Respectful Insolence

A surgeon visits Body Worlds

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgUnfortunately, as we have been dreading for the last four months or so since her relapse was diagnosed, my mother-in-law passed away from breast cancer in hospice. She died peacefully, with my wife and the rest of her family at her side. As you might expect, I do not much feel like blogging, and even if I did my wife needs me more. Because I foresaw this coming, however, I do have a series of “Best of” reposts lined up. If you’ve been reading less than a year or two, they’re new to you. If not, I hope you enjoy them again. I don’t know when I’ll be back, other than maybe a brief update or two. It could be a couple of days; it could be a couple of weeks. Right now I just don’t know. This post originally appeared in March 2006.

You may have noticed that I haven’t been paying as close attention to the ol’ blog as usual over the last three days, leading to a bit of hyperbole in the comments section of at least one post without my responding until today. Indeed, here’s a secret: Most of the posts that have appeared since Friday were written Thursday or earlier and scheduled.

My wife happened to have some time off; so I took a rare three-day weekend off work. We took a road trip to Philadelphia to check out an exhibit at the Franklin Institute that we both had wanted to see before it left Philadelphia: Gunther von Hagens’ Body Worlds. As a surgeon, I found it to be a fascinating experience, albeit a vaguely troubling one.

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For those not familiar with Body Worlds, it’s an exhibition of real human bodies that have undergone the process of plastination and are dissected and posed in a way that shows various aspects of their anatomy. People donate their bodies to anatomist Gunther von Hagens’ Heidelberg-based Institute for Plastination, which offers plastinated specimens for educational use and puts together the Body Worlds exhibition. Here is a description of the plastination process found on Franklin Institute website:

A process at the interface of the medical discipline of anatomy and modern polymer chemistry, plastination makes it possible to preserve individual tissues and organs that have been removed from the body of the deceased as well as the entire body itself. Like most inventions, plastination is simple in theory: in order to make a specimen permanent, decomposition must be halted. Decomposition is a natural process triggered initially by cell enzymes released after death and later completed when the body is colonized by putrefaction bacteria and other microorganisms. By removing water and fats from the tissue and replacing these with polymers, the plastination process deprives bacteria of what they need to survive. Bodily fluids cannot, however, be replaced directly with polymers, because the two are chemically incompatible. Dr. Gunther von Hagens found a way around this problem: In the initial fluid-exchange step, water in the tissues (which comprises approximately 70% of the human body) and fatty tissues are replaced with acetone, a solvent that readily evaporates. In the second step, the acetone is replaced with a polymer solution.

The trick that first proved to be critical for pulling the liquid polymer into each and every cell is what he calls “forced vacuum impregnation.” A specimen is placed in a vacuum chamber and the pressure is reduced to the point where the solvent boils. The acetone is suctioned out of the tissue at the moment it vaporizes, and the resulting vacuum in the specimen causes the polymer solution to permeate the tissue. This exchange process is allowed to continue until all of the tissue has been completely saturated–while a matter of only a few days for thin slices, this step can take weeks for whole bodies.

The second trick is selecting the right polymer. For this purpose, “reactive polymers” are used, i.e., polymers that cure (polymerize) under specific conditions, such as the presence of light, heat, or certain gases.

The process is summarized thusly:

The invention of plastination is an aesthetically sensitive method of preserving meticulously dissected anatomical specimens and even entire bodies as permanent, life-like materials for anatomical instruction. The body cells and natural surface structures retain their original forms and are identical to their condition prior to preservation, even at a microscopic level. The specimens are dry and odorless, and remain unchanged for a virtually unlimited amount of time, making them truly accessible. These characteristics lend plastinated specimens inestimable value both for training prospective doctors and for educating non-professionals in the field of medicine.

The results of this process are truly astonishing. Meticulously dissected human specimens are shown posed in a dynamic fashion. Examples included a hurdler posed in mid-leap, a basketball player in mid-dribble, a pair of figure skaters, the man lifting the woman above him, her back arched, a chess player sitting and contemplating a chessboard. Each of these were dissected in a unique way to show muscles, internal organs, etc. in a different light. To me it was clear that a lot of this was designed to be more art more than science or education.

