tag:theconversation.com,2011:/fr/topics/autopsy-8411/articlesAutopsy – The Conversation2022-08-02T04:48:45Ztag:theconversation.com,2011:article/1773222022-08-02T04:48:45Z2022-08-02T04:48:45ZHow do I donate my brain to science?<figure><img src="https://images.theconversation.com/files/455453/original/file-20220331-17-65g91o.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C744&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-conceptual-image-large-stone-shape-1032541603">Shutterstock</a></span></figcaption></figure><p>Have you ever thought about donating your brain to science? Don’t worry, I mean after you die.</p>
<p>Perhaps you’ve heard about donating your body to science or donating organs for transplants and wondered if it’s similar. Or perhaps you have a vague notion donating your brain might be a good idea and want to know what’s involved.</p>
<p>If you do go ahead and donate your brain, it would be stored in a <a href="https://www.sydney.edu.au/medicine-health/schools/school-of-medical-sciences/discipline-of-pathology/nsw-brain-tissue-resource-centre.html">brain bank</a>, perhaps one at the University of Sydney, where I’m the director.</p>
<p>Here are the answers to some of the most common questions we’re asked about donating your brain to science.</p>
<h2>Is it like donating a kidney?</h2>
<p>No, donating your organs, such as kidneys or your liver, during your life or after your death is <a href="https://www.donatelife.gov.au">for transplants</a>. A brain is definitely not for transplants. </p>
<p>Donating your body to science is also different and is largely so medical or allied health students can study <a href="https://www.sydney.edu.au/medicine-health/schools/school-of-medical-sciences/discipline-of-anatomy-and-histology/body-donations.html">human anatomy</a> including brain anatomy.</p>
<p>Donating your brain to a brain bank after you die allows researchers to use your brain tissue for research.</p>
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Read more:
<a href="https://theconversation.com/dead-yet-science-scaremongering-and-organ-donation-10458">Dead yet? Science, scaremongering and organ donation</a>
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</em>
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<h2>What type of brains are you after?</h2>
<p>Scientists want to study all types of brains. That includes brains from people who have brain disease, such as dementia or depression, when they sign up for our program, and those who don’t have brain disease initially but then develop it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1226109922527469568"}"></div></p>
<p>To understand why certain people get a brain diseases scientists need to compare affected brains to those from people without brain disease. Brain diseases such as Alzheimer’s disease and stroke are among Australia’s <a href="https://www.aihw.gov.au/reports/australias-health/causes-of-death">biggest causes of death</a>. Addiction, anxiety and depression are <a href="https://www.aihw.gov.au/reports/australias-health/burden-of-disease">major causes of disease</a>. </p>
<h2>How will my brain be used?</h2>
<p>Researchers use donated brain tissue to firstly confirm the patient’s diagnosis. Diseases like Alzheimer’s disease can only be confirmed after death. </p>
<p>By studying brain tissue, researchers can also learn about how brain disease progresses. By studying diseases at the microscopic level we are trying to find how they might be better diagnosed and treated.</p>
<p>We still know very little about what happens in the brain to cause these conditions and the reasons why the most promising treatments fail to improve them. </p>
<p>Many treatments’ ability to cure brain diseases in animals, but there is a high rate of failure when they are tried in humans. This is because our brains are so uniquely human, in terms of size and complexity. The only accurate model is the human brain itself. </p>
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Read more:
<a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">What causes Alzheimer’s disease? What we know, don’t know and suspect</a>
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<h2>What’s actually involved?</h2>
<p>When you die, staff from the brain bank liaise with hospital or aged-care staff, funeral directors, and your next-of-kin. Your body is transported to a mortuary, either at a public hospital or forensic medicine centre, and a brain-only autopsy is carried out. </p>
<p>The entire brain and spinal cord are removed by mortuary staff and immediately transported by brain bank staff to the bank for further preparation. </p>
<p>At the bank, staff work quickly to divide the brain in two: one half is placed into a chemical fixative, while the other half is dissected and placed in a -80°C freezer. The time between death and fixation or freezing is called the post-mortem interval and it needs to be kept as short as possible to maximise the success of future analytical techniques. </p>
<p>The fixed tissue remains in solution for three weeks before being dissected into a number of blocks that are then embedded in wax and allowed to harden. These blocks are then cut with a very fine blade to produce sections one hundredth of a millimetre thick. These sections are stained for disease-specific proteins to allow a diagnosis to be formally made by the bank’s neuropathologist. </p>
<p>Researchers interested in a specific brain disease apply to the bank’s scientific committee for tissue. A prospective study will often involve both fixed and frozen tissue so complementary spatial (from fixed tissue) and molecular (frozen tissue) studies can be performed. </p>
<p>We store about 500 brains from donors with a variety of diseases and those with “normal” brains. </p>
<h2>Why do people sign up?</h2>
<p>People donate their brains to science for all sorts of reasons. </p>
<p><a href="https://link.springer.com/article/10.1007/s10561-019-09786-3">A review</a> by colleagues in New Zealand found a major reason was a desire to help others. </p>
<p>Major reasons for not donating included the family was against it, religious concerns, and being unaware that brain donation is possible.</p>
<p>Donation was more likely if people had a thorough knowledge and understanding of the entire process.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/donating-your-body-to-science-dont-worry-its-not-what-it-used-to-be-5567">Donating your body to science? Don't worry, it's not what it used to be</a>
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</em>
</p>
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<h2>OK, you’ve convinced me. What’s next?</h2>
<p>The first step is to get in touch with <a href="https://brainfoundation.org.au/support-us/donate-your-brain/">your local brain bank</a> to find out what’s involved. </p>
<p>After discussing with your family or friends and giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/informed-consent">informed consent</a>, prospective brain donors will sign up to a program. </p>
<p>Some donor programs are associated with referral clinics for specific diseases such as Parkinson’s disease or motor neuron disease <a href="https://mndnsw.org.au/about-mnd/mnd-research/54-participating/669-brain-donor-program.html">motor neuron disease</a>. In this case, patients will be made aware of brain donation by their specialist and will be contacted by the bank if they give permission.</p>
<p>The brain bank follow donor’s lifestyle and medical history using annual questionnaires and optional additional studies.</p>
<p>We need this information years before you die to build a more complete picture of the person behind the brain, and any issues that may relate to brain disease.</p>
<h2>Thank you</h2>
<p>Australia’s brain banks have already contributed to many findings, including research into <a href="https://www.science.org/doi/10.1126/science.aah6205">Alzheimer’s disease</a>, <a href="https://www.science.org/doi/10.1126/science.aao1157">alcohol addiction</a>, <a href="https://www.nature.com/articles/ng.536">young-onset dementia</a> and <a href="https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.21956">Parkinson’s disease</a>. </p>
<p>So thank you for considering donating your brain to science so we can have a chance of learning more.</p><img src="https://counter.theconversation.com/content/177322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Greg Sutherland is the Director of the New South Wales Brain Research Tissue Centre that currently receives funding from the National Institute on Alcohol Abuse and Alcoholism (USA; R28AA012725)</span></em></p>No, it’s not like donating a kidney. But it is still a gift.Greg Sutherland, Associate Professor, Pathology, School of Medical Sciences, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666682021-08-25T15:11:34Z2021-08-25T15:11:34ZMissteps stand in the way of criminal liability in South African mental health patient deaths<figure><img src="https://images.theconversation.com/files/417609/original/file-20210824-24-2593zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 144 mental health care users were failed from the get go.</span> <span class="attribution"><span class="source">Alet Pretorius/Gallo Images/Getty Images</span></span></figcaption></figure><p><em>Between March and September 2016, nearly 2000 mental health care users were discharged from a private long term care facility after a South African provincial government organ cancelled a contract. Patients with varying mental health care needs were transferred to unlicensed nongovernmental organisations. It led to 144 deaths. Later, the public would hear details of how patients were deprived of basic provisions such as food, shelter and medication. Five years later no criminal charges have been instituted. On the eve of an <a href="https://section27.org.za/life-esidimeni/">inquest into the deaths</a>, Jo-Mari Visser unpacks how the system has failed to bring justice.</em></p>
<hr>
<h2>When did the system first fail those who lost their lives?</h2>
<p>Right at the beginning – the point at which <a href="https://www.dailymaverick.co.za/article/2017-09-04-health-e-news-esidimeni-unnatural-deaths-erased/">various medical officers</a> recorded causes of death on the death certificates.</p>
<p>First some context.</p>
<p>In South Africa, the <a href="https://www.npa.gov.za/node/9">National Prosecuting Authority (NPA)</a> is the government agency responsible for instituting criminal prosecutions and performing related functions. Included is the duty to help give effect to the provisions of the <a href="https://www.gov.za/sites/default/files/gcis_document/201505/act-58-1959.pdf">Inquest Act 58 of 1959</a> when a death due to unnatural causes has been reported to the South African Police Service. </p>
<p>The NPA decides whether there is any reason to get more information or to begin criminal proceedings. But this never happened because the deaths were recorded as natural.</p>
