Thursday, November 14, 2013

Book Review: Stiff - The Curious Lives of Human Cadavers by Mary Roach

“When you get right down to it, there is no dignified way to go, be it decomposition, incineration, dissection, tissue digestion or composting. …It takes the careful application of a considered euphemism – burial, cremation, anatomical gift-giving, water reduction, ecological funeral – to bring it to the point of acceptance."

(The US and UK covers of Mary Roach's book seem to show different pairs of feet!) 

Mary Roach is a fantastic author and her first book, Stiff - The Curious Lives of Human Cadavers , is an insightful and eye-opening (when you're not wincing) read on what can be an uncomfortable subject: dead bodies. Having written for a wide variety of periodicals including Salon, Slate, Inc, Discover, GQ and Wired, Roach is well schooled in writing in a breezy, fun style while educating us at the same time, which makes her very well placed to tackle this type of taboo and sometimes disgusting subject.

Since Stiff, Roach has published a few more books including "Packing for Mars: The Curious Science Of Life In Space" and more recently "Gulp: Adventures on the Alimentary Canal", both of which look to be on par with Stiff and which I eagerly await reading. In the mean time plenty of the author's articles are available in the public domain.

Summary book points and comments

- Human cadavers play a crucial role when it comes to forensic investigations, particulalry figuring out times of death. Research in this field often involves planting donated bodies in different locations and making observations on rates of decomposition etc. We learn, for example, that algor mortis (the cooling of dead bodies) takes place at roughly 1.5 degrees per hour until the body temperature balances with the external temperature. Also, the potassium level of the gel in a cadaver’s eye is also a useful indicator for time of death, if death occurred in the past 24 hours.

- Roach’s description of autolysis (self-digestion) is where things get really squeamish. We learn that when a person dies, their enzymes immediately begin to break down our cells walls, the result being internal liquidation. What's more, this internal meltdown means our internal bacteria now have a new food source made available to them - before we died, the bacteria merrily digested the food we ate, now they are digesting us....omm nom nom. It is this internal digestion that produces the gas and bloating effect, sometime resulting in dead people breaking wind. The next stage in the cycle is putrefaction and decay - we basically become a big human soup and the brain pours out of the ears and mouth.  Like I said, not a chapter for those with more delicate sensibilities.

- Surgery is one area where the use of cadavers is essential, yet bodies are difficult to come by. This is true in the modern era but was far more pressing in the past, when for hundreds of years venturing into the insides of bodies was off-limits and the knowledge of our inner working was a mixture of piece-meal knowledge and conjecture. The likes of Huang Ti (2600 BC), Galen and Hippocrates - all producers of classic texts on human anatomy - did get a lot surprisingly right despite the prohibitions on dissecting bodies.

- In Egypt, around 300 B.C,. King Ptolemy passed a decree permitting dissection of deceased criminals. However, it is understood that Herophilus, the father of anatomy, took things a little too far and went on to dissect live criminals. Even in England up until 1836, the only group of people legally allowed to be dissected were deceased criminals.  The shortage of criminal bodies available for dissection and surging demand from the medical schools created a black market for bodies – enter the infamous body-snatchers Hare and Burke who set about murdering instead of digging up bodies from cemeteries.

- The role of cadavers in car safety was also crucial in developing modern tempered glass windshields, which have sufficient strength in them to prevent the driver from smashing straight through the glass pane on impact, but also sufficient flexibility to minimise impact damage to the head. It is estimated that human lives saved as a result of human cadaver research (much research today uses crash test dummies) is in the region of 8,500 each year since 1987 (“For every corpse whose head has hammered a windscreen, 68 lives per year are saved”).

- An unintended consequence of the California Clear Act regulations, was that "humane societies switched from cremating their euthanized pets to what one official calls ‘the rendering situation’. I called up a rendering plant to learn into what the dogs were being rendered. ‘We grind ‘em up and turn ‘em into bone meal’, the plant manager had said. Bone meal is a common ingredient in fertilisers and animal feed – including many commercial dog foods.“

- In the ghoulish "Just a Head" chapter, we learn of some grim experiments that firmly belong in the realm of science-fiction (I'm thinking Futurama specifically), where Vladimir Demikhlov, a  1950s Soviet Union scientist, transplants the heads of puppies, including shoulders, forelimbs and oesophaguses that emptied outside of the dog, onto the the bodies of other dogs. From his reports:

"09:00 The donors head eagerly drank water or milk, and tugged as if trying to separate itself from the recipient's body"

"22:30 When the recipient was put to bed, the transplanted head bit the finger of a member of staff until it bled"

"February 26, 18:00. The donor's head bit the recipient behind the ear, so the latter yelped..."

Roach notes that the experiments may not have failed had Demikhlov understood immunology, since the brain enjoys "immunological privilege" i.e. the brain is not rejected as hostile foreign body. 

This brings us to Robert White's brain transplant experiments in the 1960s White transplanted isolated brains inside the necks and abdomens of other animals. Roach comments "While the inside of someone else's abdomen is of moderate interest ...it's not the sort of place you want to settle down in to live out the remainder of your years." When Roach meets Robert White he scarily refers to isolation chamber studies where human subjects where fully sensory deprived. The finding was that insanity doesn't take long to set in. Before thinking this is all just cruelty with no purpose, White's experiment were a step on the road to full human head transplant (useful for quadriplegics in an organ [body] donor scenario).


- In the penultimate chapter, Roach investigates the idea of being turned into human fertiliser as an environmentally friendly means of cadaver disposal. The idea sounds cold and uncaring but the reality is anything but. To me this harks back to ancient rituals where bodies would be left in the open to decompose and to be picked at by vultures and other creatures, thereby returning the body’s to the cycle of life that much faster. Indeed, the more I think about the idea of lying in a dry box, six feet under, for who knows how many decades, the more I am at unease with the "traditional" approach. Perhaps it is time to consult the will-maker with a new request?

- Roach finishes the book with her thoughts on what she would like done with her remains after she dies, noting that it is somewhat irrational to try to control what happens to you once you are gone (afterall, you are not around to care), and that making elaborate requests can be an unnecessary burden. What still matters though, is the cares and wishes of the living and these should really be taken into account. The caveat is organ donations – friends and family wishes are vetoed in this particular respect says Roach (I agree). If her husband isn’t around to influence the outcome, Roach says she has a preference for willed body donation (i.e. donating to science). All in all, a very considered approach from somebody who really understands the value of dead bodies.

**** 1/2 - I highly recommend getting over the yuck factor and reading this book to appreciate the physiological processes when we expire, as well as all the good uses who could potentially be put to, instead of being shut in a box and dropped in the ground. Even though Stiff doesn't really discuss dying - the necessary pre-requisiote for the existence of a cadaver - reading the book did make me feel more comfortable with the idea of mortality.

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