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It was profoundly unsettling to come face-to-face with these specimens. Because of the plastination process, they were more like statues than cadavers–incredibly detailed anatomic statues, but statues nonetheless. They almost don’t look real. I had to remind myself that these were real cadavers, that these had once been real people with lives, hopes, and dreams like everyone else. I hadn’t experienced this feeling, this need to remind myself of the former humanity of these shells, since my first year in medical school, when I took Gross Anatomy for the first time. The smell of the formalin preservative, rubberiness of the preserved tissues, gray and unyielding unlike living flesh, had forced me to remind myself of the same thing. It was somewhat easier then, though, because the cadavers we were dissecting, even though preservation had rendered the bodies rubbery, unyielding, and rather greyish, still looked like cadavers. Here, the bodies were solidly impregnated with various colored plastics to highlight their anatomy.

Whether through curiosity, reverence, or a combination of the two, the crowd, which started out rather boisterous, seemed to become more quiet and attentive as we moved through the exhibit. Even from teenagers, rude jokes were not to be heard. Also, perhaps it was because of the seeming unreality of these formerly living statues that people, including me, had no qualms about putting their faces mere inches from the cadavers that weren’t in glass cases to take a closer look. Touching was not allowed, but people came about as close to touching the specimens as they could without actually doing it. The specimens exuded a faint smell that seemed to be a mixture of plastic and preservative, but it was only noticeable with some specimens and very faint. When I moved in to get a closer look, I couldn’t help but try to identify individual structures. Median nerve? There it is! Where’s the subclavian artery? There! How about the celiac trunk? Found it!

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Whether art, science, or education, this exhibit managed to surprise even me, a surgeon. I’ve seen human anatomy in the O.R. and in the anatomy lab, but I’ve never seen it like this before. For example, one specimen had the entire nervous system carefully dissected out, with organs and muscles that would get in the way removed. The specimens that fascinated me the most were the ones in which the vasculature had been injected in such a meticulous manner that every blood vessel could be visualized right down to the capillary. Somehow, the anatomists could then carefully digest away all the surrounding tissue, leaving casts of the vessels and capillaries. I could see the vasculature as I had never seen it before, either in the O.R. or in any anatomy or surgery textbook. The capillaries appeared as feathery tufts resembling red clouds that permeated the entire body. The most striking example of this was a display in which a man, woman, and child had been treated and posed as a happy family, with the man and woman side-by-side and the child sitting on the man’s shoulders.

Perhaps the most difficult to stomach to me was a pregnant woman, who had been posed reclining, the wall of the uterus opened to display the fetus of eight months gestation. A sign explained that the woman had donated her body knowing that she had a fatal condition that might kill her before she gave birth. It did, and apparently doctors were unable to save the baby. Surrounding her in the gallery was a collection of plastinated embryos and fetuses at different stages of gestation. What was unnecessary was the collection of plastinated fetuses with various abnormalities, including hydrocephalus, anencephaly, and Siamese twins. My wife complained that they lent an air of a freak show to this whole part of the exhibit, and I had to agree.

One area where the plastination process seemed to be of less utility is in the preservation of individual organs, of which there were many specimens displayed. Having seen these organs in situ in living human bodies, I couldn’t help but notice that, in comparision to the whole cadaver specimens, preservation and plastination process seemed to have robbed these organs of all their color. For example, the human liver is generally a reddish-brown color. Plastinated livers on display in this exhibit were pale, almost white. To me, again, they didn’t look real.

One thing that was apparent was the evolution of von Hagen’s approach to producing specimens. Earlier in the exhibit, the displays were more straightforward: a man standing, the basketball player in mid-dribble, the chess player. These were the older pieces, dating back to the mid-1990′s. However, towards the end of the exhibit, the more recent pieces appear to be more daring and intentionally artistic, including a gymnast on a balance beam, a pair of figure skaters, and a woman kneeling and releasing two doves, both of which had been treated to show their blood vessels, as the man, woman, and child had been.

I left the exhibit somewhat conflicted. On the one hand, many of the specimens, through their meticulous and artistic dissection, had shown me human anatomy in a manner I had never imagined possible. On the other hand, I couldn’t help but feel that there was something exploitive about the whole endeavor; given the sold-out attendance and the not inexpensive price for tickets, plus all the merchandise on sale in the obligatory gift shop that the exhibit exited into, clearly this exhibit is raking in money hand over fist.

Even so, given the way that this exhibit sparked so much interest in anatomy in the children visiting it, perhaps it’s worth a little exploitation.

Comments

  1. #1 Tricia
    February 17, 2009

    My condolences to you and your family, Orac.