<p>Here’s how the process works. When the police investigation into an unnatural death has been completed and all information, post-mortem reports and witness statements have been included in the case file, it is submitted to the public prosecutors at the NPA. The Authority studies the contents of the file and decides whether there are any outstanding investigations still to be concluded. If so, the prosecutor will return the case file to the police with careful instructions about what must be done.</p>
<p>If the prosecutor is convinced that, on the face of it, there is enough potential evidence to secure a successful prosecution and there are no clear reasons not to prosecute, they will institute criminal proceedings against the suspect on behalf of the state. </p>
<p>But if the prosecutor is not convinced of the strength of the case they will submit the case file to the inquest court. This might happen if there’s doubt about the exact cause of death or if there is not a clear link between a known suspect’s actions and the fatal outcome.</p>
<p>The 144 mental health care users were failed from the get-go. Immediate police investigations into these deaths were prevented because the cause of death was indicated as “natural causes” on the death certificates. </p>
<p>Because of this, no postmortem examinations or other forensic investigations were conducted at the time.</p>
<p>This affected every subsequent development.</p>
<h2>How did the tragedy unfold?</h2>
<p>By mid-2016, the Health Department of the Gauteng Province – South Africa’s economic hub – had implemented its decision to cancel its contract with the Life Esidimeni Health Care Centre. This resulted in <a href="https://www.researchgate.net/publication/329988090_Contribution_of_the_Health_Ombud_to_Accountability_The_Life_Esidimeni_Tragedy_in_South_Africa">more than 1700</a> patients being moved haphazardly to other hospitals and non-governmental organisations. This was despite <a href="http://healthombud.org.za/wp-content/uploads/2017/05/FINALREPORT.pdf">warnings</a> that such a move would be detrimental to the patients’ well-being. </p>
<p>Almost immediately reports of abuse, starvation, dehydration and neglect surfaced, and by September 2016, a reported <a href="http://healthombud.org.za/wp-content/uploads/2017/05/FINALREPORT.pdf">77 patients had died</a> under suspicious circumstances.</p>
<p>Under public pressure, the Minister of Health instructed the Health Ombud of South Africa to investigate the circumstances surrounding the deaths. In a comprehensive <a href="http://healthombud.org.za/wp-content/uploads/2017/05/FINALREPORT.pdf">report</a> published in February 2017, the ombud detailed the unacceptable – and often horrific – conditions in which the patients were moved and cared for after their removal from Life Esidimeni. </p>
<p>The report showed that almost all aspects of the move and subsequent care violated the National Health Act and the Mental Health Care Act. It also violated the patients’ and their families’ constitutional rights to, among others, dignity, life, access to quality health care services and environments that are not harmful to their health and well-being. </p>
<p>The report also revealed the entries on the death certificates. But it made clear in its findings that “natural causes” did <em>not</em> reflect the circumstances in which these mental health care patients died. </p>
<p>The entries on the death certificates came under scrutiny again some time later during a dispute resolution process between the families of the deceased patients and the government, a restorative process recommended by the ombud. Former <a href="http://section27.org.za/wp-content/uploads/2018/05/Life-Esidimeni-arbitration-award-by-retired-Deputy-Chief-Justice-Dikgang-Mosenke.pdf">Deputy Justice Dikgang Moseneke</a> oversaw this arbitration process.</p>
<p>In his arbitration report Moseneke recorded the concessions made by the state that</p>
<blockquote>
<p>the deaths of the concerned mental health care users were not natural deaths but caused by the unlawful and negligent omission or commissions of its employees… </p>
</blockquote>
<p>He attributed blame to the former Gauteng MEC for Health who cancelled the contract with Life Esidimeni, several provincial governmental officials, and the staff of the NGOs who carried the same legislative and constitutional duties of care as the state toward the patients and their families. </p>
<p>But Justice Moseneke stopped short of ordering the police to investigate criminal charges against the mentioned parties. He rightly held that the police must perform their investigative functions as the law commands it, and not at his bidding.</p>
<p>By this time, <a href="https://section27.org.za/">SECTION27</a>, a <a href="https://section27.org.za/life-esidimeni/">public interest law centre</a>, had assisted some families of deceased patients to submit requests with the South African Police Service to launch inquests into these deaths. By the time the arbitration was concluded, all 144 case files had been submitted to the NPA. </p>
<p>Despite the NPA’s <a href="https://www.timeslive.co.za/news/south-africa/2019-09-17-not-enough-evidence-to-prosecute-esidimeni-deaths-npa/">fervent investigations</a> it found that not enough evidence existed to justify the institution of criminal proceedings. Insufficient evidence about the exact cause of death and the connection of specific role-players to these deaths resulted in the NPA submitting the case files for joint inquest in 2021. </p>
<h2>What good will the inquest do?</h2>
<p>An inquest is not a trial. No pronouncements on guilt will be made and no person will be named “accused”. </p>
<p>The purpose is to fill those evidential gaps that preclude the NPA from instituting criminal proceedings. During the inquest, each piece of evidence will be perused, more evidence will be collected and all possible avenues will be scoured to find answers to the questions: how did the patients really die? And who exactly caused their deaths? </p>
<p>It is important to remember that while the health ombud and arbitration assigned blame to certain entities and individuals, criminal proceedings are conducted on a much higher standard of proof. Potential evidence will be subjected to strict rules of admissibility and must carry sufficient probative value to persuade a criminal court of the guilt of specific perpetrators - <a href="https://www.npa.gov.za/sites/default/files/resources/justice_system/NPA_eng.pdf">beyond reasonable doubt</a>. </p>
<p>But this reflects the second great failure in the process of pursuing justice for the deceased and their loved ones. The police investigations and forensic examinations of most of the deaths only started during and after the arbitration. It is not known how much time had elapsed between the deaths and the performance of autopsies once it was determined that the deaths were not – as initially indicated – due to natural causes. </p>
<p>Even less is known about any opportunities the South African Police Service and its Forensic Division should have had to collect crucial evidence during the time immediately following the deaths. We will never fully understand how much evidence has been lost due to these failures.</p><img src="https://counter.theconversation.com/content/166668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo-Marí Visser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An immediate police investigation into the deaths was prevented because the cause of death was indicated as ‘natural causes’ on their death certificates.Jo-Marí Visser, Senior Lecturer: Department Public Law, University of the Free StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1430702020-09-15T11:49:57Z2020-09-15T11:49:57ZWhen someone dies, what happens to the body?<figure><img src="https://images.theconversation.com/files/357962/original/file-20200914-24-jc0twd.jpg?ixlib=rb-1.1.0&rect=383%2C225%2C4551%2C3250&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When a life ends, those who remain deal with the body.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/funeral-home-director-chris-fontana-and-apprentice-news-photo/1212133109">Jim Watson/AFP via Getty Images</a></span></figcaption></figure><p>Upwards of <a href="https://www.cdc.gov/nchs/fastats/deaths.htm">2.8 million people die</a> every year in the United States. As a funeral director who heads a university mortuary science program, I can tell you that while each individual’s life experiences are unique, what happens to a body after death follows a broadly predictable chain of events.</p>
<p>In general, it depends on three things: where you die, how you die and what you or your family decide on for funeral arrangements and final disposition.</p>
<h2>In death’s immediate aftermath</h2>
<p>Death can happen anywhere: at home; in a hospital, nursing or palliative care facility; or at the scene of an accident, homicide or suicide.</p>
<p>A medical examiner or coroner must investigate whenever a person dies unexpectedly while not under a doctor’s care. Based on the circumstances of the death, they determine whether an autopsy is needed. If so, the body travels to a county morgue or a funeral home, where a pathologist conducts a detailed internal and external examination of the body as well as toxicology tests.</p>
<p>Once the body can be released, some states allow for families to handle the body themselves, but most people employ a funeral director. The body is placed on a stretcher, covered and transferred from the place of death – sometimes via hearse, but more commonly these days a minivan carries it to the funeral home. </p>
<p>State law determines who has the authority to make funeral arrangements and decisions about the remains. In some states, you can choose during your lifetime how you’d like your body treated when you die. In most cases, however, decisions fall on surviving family or someone you appointed before your death.</p>
<h2>Preparing the body for viewing</h2>
<p>In a 2020 consumer survey conducted by the National Funeral Directors Association, 39.4% of respondents reported feeling it’s very important to have the <a href="https://www.census.gov/content/dam/Census/newsroom/press-kits/2018/jsm/jsm-presentation-pop-projections.pdf">body or cremated remains present</a> at a funeral or memorial service.</p>
<p>To prepare for that, the funeral home will usually ask whether the body is to be embalmed. This process sanitizes the body, temporarily preserves it for viewing and services, and restores a natural, peaceful appearance. Embalming is typically required for a public viewing and in certain other circumstances, including if the person died of a communicable disease or if the cremation or burial is to be delayed for more than a few days.</p>
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<a href="https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two funeral home staff stand behind a mortuary table" src="https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357964/original/file-20200914-18-5u75p6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A funeral home director and an intern stand by a mortuary table.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/funeral-director-alexandra-burke-and-intern-vincent-news-photo/1248738963">John Moore/Getty Images News via Getty Images</a></span>
