s goal was to find a better way of preserving bodies, one that would leave the tissues flexible without compromising the longevity of the material, and which would at the same time ensure a healthier working environment for anatomists and students. He had noticed that the quality of the texture of the ‘wet-cured’ ham in his local butcher’s shop was infinitely superior to the end product he was able to achieve in his embalming rooms. The ham retained both its colour and its flexibility after being preserved in a solution of salts. It occured to him that perhaps the food industry may have something new to teach anatomy.

  The butcher was of course restricted to using chemicals suitable for the food chain that would not poison his customers. Walter Thiel had no such limitations. His medium was never going to be sold over the counter for consumption. So he embarked on a painstaking process of trial and error to perfect a soft-fix solution – pickling, basically – using a combination of water, alcohol, ammonium and potassium nitrate salts (to fix the tissues), boric acid (for its antiseptic properties), ethylene glycol (to increase plasticity) and just enough formalin to act as a fungicide.

  Beginning his trials with cuts of beef from the same butcher’s
shop, he worked his way up to whole animals. He realised that it wasn’t sufficient just to perfuse the body, it also had to be immersed in the fluid for quite a long time to ensure that it was preserved from the inside out and the outside in. The tissues then remained fixed, retained colour and plasticity and did not need to be refrigerated. Importantly, there was also no sign of bacteria, fungus or other pathogens. It took him thirty years and over 1,000 bodies to arrive at a formula with which he was finally satisfied, and which he felt would be effective for a period that was optimal for the dissection of all the tissues. The last and best solution he manufactured was virtually sterile, virtually colourless and almost odourless. It did everything he required of it, and it was relatively cheap to produce.

  The motto by which Walter Thiel lived – ‘Only the best is just good enough’ – his infectious optimism and his unbreakable spirit were all reflected in his determination to make a difference in his chosen subject. Probably much to the chagrin of his university today, he did not patent his method. It is testament to his generosity of spirit and firm commitment to collaborative research and learning that he instead published it to the world, believing that such scientific developments should be open to all and not appropriated to make a profit or for the advantage of one school over another. His ethos resonated loudly with us.