  2. #2 Alison Cummins
    February 17, 2009

    RE the “hyperbolic” comments on that one blog. I’m with Michelle Dawson on this one. In his discussion of genetic testing and abortion, Caplan assumes that abortion of a fetus that would otherwise grow into a diseased and suffering adult is ethically justifiable on the grounds that the life of the adult would be unacceptable to the adult.

    There are a lot of problems with this line of thinking, most of which are obvious to disabled people (like Michelle Dawson and some of my friends) but seem peculiar, narrowly-focussed and hysterical to able-bodied, NT people (like me).

    When Robert Latimer killed his daughter because she was suffering too much, it took me a while to understand where my disabled friends’ distress over the popular compassion for his act was coming from. They felt immediately and personally threatened; I thought that was hyperbolic. What got through to me was this presentation: Yes, Robert Latimer believed that Tracy’s life was intolerable to her; yes, he loved her. But a caregiver for a disabled person can be so involved that they cannot distinguish between the life that is intolerable to them and a life that is intolerable to the disabled person. Perhaps Tracy did suffer and wanted to die because of her suffering; alternatively, perhaps her parents just couldn’t stand watching her suffer any more and/or were too exhausted to care for her. Those are different questions.

    So. Back to abortion of the possibly disabled. While for various reasons we may need to accept as a society that people will abort for their own reasons, we do not need to recast that decision as aborting the disabled for their own good because disabled adults wish they had never been born. In fact, if you ask, most disabled adults do not wish this. And most disabled adults become very agitated when able-bodied people discuss aborting disabled fetuses or killing disabled teenagers for their own good. They take it very personally, because they are dependent on the cooperation of the society they live in, a society that could at any time declare their lives unworthy of living and supporting, on the grounds of eliminating suffering.

    While this may seem hysterical and nit-picky to someone who is not disabled, if you assume that very bright disabled people have a perspective you do not, you can learn something.

  3. #3 Kathryn
    February 17, 2009

    I saw this exhibit last spring in Mobile, AL, apparently in a more abbreviated form. Some of the exhibits you mention were not at this one. Even so, it was a marvelously inventive way to make the inner workings of the human body a visual experience. I, too, found it disquieting to think that these were once living people but was thankful to them for making it possible for me to gain new insight into anatomy and physiology.
    Make the effort to go see it, even if someone is making a boatload of money from it. It is very respectful and you can sidestep the few portions that seem like a freak show.

  4. #4 Kathryn
    February 17, 2009

    I saw this exhibit last spring in Mobile, AL, apparently in a more abbreviated form. Some of the exhibits you mention were not at this one. Even so, it was a marvelously inventive way to make the inner workings of the human body a visual experience. I, too, found it disquieting to think that these were once living people but was thankful to them for making it possible for me to gain new insight into anatomy and physiology.
    Make the effort to go see it, even if someone is making a boatload of money from it. It is very respectful and you can sidestep the few portions that seem like a freak show.

  5. #5 Calli Arcale
    February 17, 2009

    I saw this in Chicago and then, later, in St Paul. One thing not made very clear in the display is that most of the individual organs were not plasticized using the same process as the bodies. Some were from early plastination efforts. Some were not even the work of Von Hagens’ team but were lent to the exhibition by various museums and other organizations in order to fill out the displays. The same is true of many of the embryos and fetuses on display, particularly the ones displayed in jars. This is why they seem so different from the full-body specimens — they *are*.

    I found it a profoundly moving experience, and also very educational. I never quite understood *why* sciatica was such a problem until I saw where the sciatic nerve is positioned. I’m a software engineer; I haven’t studied this stuff like you surgeons have. ;-) So a lot of this was very new to me. Fascinating, and beautiful.

  6. #6 JustaTech
    February 17, 2009

    I saw this exhibit in Boston with my parents and boyfriend. The exhibit was quite crowded (and warm), but like Orac said, most of the people were quiet as churchmice. The selection of smokers’ lungs and alcoholics’ livers was very affecting for some people. There was also a camel (half-furred) and a separate room for the fetuses.

    My father and I made it through the exhibit rather quickly and needed a bit of a sit-down afterward. My boyfriend and mom thought it was wonderful and could have stayed for hours. Eww.

  7. #7 Holly
    February 17, 2009

    my daughter is a medical office management student and so when I heard about this I told her. It was showing in the city she is attending school. She and a few of her friends went and thought it was outstanding. She said she would go back through it again. The lines to get in were VERY long and she also experienced the hushed, reverence you did.