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<p>When the funeral director begins the embalming process, he places the body on a special porcelain or stainless steel table that looks much like what you’d find in an operating room. He washes the body with soap and water and positions it with the hands crossed over the abdomen, as you’d see them appear in a casket. He closes the eyes and mouth.</p>
<p>Next the funeral director makes a small incision near the clavicle, to access the jugular vein and carotid artery. He inserts forceps into the jugular vein to allow blood to drain out, while at the same time injecting embalming solution into the carotid artery via a small tube connected to the embalming machine. For every 50 to 75 pounds of body weight, it takes about a gallon of embalming solution, largely made up of formaldehyde. The funeral director then removes excess fluids and gases from the abdominal and thoracic cavities using an instrument called a trocar. It works much like the suction tube you’ve experienced at the dentist.</p>
<p>Next the funeral director sutures any incisions. He grooms the hair and nails and again washes the body and dries it with towels. If the body is emaciated or dehydrated, he can inject a solution via hypodermic needle to plump facial features. If trauma or disease has altered the appearance of the deceased, the embalmer can use wax, adhesive and plaster to recreate natural form. </p>
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<a href="https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A funeral home worker handles cosmetics used to makeup the deceased." src="https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357966/original/file-20200914-20-ys77cf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A funeral director prepares to apply makeup to a man who died of COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jeffrey-rhodes-funeral-home-director-applies-makeup-for-man-news-photo/1228017197">Octavio Jones/ Getty Images North America via Getty Images</a></span>
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</figure>
<p>Lastly, the funeral director dresses the deceased and applies cosmetics. If the clothing provided does not fit, he can cut it and tuck it in somewhere that doesn’t show. Some funeral homes use an airbrush to apply cosmetics; others use specialized mortuary cosmetics or just regular makeup you might find at a store.</p>
<h2>Toward a final resting place</h2>
<p>If the deceased is to be cremated without a public viewing, many funeral homes require a member of the family to identify him or her. Once the death certificate and any other necessary authorizations are complete, the funeral home transports the deceased in a chosen container to a crematory. This could be onsite or at a third-party provider.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man reaches into cremator with a long-handled tool." src="https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357967/original/file-20200914-14-b2zisf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">More people in the U.S. are now cremated than embalmed and buried.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/maryland-cremation-services-cremation-operator-edward-pugh-news-photo/1225638524">Chip Somodevilla/Getty Images North America via Getty Images</a></span>
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<p>Cremations are performed individually. Still in the container, the deceased is placed in the cremator, which produces very high heat that reduces the remains to bone fragments. The operator removes any metal objects, like implants, fillings and parts of the casket or cremation container, and then pulverizes the bone fragments. He then places the processed remains in the selected container or urn. Some families choose to keep the cremated remains, while others bury them, place them in a niche or scatter them.</p>
<p>The year 2015 was the first year that the <a href="https://nfda.org/news/in-the-news/nfda-news/id/5223/2020-cremation-burial-projects-cremation-rate-of-87-by-2040">cremation rate exceeded the casketed burial rate</a> in the U.S., and the industry expects that trend to continue.</p>
<p>When earth burial is chosen, the casket is usually placed in a concrete outer burial container before being lowered into the grave. Caskets can also be entombed in above-ground crypts inside buildings called mausoleums. Usually a grave or crypt has a headstone of some kind that bears the name and other details about the decedent.</p>
<p>Some cemeteries have spaces dedicated to environmentally conscious “green” burials in which an unembalmed body can be buried in a biodegradable container. Other forms of final disposition are less common. As an alternative to cremation, the chemical process of alkaline hydrolysis can reduce remains to bone fragments. Composting involves placing the deceased in a vessel with organic materials like wood chips and straw to allow microbes to naturally break down the body.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>I’ve seen many changes over the course of my funeral service career, spanning more than 20 years so far. For decades, funeral directors were predominantly male, but now mortuary school enrollment nationwide is roughly 65% female. Cremation has become more popular. More people pre-plan their own funerals. Many Americans do not have a religious affiliation and therefore opt for a less formal service.</p>
<p>Saying goodbye is important for those who remain, and I have witnessed too many families foregoing a ceremony and later regretting it. A dignified and meaningful farewell and the occasion to share memories and comfort each other <a href="https://www.jstor.org/stable/26555297">honors the life of the deceased and facilitates healing</a> for family and friends.</p><img src="https://counter.theconversation.com/content/143070/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Evely is affiliated with Volunteer with National Funeral Directors Association, Michigan Funeral Directors Association, American Board of Funeral Service Education and International Conference of Funeral Service Examining Boards.</span></em></p>A funeral director explains how the bodies of the deceased are prepared for burial or cremation in the United States.Mark Evely, Program Director and Assistant Professor of Mortuary Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1352752020-04-08T17:26:42Z2020-04-08T17:26:42ZOverloaded morgues, mass graves and infectious remains: How forensic pathologists handle the coronavirus dead<figure><img src="https://images.theconversation.com/files/326115/original/file-20200407-74220-elf1i1.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4977%2C3330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mortuary in Girona, Spain, one of the countries hardest hit by coronaviurs. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/worker-stands-next-to-a-coffin-at-the-mortuary-in-girona-news-photo/1209215783?adppopup=true">Marti Navarro/SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">find all of the stories here</a>.</em></p>
<p><em>Editor’s note: Most scientists and doctors in the coronavirus crisis are working to save the living. Those in the field of forensic pathology, however, <a href="https://theconversation.com/humanitarian-forensic-scientists-trace-the-missing-identify-the-dead-and-comfort-the-living-115623">focus on the dead</a>.</em> </p>
<p><em>Ahmad Samarji, a Lebanon-based scholar of forensic science, reports on the extraordinary challenges facing coroners and pathologists in outbreak zones, where governments have to take “very limited but essential choices” to avoid a dangerous pileup of dead bodies. This Q+A has been edited and condensed for publication.</em> </p>
<p><strong>What is the role of forensic pathologists in a pandemic?</strong></p>
<p><a href="https://www.crcpress.com/Forensic-Science-An-Introduction-to-Scientific-and-Investigative-Techniques/Bell/p/book/9781138048126">Forensic pathologists</a> are physicians who integrate <a href="https://www.sciencedirect.com/referencework/9780128000557/encyclopedia-of-forensic-and-legal-medicine">law and medicine</a> to determine the cause, mechanism, manner and time of a person’s death. Their everyday work has important <a href="https://trove.nla.gov.au/work/25224098?q&sort=holdings+desc&_=1586298130543&versionId=222122243+256989756">legal, social and economic consequences</a> for family members of the deceased and for the larger community. </p>
<p>During a pandemic, forensic pathologists are heavily involved in managing the crisis, either within their local communities or as part of a humanitarian mission working with vulnerable communities abroad. </p>
<p>Their role in these extremely challenging times is to ensure the proper management of dead bodies, minimizing the spread of the virus, and to guide authorities, hospitals and funeral directors about the “do’s and don'ts” of dealing with these bodies. </p>
<p>There is a general assumption in medicine that dealing with the deceased does not require the same urgency as working with an acutely ill patient, and normally that is true. However, in a pandemic like COVID-19, large numbers of the dead can quickly exceed local capacities if not managed in a timely manner. </p>
<p>With highly infectious diseases, it is urgent that the post-mortem procedures – from death, examination, certification, registration and release of the body to safe cremation or burial – flow as properly and smoothly as possible. </p>
<p><strong>Are the bodies of COVID-19 victims infectious?</strong></p>
<p>While a lot is known about the coronavirus family, much is yet to be understood about the transmission modes and effects on the body of SARS-CoV-2, the virus that causes COVID-19. We don’t know whether human remains are infectious, but the likelihood is high. So forensic pathologists <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html">around the world</a> are <a href="https://www.ecdc.europa.eu/en/publications-data/considerations-related-safe-handling-bodies-deceased-persons-suspected-or">urging governments</a> to <a href="https://www.mohfw.gov.in/1584423700568_COVID19GuidelinesonDeadbodymanagement.pdf">restrict viewing</a> and <a href="http://www.moh.gov.my/moh/resources/Penerbitan/Garis%20Panduan/Pengurusan%20KEsihatan%20&%20kawalan%20pykit/2019-nCOV/Bil%204%20%202020/Annex%2020%20Guidelines%20Managing%20Dead%20Bodies_26022020.pdf">handling of the body after examination is completed</a>. </p>
<p>During the Ebola epidemic – which claimed around 11,300 lives in West Africa between 2014 and 2015 – handling of the dead was <a href="https://international-review.icrc.org/sites/default/files/irc98_15.pdf">one of the main modes of transmission of the disease</a>. So one of the lessons <a href="https://www.sciencedirect.com/science/article/pii/S0379073817303109?via%3Dihub">forensic humanitarians took from this experience</a> – which is now being applied to coronavirus – was that untrained first responders should not be involved in handling human remains during outbreaks of highly contagious diseases. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326136/original/file-20200407-27948-n934o4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bodies are moved to a refrigerated truck serving as a temporary morgue for Wyckoff Hospital, Brooklyn, April 4, 2020 in New York City, where someone dies from COVID-19 every few minutes.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/bodies-are-moved-to-a-refrigerator-truck-serving-as-a-news-photo/1209150285?adppopup=true">BRYAN R. SMITH/AFP via Getty Images</a></span>
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</figure>
<p><strong>Are cities with coronavirus outbreaks able to manage the dead safely?</strong></p>
<p>With the death toll from coronavirus <a href="https://www.nbcnews.com/news/us-news/dr-deborah-birx-predicts-200-000-deaths-if-we-do-n1171876">projected to exceed many hundreds of thousands worldwide</a>, governments everywhere are scrambling. But health systems that have planned for pandemics – and allocated sufficient resources to manage them – seem to be in decent shape. </p>
<p>My colleague Dr. Ralph Bouhaidar – a consultant forensic pathologist at the University of Edinburgh – told me that in addition to spending long hours in the Edinburgh City Mortuary, he is closely collaborating with prosecutors, police, funeral directors and hospitals across Scotland to review, assess and update existing procedures for managing “excess deaths in a pandemic.” </p>
<p>Dr. Bouhaidar emphasized that an appropriate COVID-19 response does not “emerge from a vacuum.” Rather, he said, proper management of the dead is “the result of cumulative work and planning…to have an understanding of local capacities and study our resilience in dealing with such possibilities, whilst liaising nationally and internationally with colleagues to share knowledge and experiences.”</p>
<p>So far, with <a href="https://www.edinburghnews.scotsman.com/health/coronavirus/41-deaths-linked-covid-19-nhs-lothian-number-cases-rises-79-2533182">4,565 confirmed COVID-19 cases and 366 dead</a>, Scotland’s hospitals and morgue are not overwhelmed.</p>
<p><strong>But there are grim reports from hard-hit cities – like New York and <a href="https://www.reuters.com/article/us-health-coronavirus-ecuador/ecuador-struggles-to-collect-the-dead-as-coronavirus-spreads-idUSKBN21I03Q">Guayaquil, Ecuador</a>, for example – of coronavirus patients dying so fast that bodies are just piling up. Both cities are considering <a href="https://www.nytimes.com/2020/04/06/nyregion/mass-graves-nyc-parks-coronavirus.html">digging mass graves</a>.</strong></p>
<p>When national plans for managing dead bodies in pandemics are exhausted, it leads to the piling up of bodies, issues with storage and refrigeration, and decomposition. That, as a result, increases risk of infection across the community. </p>
<p>Under such conditions, local and federal governments have very limited – yet essential – choices to handle the volume of bodies. </p>
<p>They should allow for the certification of medical deaths due to COVID-19 by the treating clinician, without the need for a post-mortem examination, to enable a swifter flow of the deceased within the system. They must also set up temporary mortuaries big enough to accommodate thousands of bodies. British authorities, for example, are building a special COVID-19 mortuary at the Birmingham Airport to <a href="https://www.itv.com/news/2020-03-27/work-starts-on-birmingham-airport-covid-19-mortuary-for-up-to-12-000-bodies/">accommodate 12,000 bodies</a>. And, yes, they may need to excavate mass graves. </p>
<p>All this must be done while ensuring a dignified burial for the bodies and proper labeling of the graves as <a href="https://ihl-databases.icrc.org/customary-ihl/eng/docs/v2_rul_rule115">required by international humanitarian law</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326116/original/file-20200407-36391-1jgd0u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The eastern Ukrainian city of Dnipro has prepared more than 600 graves for coronavirus victims, April 7, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/view-shows-dozens-of-freshly-dug-graves-at-a-cemetery-in-news-photo/1209325869?adppopup=true">STANISLAV VEDMID/AFP via Getty Images</a></span>
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<p><strong>What dangers does the COVID-19 pandemic present for forensic scientists?</strong></p>
<p>Despite all protective measures, forensic experts are at constant risk of exposure to this deadly virus. And when pathologists in hard-hit areas contract coronavirus, it intensifies a vicious cycle. </p>
<p>They must absent themselves from work for at least 14 days, and some will die. This worsens an already miserable situation with the handling of dead bodies and, as a result, threatens the health of the entire community. </p>
<p>Forensic scientists from the Red Cross are being <a href="https://www.icrc.org/en/document/icrc-operational-response-covid-19">sent into refugee camps, war zones</a> and overwhelmed cities on humanitarian COVID-19 missions to provide pandemic assistance. In these places, the risk of contagion is even greater. The morgues they work in there most likely face shortages of staff with expert skills and appropriately equipped mortuaries. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326139/original/file-20200407-182957-g89qpp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People wait next to coffins and cardboard boxes to bury their loved ones outside a cemetery in Guayaquyil, Ecuador, April 6, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-wait-next-to-coffins-and-cardboard-boxes-to-bury-news-photo/1209305597?adppopup=true">JOSE SANCHEZ/AFP via Getty Images</a></span>
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</figure>
<p>Generally speaking, the forensic examination of a dead person doesn’t require highly complex equipment and machinery compared to other health specialties. Pathologists just need appropriate storage, personal protective equipment, basic dissection tools and specimen collection material. </p>
<p>But our work falls within a larger chains of events. Hospitals must have the capacity to identify the person, determine their cause of death, physically dispose of the body and work through the various legal complexities that these cases attract – and to do so swiftly.</p>
<p><strong>You mentioned how forensic scientists learned about Ebola on the job. What are we learning about coronavirus that’s aiding the pandemic response?</strong></p>
<p>The lessons from Ebola were reflected into the revised “<a href="https://www.paho.org/disasters/index.php?option=com_docman&view=download&category_slug=books&alias=2468-management-dead-bodies-after-disasters-a-field-manual-for-first-responders-second-edition-8&Itemid=1179&lang=en">Management of Dead Bodies following Disasters</a>” manual, published in 2016 by the World Health Organization and International Committee of the Red Cross, that is now aiding governments and first responders worldwide in the COVID-19 pandemic. </p>
<p>Today, cross-disciplinary research is underway about COVID-19 that connects the knowledge of forensic pathologists with that of clinical medical practitioners, virologists and biochemists. </p>
<p>In Italy, for example, <a href="https://www.pathologica.it/article/view/101">a study published March 26</a>, led by 25 health professionals across fields, warned health care professionals and morgue staff about specific risks in handling COVID-19 patients and provided guidance for autopsies of suspected, probable and confirmed cases of COVID-19.</p>
<p>Such work, when replicated and carried out across various research teams and countries, will greatly assist in managing this global crisis, formulating an effective treatment plan – and potentially creating a vaccine. </p>
<p><em>The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find <a href="https://theconversation.com/us/topics/covid-19-front-lines-84846">all of the stories here</a>.</em></p><img src="https://counter.theconversation.com/content/135275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmad Samarji does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An expert on forensic science explains the critical role of coroners and pathologists in the COVID-19 crisis, as many cities struggle to manage the soaring number of dead bodies.Ahmad Samarji, Associate Professor of Forensic Science Education & STEM Education and the Assistant Dean of the College of Arts and Sciences, Phoenicia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/640312016-08-17T19:00:42Z2016-08-17T19:00:42ZUnder the Influence of … Paul Stopforth’s Biko painting called ‘Elegy’<figure><img src="https://images.theconversation.com/files/134410/original/image-20160817-3597-1t5w78l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paul Stopforth (b. 1946) 'Elegy' (1980). Graphite and wax on paper on board: 149 x 240 cm
</span> <span class="attribution"><span class="source">Courtesy Durban Art Gallery</span></span></figcaption></figure><p><em>In our weekly series, “Under the influence”, we ask experts to share what they believe are the most influential works of art in their field. Here, artist/academic/forensic practitioner Kathryn Smith explains why she believes Paul Stopforth’s “Elegy” (1980) is hugely influential.</em></p>
<p>“Elegy” is a postmortem portrait of South African Black Consciousness activist <a href="http://www.sahistory.org.za/people/stephen-bantu-biko">Stephen Bantu Biko</a> (1946-1977) by <a href="http://paulstopforth.com/">Paul Stopforth</a> (b. Johannesburg, 1945). It is executed in graphite powder painstakingly polished into layers of Cobra floor wax from which countless hair-fine excisions then excavate the figure from its ground.</p>
<p>Measuring 149 x 240 cm – near life-size – it hovers between drawing, photography, sculpture and painting, demonstrating kinship with all these media and yet claiming a singular materiality. </p>
<h2>My relationship with the work</h2>
<p>The work was completed in 1980, three years after Biko’s violent death in police custody. It was purchased by the <a href="http://www.durban.gov.za/city_services/parksrecreation/durban_art_gallery/Pages/default.aspx">Durban Art Gallery</a> in 1981, where I first encountered it as a young child.</p>
<p>I have a distinct recollection of being drawn towards the surface of this phantom image. Of it filling my child-self’s visual field from above as I tried to make sense not of what, but how it was: it was obvious to me that whoever this man was, he was not asleep. And why did the light in the picture seem so off, seeping out from this body’s darkest parts like a photograph gone wrong?</p>
<p>As with the series of smaller, more fugitive drawings of Biko’s hands and feet that preceded this monumental study, “Elegy” was made with direct reference to the forensic photographs of his postmortem examination, given to Stopforth by the Biko family’s lawyer. There can be no doubt that it borrows from religious iconography, presenting Biko as a secular martyr (the clue is in the title). </p>