    I missed it, but if it comes this way again, I would make an extra special trip, just to see it.

  8. #8 llewelly
    February 17, 2009

    I saw Body Works with my siblings in Salt Lake City. The pregnant woman and the deformed fetuses (feti?) were not presents – however a plastinatied fetus from every segment of pregnancy was on display.

  9. #9 The Mother
    February 17, 2009

    I saw this exhibit in Houston. A physician and home-schooler, I took my kids and another home-schooling mom with hers. As a pathologist, none of this was new to me. What was new was watching the other woman’s fascination.

    She had never seen anything like it before. Not an uneducated woman, by any means, she simply had no idea what the stuff under our skin really looked like.

    We as physicians tend to forget how what we know and the way we see the world is so different from those around us. Exhibits like these open eyes, windows and minds.

  10. #10 Joseph C.
    February 17, 2009

    I saw a similar exhibit (Bodies) last summer and was absolutely floored at the quality of the specimens. These exhibits are great, especially in this time where interest in science is at an apparent all-time low.

  11. #11 storkdok
    February 18, 2009

    We are going to see it in San Diego on the spring break when we go for a visit to SoCal. Looking forward to it. I suspect I will have much the same feelings of awe and respect for the human body as well as sobering thoughts that these were living, breathing human beings who were loved, and loved others, and had jobs, etc., as we did in Gross Anatomy. I don’t know how I will feel seeing the pregnant woman and fetus, even though it is my specialty. Something so sad. Of course, it will drive me mad to not know why she died. It is so rare in the developed countries to die during pregnancy.

  12. #12 Clare
    February 18, 2009

    At the Portland, Oregon version of Body Worlds, the saddest example was the body — preserved by a different process — of a woman who had died a hundred years ago or so. I may not remember the details entirely correctly — others who may have seen and remembered her can put me right — but as I recall, she was a servant who had killed herself after becoming pregnant by one of the doctors at the hospital where she worked. Her body was preserved at the same hospital. Although another preserved body, unlike the others, she was given an identity and a history, and was thus a kind of stranger to the whole concept of the show. All the others gave informed consent to become anonymous representatives of what humans share. She, in contrast, stood for what makes us unique. In her case, her uniqueness came from her personal tragedy, and the careless decision to give a use to her body after death that no-one saw fit to give it in life.

  13. #13 Unistrut
    February 18, 2009

    I saw this exhibit when it came out to Los Angeles. I’m a stagehand, with no medical training beyond first aid. Luckily as a freelance stagehand I was able to go during a weekday while everyone else was at work and there wasn’t much of a crowd. The most informative part for me was a slice showing exactly what doctors mean when they say “inoperable cancer”. I’d always been confused by that phrase, always thinking of cancer as a nice little lump. Seeing the multiple small tumours laced through just about every bit of the body explained it quite quickly. Once again, the people who were there were mostly respectful, the only exception being the Fox News crew.

  14. #14 outre
    February 18, 2009

    There are couple of these plastinated bodies exhibits going around, Body Worlds, Body Worlds 2, and Body Worlds 3 are Gunther von Hagens’s exhibitions. I think there’s a BW 4, but it’s in Europe, not in the states, afaik.

    Bodies is a copycat done by one of his former assistants. The cadavers in the Bodies exhibits came from unwilling Chinese donors… quite unfortunate. I haven’t seen the Bodies exhibit so I can’t speak from a persona experience but apparently, things look rushed and some of the exhibits had um, moisture problems.

    von Hagens’s exhibits aren’t without faults, he still hasn’t provided enough documents to fully prove ALL his bodies are consented donors, but compared to Bodies, much less shadier. At this point, he has enough people signed up to be plastinated that he probably doesn’t need to obtain them questionably.

    I went to the the first Body Worlds when it was in Boston while there for a conference. Our group had fun pimping the tour guides… semi mean now that I think about it, considering many were graduate students that were volunteering…

  15. #15 True Bob
    February 24, 2009

    I saw Body Works in LA a few years ago with my brother. I found the most impressive exhibit to be the man, woman and child with the plastinated vasculature. It was very impressive in the super fine detail they captured. I would recommend it to anyone – I never had the same kind of oogy feeling I might have if they weer living people. I think the mannequin-like appearance helped make the entire exhibit more viewable.

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