<h2>Why it is/was influential</h2>
<p>Art historian Shannen Hill suggested in her 2005 article “Iconic autopsy: postmortem portraits of Bantu Stephen Biko” (published in a special edition of the journal <a href="http://www.international.ucla.edu/africa/africanarts/">African Arts</a>) that Stopforth’s graphic techniques “disrupt detached viewing”. Our experience is a kind of looking that is tactile, penetrative, what I would call a forensic gaze.</p>
<p>Forensic photographs embody a beguiling paradox: they perform as evidence, yet they are not self-evident. We demand that they act as arbiters of empirical data, while knowing they are technological constructions that require expert interlocution to reveal their truths.</p>
<p>“Elegy’s” impact on my childhood idea of what art could be – do even – was utterly formative, not least because it was through an embodied connection with an image that I later learned of the existence and significance of its subject. </p>
<p>“Elegy” could be said to represent the critical coordinates of my creative and intellectual life, which has been consistently involved with ideas of the body as image and as experience, evidence and affect, absence and presence. </p>
<p>My praxis is now bifurcated between my experimental (and perhaps even impolitic) interests as an artist, and my professional responsibilities as a forensic practitioner. It requires of me, among other things, to recreate convincing facial images for deceased or disappeared individuals who cannot be otherwise legally identified, in the hope that they might be.</p>
<p>This work feeds the tensions I perceive between conceptions of identity and technologies of identification, the revelatory and obfuscatory powers of archives, and the capacity of objects to be simultaneously loquacious and mute. So it is productive to think through “Elegy” as a sort of conceptual and ethical compass. </p>
<p>Did this image subconsciously navigate my earliest tussles with school teachers who insisted that my mutual inclination towards both visual art and forensic pathology was at worst impossible and at best, deeply conflicted? Did it silently guide me, many years later, from Durban to Johannesburg, and to the <a href="http://wsoa.wits.ac.za/fine-arts/">Wits Fine Arts</a> department, where I would encounter an influential tutor who insisted the opposite, and who showed me how it could be so?</p>
<p>That tutor was <a href="http://mg.co.za/article/2013-01-18-obituary-colin-richards-1954-2012/">Colin Richards</a> (1954-2012). I would later discover that he’d had his own powerful encounters with images of Biko’s body, twice. The first was while working as a medical illustrator at Wits in the late 1970s. The second was as a deliberate confrontation with his perceived complicity in the administration of Biko’s death. The outcome he presented as the multi-part work, “Veils” (1996).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134412/original/image-20160817-3583-i26tse.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Colin Richards (1954-2012) - ‘Veils’ (1996). Mixed media.</span>
<span class="attribution"><span class="source">Courtesy of the author</span></span>
</figcaption>
</figure>
<p>Here Richards employs a representation of the Biblical “<a href="http://www.ancient-origins.net/unexplained-phenomena/mysterious-veil-veronica-masterpiece-or-miracle-004917">veil of Veronica</a>”, a piece of cloth onto which the face of a suffering Christ was reportedly imprinted. As an analogue “print” made directly from a source, it is considered to be the first photograph. On his recrafted veils, Richards instead imprinted facsimiles of images of the cell in which Biko was tortured, and two macroscopic pathology photographs which do not identifiably belong to a specific body (yet they are Biko). </p>
<p>In an interview with Richards in 2004, he suggested to me that “Illustration is a hinge between the linguistic and the visual, and it can turn many ways”. This is particularly true of forensic images. Their simultaneous ability to be authoritative and obtuse is the source of their potency and fallibility. </p>
<p>Public memorialisation of the dead pivots on a core ethical decision: whether to respect personal privacy through maintaining anonymity, or to name. The dead cannot give informed consent. Publishing images of corpses is regarded as something which requires very careful management, lest such dissemination is seen to either objectify or profit from the deceased. Like public shaming, such exposure can turn many ways. And that line is thin indeed.</p>
<p>The figure in “Elegy” is not visually identifiable as Stephen Bantu Biko. This has two possible effects, neither of which are easy: sublimating his identity counts as yet another violation of the historical specificity of Biko as an individual. Protecting his identity could be considered a sensitive choice – a tactical dehumanisation, if you will.</p>
<h2>Why it is still relevant</h2>
<p>In many ways, “Elegy” tests the very limits of representational politics. After all, it’s yet another instance of a violated black man represented by his social and political opposite, an artist who embodies Apartheid’s privileged classes, specifically the white, patriarchal subject position it worked to strengthen and maintain.</p>
<p>Should this difficulty make us avert our gaze or even more seriously, reject the image? I cannot, because its effect on me now is as potent as it was three decades ago: the sharp, sour shock of touching your tongue on a battery.</p>
<p>Significant events are unlikely to rise to public consciousness without a visual record, and recent events in South Africa - such as the <a href="http://www.sahistory.org.za/article/marikana-massacre-16-august-2012">Marikana massacre</a> where police killed 34 striking mineworkers - have demonstrated the extraordinary productive and destructive power of images. A direct response to the atrocities of its moment, “Elegy” reflects on political oppression, those tasked with propagating the abuse of state power and those set up to bear such abuse. It represents processes of concealment and revelation with very real social and political consequences.</p>
<p>Yet images like this are not stable; their significance is neither continuous nor equivalent. They are ciphers for what it means to be human and vulnerable within a social and political regime in which not all bodies are considered equal, and where a state under threat resorts to covert and fatal tactics.</p><img src="https://counter.theconversation.com/content/64031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Works like “Elegy” are ciphers for what it means to be human and vulnerable within a social and political regime in which not all bodies are considered equalKathryn Smith, Visual/forensic artist, PhD researcher, Liverpool John Moores UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/597202016-06-08T03:54:49Z2016-06-08T03:54:49ZAre pop stars destined to die young?<p><a href="http://www.nytimes.com/2016/06/03/arts/music/prince-death-overdose-fentanyl.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news">Prince’s autopsy</a> has determined that the artist died of an accidental overdose of the synthetic opioid fentanyl. The news comes on the heels of the death of former Megadeth drummer Nick Menza, <a href="http://www.nytimes.com/aponline/2016/05/22/us/ap-us-obit-megadeth-drummer.html">who collapsed on stage and died in late May</a>. </p>
<p>Indeed, it seems as though before we can even finish mourning the loss of one pop star, another falls. There’s no shortage of groundbreaking artists who die prematurely, whether it’s Michael Jackson, Elvis Presley or Hank Williams. </p>
<p>As a physician, I’ve begun to wonder: Is being a superstar incompatible with a long, healthy life? Are there certain conditions that are more likely to cause a star’s demise? And finally, what might be some of the underlying reasons for these early deaths? </p>
<p>To find out the answer to each of these questions, I analyzed the 252 individuals who made Rolling Stone’s list of the <a href="http://www.rollingstone.com/music/lists/100-greatest-artists-of-all-time-19691231">100 greatest artists</a> of the rock & roll era.</p>
<h2>More than their share of accidents</h2>
<p>To date, 82 of the 252 members of this elite group have died. </p>
<p>There were six homicides, which occurred for a range of reasons, from the psychiatric obsession that led to the shooting of John Lennon to the planned “hits” on rappers Tupac Shakur and Jam Master Jay. There’s still <a href="http://www.history.com/this-day-in-history/sam-cooke-dies-under-suspicious-circumstances-in-la">a good deal of controversy</a> about the shooting of Sam Cooke by a female hotel manager (who was likely protecting a prostitute who had robbed Cooke). Al Jackson Jr., the renowned drummer with Booker T & the MGs, was shot in the back five times in 1975 by a burglar <a href="https://www.theguardian.com/music/2015/nov/25/al-jackson-jr-memphis-sunset-the-mysterious-death-of-stax-heartbeat">in a case that still baffles authorities</a>.</p>
<p>An accident can happen to anyone, but these artists seem to have more than their share. There were numerous accidental overdoses – Sid Vicious of the Sex Pistols at age 21, David Ruffin of the Temptations at 50, The Drifters’ Rudy Lewis at 27, and country great Gram Parsons, who was found dead at 26. </p>
<p>And while your odds of dying in a plane crash are about one in five million, if you’re on Rolling Stone’s list, those odds jump to one in 84: Buddy Holly, Otis Redding and Ronnie Van Zant of the Lynyrd Skynyrd Band all died in airplane accidents while on tour. </p>
<h2>A drink, a smoke and a jolt</h2>
<p>Among the general population, <a href="http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf">liver-related diseases are behind only 1.4 percent</a> of deaths. Among the Rolling Stone’s 100 Greatest Artists, however, the rate is three times that. </p>
<p>It’s likely tied to the elevated alcohol and drug use among artists. Liver bile duct cancers – which are extremely rare – happened to two of the top 100, with Ray Manzarek of The Doors and Tommy Ramone of the Ramones both succumbing prematurely from a cancer that normally affects <a href="http://emedicine.medscape.com/article/277393-overview#a6">one in 100,000 people a year</a>. </p>
<p>The vast majority of those on Rolling Stone’s list were born in the 1940s and reached maturity during the 1960s, <a href="http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf">when tobacco smoking peaked</a>. So not surprisingly, a significant portion of artists died from lung cancer: George Harrison of the Beatles at age 58, Carl Wilson of the Beach Boys at 51, Richard Wright of Pink Floyd at 65, Eddie Kendricks of the Temptations at 52 and Obie Benson of the Four Tops at 69. Throat cancer – also linked with smoking – caused the deaths of country great Carl Perkins at 65 and Levon Helm of The Band at 71.</p>
<p>A good number from the list had heart attacks or heart failure, such as Ian Stewart of the Rolling Stones at 47 and blues greats Muddy Waters at 70, Howlin Wolf at 65, Roy Orbison at 52 and Jackie Wilson at 49. </p>
<p>We recently saw The Eagles’ Glenn Frey succumb to pneumonia, but so did soul singer Jackie Wilson at age 49, nine years after a massive heart attack. James Brown complained of a persistent cough and declining health before he passed at 73, <a href="http://www.nytimes.com/2006/12/26/arts/music/26brown.html?pagewanted=all">with the cause of death listed as congestive heart failure as a result of pneumonia</a>.</p>
<p>Currently, the U.S. is in the midst of an opioid abuse epidemic, with heroin and prescription drug overdoses happening <a href="http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf">at historic rates</a>. </p>
<p>But for rock stars, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760168/">opioid abuse is nothing new</a>. Elvis Presley, Jimi Hendrix, Janis Joplin, Sid Vicious, Gram Parsons, Whitney Houston (who didn’t make the list), Michael Jackson and now Prince all died from accidental opioid overdoses. </p>
<h2>Two key findings</h2>
<p>One of the two shocking findings of this analysis deals with life expectancy. Among those dead, the average age was 49, which is <a href="https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html">the same as Chad</a>, the country with the lowest life expectancy in the world. The average American male <a href="http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf">has a life expectancy of about 76 years</a>. </p>
<p>Factoring in their birth year and a life expectancy of 76 years, only 44 should have died by now. Instead, 82 have. (Incidentally, of the 44 we would have expected to be dead by now, 19 are still alive.)</p>
<p>The second shocking discovery was the sobering and disproportional
occurrence of alcohol- and drug-related deaths. </p>
<p>There was Kurt Cobain’s gunshot suicide while intoxicated and Duane Allman’s drunk driving motorcycle crash. Members of legendary bands like The Who (John Entwistle, 57, and Keith Moon, 32), The Doors (Jim Morrison, 27), The Byrds (Gene Clark, 46, and Michael Clarke, 47) and The Band (Rick Danko, 55, and Richard Manuel, 42) all succumbed to alcohol or drugs.</p>
<p>Others – The Grateful Dead’s Jerry Garcia and country star Hank Williams – steadily declined from substance abuse while their organs deteriorated. Their official causes of death were heart-related. In truth, the cause may have been more directly related to substance abuse. </p>
<p>In all, alcohol and drugs accounted for at least one in 10 of these great artists’ deaths. </p>
<h2>Does a quest for fame lead to an early demise?</h2>
<p>Many have explored the root causes behind these premature deaths.</p>
<p>One answer may come from dysfunctional childhoods: experiencing physical or sexual abuse, having a depressed parent or having a family broken up by tragedy or divorce. <a href="http://bmjopen.bmj.com/content/2/6/e002089.short">An article published</a> in the British Medical Journal found that “adverse childhood experiences” may act as a motivator to become successful and famous as a way to move past childhood trauma. </p>
<p>The authors noted an increased incidence of these adverse childhood experiences among famous artists. Unfortunately, the same adverse experiences also predispose people to depression, drug use, risky behaviors and premature death. </p>
<p>A somewhat similar hypothesis is proposed by the <a href="http://selfdeterminationtheory.org/aspirations-index/">Self Determination Theory</a>, which addresses human motivation through the lens of “intrinsic” versus “extrinsic” life aspirations. People who have intrinsic goals seek inward happiness and contentment. On the other hand, people who possess extrinsic goals focus on material success, fame and wealth – the exact sort of thing attained by these exceptional artists. According to research, people who have extrinsic goals tend to have had less-involved parents and are more likely to experience bouts of depression.</p>
<p><a href="http://www.psychiatrictimes.com/major-depressive-disorder/association-between-major-mental-disorders-and-geniuses">A good deal of research</a> has also explored the fine line between creative genius and mental illness across a wide range of disciplines. They include authors (<a href="http://www.mcmanweb.com/woolf.html">Virginia Woolf</a> and <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=490460">Ernest Hemingway</a>), scholars (<a href="http://www.sciencedirect.com/science/article/pii/S0165032707001395">Aristotle</a> and <a href="http://journals.cambridge.org/download.php?file=%2FPSM%2FPSM18_01%2FS0033291700001823a.pdf&code=479300979b92179f454f2789ffa4ab4d">Isaac Newton</a>), <a href="http://www.allmusic.com/blog/post/classical-composers-and-their-maladies">classical composers</a> (Beethoven, Schumann, and Tchaikovsky), painters (<a href="http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.159.4.519">Van Gogh</a>), sculptors (<a href="http://bjp.rcpsych.org/content/199/5/373.full">Michelangelo</a>) and <a href="http://bjp.rcpsych.org/content/183/3/255?.full">contemporary musical geniuses</a>. </p>
<p>Psychiatrist Arnold Ludwig, in his meta-analysis of over 1,000 people, “<a href="https://books.google.com/books?hl=en&lr=&id=6coe7r9iwosC&oi=fnd&pg=PA1&dq=a+m+ludwig+price+of+greatness&ots=TJhiaV1tOL&sig=ogU7wt65ZQ96YnvR8EJ1UraWFYg#v=onepage&q=a%20m%20ludwig%20price%20of%20greatness&f=false">The Price of Greatness: Resolving the Creativity and Madness Controversy</a>,” concluded that artists, compared to other professions, were much more likely to have mental illnesses, and were prone to being afflicted with them for longer periods of time.</p>
<p>Meanwhile, Cornell psychiatrist William Frosch, author of “<a href="http://www.sciencedirect.com/science/article/pii/0010440X87900678">Moods, madness, and music: Major affective disease and musical creativity</a>,” was able to connect the creativity of groundbreaking musical artists to their psychiatric disorders. According to Frosch, their mental illnesses were behind their creative output.</p>
<p>My review also confirmed a greater incidence of mood disorders among these Great 100 rock stars. Numerous studies have shown that depression, bipolar disease and related diagnoses come with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102288/">an increased risk</a> <a href="http://jama.jamanetwork.com/article.aspx?articleid=383975">for premature death, suicide and addiction</a>. </p>
<p>By following the relationship between genius and mental illness, mental illness and substance abuse, and then substance abuse, health problems and accidental death, you can see why so many great artists seem almost destined for a premature or drug-induced demise.</p><img src="https://counter.theconversation.com/content/59720/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregory L. Hall does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For those on Rolling Stone’s list of 100 Greatest Artists, their life expectancy is on par with the people of Chad, the nation with the lowest life expectancy in the world.Gregory L. Hall, Assistant Clinical Professor, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/429202015-06-06T08:32:00Z2015-06-06T08:32:00ZHow I dissected a T.rex (it took chainsaws, feathers and lots of latex)<figure><img src="https://images.theconversation.com/files/84141/original/image-20150605-8719-1pl8ao6.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prepare to meet thy chainsaw</span> <span class="attribution"><a class="source" href="http://channel.nationalgeographic.com/t-rex-autopsy/videos/t-rex-behind-the-build/">NatGeoTV</a></span></figcaption></figure><p>I dissected a <em>Tyrannosaurus rex</em> in front of television cameras. </p>
<p>That may be the most surreal sentence I’ve ever written. So let me explain. I’m part of a team that built a life-sized model of <em>Tyrannosaurus rex</em> and then cut it up. The spectacle is a bloody, gory two-hour television special called <em>T</em>.<em>rex</em> Autopsy. The premise may seem absurd. But this is a whole new way of communicating science to the public, and it has been one of the highlights of my career.</p>
<p>I’m a paleontologist who has been studying dinosaurs for more than a decade. I’ve dug up <em>T.rex</em> fossils in the western United States, travelled the world studying tyrannosaur bones in museums, and described some of <em>T.rex</em>’s closest cousins. It’s a pretty cool job, but it comes with something of a peculiar annoyance. Sometimes I get strange people ringing me up with their pet theories on how dinosaurs evolved from space aliens, or emailing me long screeds about how dinosaurs never existed.</p>
<p>I got an email like that last August from a television producer in London. At first it seemed like a joke: they wanted to autopsy a <em>T.rex</em> corpse in front of the cameras. Just another ambitious but insane young producer, I thought, wanting to make his mark in a television landscape where shows on Bigfoot and mermaids are now standard fare on networks that used to be dedicated to science programming.</p>
<p>But I agreed to hear him out, and very quickly my opinion changed. They wanted to dissect a <em>T.rex</em> alright, but by building the most scientifically accurate model possible, then using the pageantry of an autopsy to reveal how this most famous of dinosaurs actually functioned as a living, breathing, feeding, moving, growing animal.</p>
<p>They needed a <em>T.rex</em> expert to consult on the build of the model. I signed up immediately, along with several of my esteemed colleagues, and was later asked to expand my role and appear on-screen as one of the dissectors. That was how I found myself in the famous <a href="http://www.pinewoodgroup.com/our-studios/uk/pinewood-studios">Pinewood Studios</a> near London last April, next to where they were filming the new Bond movie, chopping up a 43-foot <em>T.rex</em> with chainsaws, dripping with synthetic blood. Not a normal day at the office for an academic scientist who spends most of his time writing grants, advising students, and lecturing. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/p6Uimaq9pcs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>I’m incredibly proud of the end result. We’ll probably be criticised by some internet cynics who feel we’re trying to hoodwink the public into thinking this is a real tyrannosaur, or who disparage the whole idea of doing a dinosaur autopsy as too over-the-top. But that would be missing the point. </p>
<p>We took the utmost care to make sure our tyrannosaur was completely in line with what we know from fossils. Everything we couldn’t reconstruct from real fossils was informed speculation based on careful comparisons with living crocodiles, <a href="https://theconversation.com/take-a-t-rex-and-a-chicken-and-youll-see-how-dinosaurs-shrank-survived-and-evolved-into-birds-29996">which are</a> close cousins of dinosaurs, and birds, which are their descendants. And having four real scientists (a vet and three paleontologists) conducting the autopsy, without a script, made it even more authentic. </p>
<p>When I first walked into the autopsy room and saw the dinosaur, I was blown away.
Yes I had consulted on the build, but the producers had deliberately prevented me from seeing the final model so I would be surprised. It was so realistic – pretty much how I think a real <em>T.rex</em> would have looked – but made of latex, silicone, plastic, corn syrup, and various other goodies. What the artists made in four-and-a-half months and 10,000+ man hours is surely the most accurate and life-like dinosaur of all time. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/shBGtdqvLs4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Inside rex</h2>
<p>We go from head-to-tail on the dinosaur, cutting it up, talking about how each bit helps us understand <em>T.rex</em> as a living animal; what it ate, how fast it moved, what injuries it suffered, what its metabolism was like and how quickly it grew, how it reproduced. </p>
<p>So what exactly did we learn? If you thought dinosaurs were dim-witted, overgrown reptiles, think again. <em>T.rex</em> had a huge brain, its eyesight was keen, it had feathers and it grew really fast. It was essentially a huge fluffy bird from hell. </p>
<p>Some of my favourite moments were spent inside the belly of the beast, as we removed the super-sized internal organs. We don’t know much about dinosaur hearts and lungs and stomachs, because these soft parts don’t easily fossilise. But they can leave signatures on the bones, and we can use birds and crocodiles for plausible speculation. That’s how we designed the size, shape, and position of the guts in our model.</p>
<p>The organs were remarkably life-like, and I say this as somebody who has dissected a lot of animals. In particular, the suitcase-sized heart really looked and felt like it had just been cut from a real <em>T.rex</em> cadaver. The heart had four chambers inside, just like a bird, a sign of high metabolism and consistent with evidence from bones that <em>T.rex</em> was a dynamic, fast-growing animal. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84142/original/image-20150605-8706-6mct8m.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Everything was designed to be as life-like as possible.</span>
<span class="attribution"><a class="source" href="http://channel.nationalgeographic.com/t-rex-autopsy/videos/t-rex-behind-the-build/">NatGeoTV</a></span>
</figcaption>
</figure>
<p>The lungs had balloon-like extensions called air-sacs. These store air during the breathing cycle to make the lungs extra efficient, also just like birds. We know about these from the traces the air-sacs have left on <em>T.rex</em> bones. The stomach was also incredibly bird-like, with two chambers. This isn’t total speculation either: there is one spectacularly preserved tyrannosaur fossil with stomach contents that helped us in our design.</p>
<p>It’s easy to think of <em>T.rex</em> as a monster, a villain in movies, a terror in our nightmares. But it was a real living breathing animal, a great lost wonder of the world. If our programme gives people a sense of what this creature was really like, it will have been well worth the hard work. </p>
<p><em>T.rex Autopsy is on the <a href="http://channel.nationalgeographic.com">National Geographic Channel</a>.</em></p><img src="https://counter.theconversation.com/content/42920/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen was a paid consultant and on-screen presenter for T Rex Autopsy</span></em></p>Ever wondered what it would like if you carved up the biggest land-based carnivore of all time?Stephen Brusatte, Chancellor's Fellow in Vertebrate Palaeontology, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/358192014-12-31T08:34:54Z2014-12-31T08:34:54ZThe man who revolutionized our knowledge of the human body<figure><img src="https://images.theconversation.com/files/68082/original/image-20141229-8201-161ez5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drawn directly from the flesh</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/publicdomainreview/8659812379">Public Domain Review/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>December 31, 2014 marks the 500th anniversary of the birth of one of the most important figures in the history of medicine. He authored one of the most elegant and influential books in scientific history. His investigations revolutionized our understanding of the interior of the human body and the methods physicians use to study and teach about it, reverberating throughout medicine down to the present day. </p>
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<img alt="" src="https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=814&fit=crop&dpr=1 600w, https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=814&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=814&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1023&fit=crop&dpr=1 754w, https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1023&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/68085/original/image-20141229-8211-kqouyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1023&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Andreas Vesalius.</span>
<span class="attribution"><span class="source">Everett Historical/Shutterstock</span></span>
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<p>His name was <a href="http://evolution.berkeley.edu/evolibrary/article/history_02">Andreas Vesalius</a>. He was born into a medical family in what is now Belgium. As a boy he showed a great interest in the dissection of animals, a predilection that disgusted his contemporaries. Yet he persevered, going on to study medicine at both Paris and Padua, then two of the great centers for anatomic research. When he graduated, he was immediately offered a teaching position. Unlike those who taught him, he insisted on performing the dissections himself and encouraged his students to do likewise. </p>
<p>Comparing what his dissections revealed with what he read in the textbooks of the day, Vesalius asserted that the flesh itself is a more reliable guide than the written word. He contradicted more than 200 of the teachings of perhaps the most towering figure in the history of anatomy, the 2nd century Roman physician and anatomist Galen. For example, Vesalius pointed out that Galen erred in asserting that the human jaw consists of two bones. </p>
<p>How could a man whose teachings withstood the scrutiny of <a href="http://www.nejm.org/doi/full/10.1056/NEJM199812033392318">1,300 years</a> make such a seemingly elementary mistake? Some of the authorities of Vesalius’s day defended Galen by suggesting that the anatomy of the human body itself must have changed over the generations since. But Vesalius knew the real answer: Roman custom had prevented Galen from dissecting the bodies of humans, forcing him to rely on those of other creatures, such as pigs, apes and dogs. And when it came to the jaw of a dog, Galen was right. </p>
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<span class="caption">Vesalius insisted teachers and students learn anatomy directly. Image of brain from On the Fabric of the Human Body.</span>
<span class="attribution"><a class="source" href="http://upload.wikimedia.org/wikipedia/commons/a/a7/Vesalius_609c.png">Wikimedia Commons</a></span>
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<p>Of course, Vesalius himself knew that Galen was far more often right than he was wrong, and he frequently marveled at the depth of his ancient predecessor’s knowledge. For example, Galen had <a href="https://www.princeton.edu/%7Ecggross/neuroscientist_4_98_216.pdf">experimented</a> on the spinal cords of pigs, demonstrating that when he cut the cord near the tail end, the animal first lost the use of its hind limbs. When another cut was made closer to the head, the forelimbs ceased moving. And when he cut still higher, the animal would cease breathing – a truly extraordinary experimental linkage of neurological structure and function. </p>
<p>In insisting that teachers and students study anatomy directly instead of memorizing what they found in the textbooks, Vesalius was in a sense rekindling the flames of Galen’s own passion for direct
observation. But he was also elevating them to levels not equaled for well over a millennium. In the process, he was creating truly remarkable anatomic specimens. His 1543 public dissection of a famous criminal’s body produced the world’s oldest surviving complete anatomic skeleton. It’s still <a href="https://anatomie.unibas.ch/museum/en/aktuelles/index.html">on display</a> today in Basel, Switzerland. </p>
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<span class="caption">On the Fabric of the Human Body frontispiece.</span>
<span class="attribution"><a class="source" href="http://en.wikipedia.org/wiki/De_humani_corporis_fabrica#mediaviewer/File:Vesalius_Fabrica_fronticepiece.jpg">Wikimedia Commons</a></span>
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<p>Perhaps Vesalius’s most remarkable achievement of all was his publication, <a href="http://www.vesaliusfabrica.com/">On the Fabric of the Human Body</a>. It consists of seven volumes describing the bones, muscles, blood vessels, nerves, digestive system, heart, and brain. The works contains over 200 illustrations, many of which are recognized today as among the most exquisite anatomic images ever produced. Produced by artists he retained, the drawings were engraved on wood blocks for reproduction, and they represent a quantum leap beyond their predecessors in anatomic detail and sophistication. </p>
<p>Vesalius’ masterpiece stands as one of the greatest books ever produced. It is simply beautiful, reflecting an unparalleled degree of both scientific erudition and aesthetic sensitivity. It showed the body not as inert flesh but enlivened and in motion, emphasizing the correlation of form and function. It also established vastly higher standards for anatomical research and teaching, setting biology and medicine on new paths of discovery. And finally, it is one of the greatest marriages of science, art, and humanism ever achieved. </p>
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<span class="caption">Woodcut from On the Fabric of the Human Body.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Vesalius_Fabrica_p194.jpg">Wikimedia Commons</a></span>
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<p>Equally impressive is the fact that Vesalius published his magnum opus at the incredibly young age of 28, in an era when most authorities in medicine were a generation or two his senior. But he was no <em>enfant terrible</em>. In presenting this new anatomic vision to the world, he was not so much tearing down idols as reestablishing the primacy of the human form itself as medicine’s most important text. Those who would know the human form, he said, must devote themselves to studying it for themselves, rather than delegating the responsibility to others. </p>
<p>Our understanding of human anatomy has advanced quite far since Vesalius. The introduction of the microscope opened up a world of cells that Vesalius could scarcely have dreamt of, and the invention of CT and MRI scanners has made it possible to inspect the interior of the human form in life and without the use of a scalpel. Yet even these more recent innovations bear the spirit of Vesalius, who insisted that those who wish to understand the body must see it for themselves.</p>
<hr>
<p><em>This article has been updated to correct information about jaw bones in apes.</em></p><img src="https://counter.theconversation.com/content/35819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>December 31, 2014 marks the 500th anniversary of the birth of one of the most important figures in the history of medicine. He authored one of the most elegant and influential books in scientific history…Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/254082014-04-11T10:19:07Z2014-04-11T10:19:07ZDoctors need to come face-to-face with death to care for those who are dying<figure><img src="https://images.theconversation.com/files/46136/original/vnr5m5gk-1397146600.jpg?ixlib=rb-1.1.0&rect=49%2C156%2C689%2C476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taking a fresh look.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/staciebee/4707854029/sizes/l">StacieBee</a></span></figcaption></figure><p>Very few, if any, medical students would say their reason for wanting to become a doctor is so they can face death on a regular basis. Yet it is a crucially important part of the job, especially when patients need palliative care; doctors have to be willing and able to care for patients with incurable and life-limiting illnesses.</p>
<p>To provide <a href="http://www.ncpc.org.uk/palliative-care-explained">good palliative care</a> all healthcare professionals, including doctors, should be able to provide pain and symptom control, psychological and social support, as well as disease-focused treatments. The aim of palliative care is to support patients who are living with a closer prospect of death to continue to live their lives with as much quality as possible, even while they are dying. However, many junior doctors <a href="http://www.ncbi.nlm.nih.gov/pubmed/21401687">report feeling ill-equipped and unprepared</a> to discuss palliative and end of life care with patients. </p>
<p>While this kind of work can be rewarding, it can <a href="https://theconversation.com/we-need-to-get-over-our-fear-of-talking-about-dying-14186">also be challenging</a>. Many students have little exposure to death and dying before entering medical school. Doctors are no different to other people: some might choose to cope by creating an emotional distance or detachment, others might become too personally involved, others might avoid patients with life limiting illnesses if they don’t think they can help. However, ultimately, disinvestment isn’t best for patients.</p>
<p>In <a href="http://spcare.bmj.com/content/early/2012/12/14/bmjspcare-2012-000330.abstract">research carried out</a> with first and second year medical students about perceptions of students, following early clinical placements including attending an autopsy, detachment and avoidance were described partly as mechanisms for self-protection but also justified as a means of protecting patients from distress caused by students’ and doctors’ sense of their own limitations and emotional reactions. </p>
<p>The research found that from the very beginning medical students are caught in a tension between a normal “lay” person reaction to death and their perceptions of what the “professional reaction” should be. These tensions were illustrated in the research by the language medical students used after attending autopsies: switching back and forth between relating to individual patients as people, albeit people who have died, and referring to them as objects. </p>
<p>At this very early stage of their careers these students also described autopsies as an opportunity to “meet” real patients, albeit it after death, and to learn about preceding illness and healthcare experiences of these patients, as well as the cause of death. They described their experiences as initially “scary” and many reflected on their own mortality. This was balanced by a strong desire to demonstrate they could cope, they “had what it takes” to be a doctor.</p>
<p>The experience of an autopsy may seem a long way from learning to care for the patient who is living with the prospect of death, but this research shows there is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24644336">potential for it to help</a> medical students develop important transferable skills. For example, understanding the processes around autopsies can help develop appropriate communication skills. Two pathologists interviewed in the research said an important part of their job was explaining the important purposes of an autopsy to bereaved relatives, and the ability to complete the procedure in a dignified manner. </p>
<p>Doctors, along with other healthcare professionals, are required to competently explain what is happening and support a patient, their family and friends during the dying process. If an autopsy is either requested or required by law then doctors need to be able to compassionately explain what will happen and what the body will look like afterwards. This requires communication skills such as sensitivity, clarity of language, and responding appropriately to distress. These skills are equally core to good palliative care.</p>
<p>Medical students need the support of experienced clinicians to make links between learning in different contexts and to integrate their learning from the many component parts of a medical curriculum. Autopsies are an opportunity to learn about death and dying in a social context, including the role of doctors interacting with dying patients and their families. </p>
<p>Careful consideration should be given to helping students learn to balance being able to function as a professional in challenging situations while remaining engaged in compassionate care that meets their patients’ needs. Doctors, patients and relatives have an opportunity to help medical students as future clinicians to understand more about death and dying by discussing their experiences and sharing what they have learned from these. And if medical students are better prepared, they will better support those at the end of their life, as well as their families before and after bereavement. </p>
<p><em>Sarah Yardley is speaking at <a href="http://potts-%20pots.blogspot.co.uk/p/the-death-salon-2014.html">Death Salon UK 2014</a> at Barts Pathology Museum, part of Queen Mary, University of London.</em></p><img src="https://counter.theconversation.com/content/25408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Yardley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Very few, if any, medical students would say their reason for wanting to become a doctor is so they can face death on a regular basis. Yet it is a crucially important part of the job, especially when patients…Sarah Yardley, Consultant in Palliative Medicine and Honorary Lecturer , Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/212452013-12-19T14:53:49Z2013-12-19T14:53:49ZAs a pathologist, it’s my job to speak up for the dead<figure><img src="https://images.theconversation.com/files/37876/original/ywt55688-1387192883.jpg?ixlib=rb-1.1.0&rect=2%2C11%2C1979%2C1401&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Silent Witness, more added glam to the final exam.</span> <span class="attribution"><span class="source">BBC Pictures</span></span></figcaption></figure><p>Pulling bullets out of homicide victims makes up <a href="http://pathologyexpert.blogspot.co.uk/">part of my job</a> as a forensic pathologist, but not the most interesting part. No, I love a head-scratcher. Dead for no clear reason is the real whodunit. My favourite autopsies are unresolved hospital cases, when other doctors need my help in figuring out what went wrong, and what to do about it.</p>
<p>The paperwork told me the young woman on my table bled to death a few hours after receiving a transplanted liver from the victim of a motor vehicle accident. She had survived the transplant surgery, but afterwards appeared to be bleeding internally. Her surgeons had rushed her back into the operating room and performed a second operation in a failed effort to stem the haemorrhage.</p>
<p>When you bury an organ recipient you are putting two patients in the ground, so it was doubly important to me to figure out why this procedure had failed; but tracking down the source of internal bleeding during autopsy can be tricky. It’s like tracing a leak in an old house: a pool of water in the basement could be coming from a broken pipe or an over-running bathtub, or from a leaky roof. Blood inside the body might have trickled over time from faulty small vessels or gushed out all at once from torn large ones. It can slosh around inside one of the enclosed cavities of the torso, or it might sneak into unexpected and otherwise invisible spaces. </p>
<p>If enough of it leaves the closed loop of your circulatory system, however, the end result is always the same: you end up on my table in the morgue.</p>
<p>I took a scalpel to the woman’s chest and sliced down through the soft tissues until I reached bone. After cutting the ribs and opening the torso, I scissored the surgical sutures to open the patient’s stomach cavity to look for possible bleed sites, turning my attention first to the anastamosis, the connecting “suture” line between the blood vessels of the donor’s liver and the recipient’s body. </p>
<p>The sewn juncture of the inferior vena cava – the large vein that runs behind the liver – had a ratty look, with clotted blood around tiny tears in the vessel wall. This is normal, and if the clots had held this would not account for a belly full of blood. Around the surgery site I only found about a tablespoon’s worth. </p>
<p>However, in the rest of the abdomen there were small burst blood vessels (petechial haemorrhages) all over the place. Most of them had been burnt to a crisp with a cauterising tool during the emergency surgery. Cauterising is used to stop small haemorrhages during surgery. Could those pinprick leaks have been the source of all the bleeding? I’d seen plenty of transplant surgeries, but had never found so many bleeds.</p>
<p>It appeared the patient had died because she was prone to bleeding – but all liver transplant patients are. The blood’s clotting factors are proteins manufactured in the liver, and it can sometimes take a while for the newly transplanted organ to start producing them. The only clots I could find were around the suture line. From the autopsy it was clear this patient had continued to bleed from elsewhere – from everywhere. So the transplant surgery was a success, but the patient died. </p>
<p>The day after the autopsy I called the surgeon to get his story. What he described matched my naked-eye findings. “When we opened her back up she was oozing from everywhere,” he said. “Even the peritoneal wall was leaking blood.” He was chiefly interested in finding out whether the stitches on the inferior vena cava appeared intact. They had, I assured him. Based on what I saw when I dissected his work, both operations had been performed properly.</p>
<p>About two weeks later I got a call from a risk manager at the medical centre. Risk managers are hospital lawyers who can be either the bane of a clinician’s life or a knight in shining armour when something goes wrong and a patient gets hurt or dies. </p>
<p>The risk manager wanted to know which role he should assume for the surgeon in this case. “I wasn’t in the operating room,” I began, “but your surgeon’s story is consistent with my findings on autopsy. Well, not inconsistent anyway.” I told him that the tears I saw on the suture line could have been the source of lots of haemorrhage – or not. It depends on the patient’s blood flow and circulation at the time and whether the clot around the vessel held.</p>
<p>The lawyer didn’t much like that answer. It would be very hard for him to defend the hospital in a lawsuit by making a case that the patient died because she was “prone to bleeding”, since the reason she was prone to bleeding in the first place was the liver transplant surgery. That’s blaming the victim, which is never a good tactic. The lawyer had been hoping I would give him some other avenue to pursue.</p>
<p>But it’s my job to see for myself what happened to the body. That’s what the word autopsy means: “See for yourself”. I saw that this patient had slipped away in a seeping death of a thousand cuts, which no amount of desperate operating-room cauterising could have stemmed.</p>
<p>I never heard back from the lawyer so I assume no lawsuit happened. It struck me after filing this death certificate that I could have served as a witness for either the dead woman’s family or for the hospital. After I perform an autopsy I serve as advocate for no one but my patient. I am <a href="http://www.drworkingstiff.com/">a doctor to the dead</a>.</p><img src="https://counter.theconversation.com/content/21245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Judy Melinek is co-author of Working Stiff: The Making of a Medical Examiner. She blogs at Forensic Pathology Forum.</span></em></p>Pulling bullets out of homicide victims makes up part of my job as a forensic pathologist, but not the most interesting part. No, I love a head-scratcher. Dead for no clear reason is the real whodunit…Judy Melinek, Associate Clinical Professor of Pathology, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.