The Bioarchaeology of Structural Violence and Dissection in the 19thCentury United States

Structural violence is harm done to individuals or groups through the normalization of social inequalities in political-economic organization. Researchers working in both modern and prehistoric contexts focus on the lived experiences of individuals and the health disparities that arise from such violence. With this article, I seek to contribute to this literature by considering how skeletal evidence of dissection from the 19th-century United States reflects structural violence. I focus on “death experiences” and suggest that studies of structural violence must consider not only how inequality may be embodied as health disparities in the living but also “disembodiment” and the treatment and fate of the dead body. [bioarchaeology, dissection, autopsy, structural violence, United States] RESUMEN Violencia estructural es el daño hecho a individuos o grupos a través de la normalización de desigualdades sociales en una organización polı́tico-económica. Investigadores trabajando en contextos tanto modernos como prehistóricos se centran en las experiencias vividas por individuos y las disparidades en salud surgidas de tal violencia. Con este artı́culo, busco contribuir a ésta literatura a través de considerar cómo evidencia esqueletal de disección del siglo XIX en los Estados Unidos refleja violencia estructural. Me enfoco en las “experiencias de muerte” y sugiero que estudios de violencia estructural deben considerar no sólo cómo la desigualdad puede ser corporizada como disparidades en salud en el viviente, sino también en “descorporización” y el tratamiento y destino del cuerpo muerto. [bioarqueologı́a, disección, violencia estructural, Estados Unidos] S violence is harm done to individuals or groups through the normalization of inequalities that are intimately, and invisibly, embedded in political-economic organization (Farmer et al. 2006). Research on modern groups (Farmer 2004; Farmer et al. 2006; Holmes 2013) and bioarchaeological skeletal collections (Harrod et al. 2012; Klaus 2012) that employ the concept of structural violence have focused on the lived experiences of individuals and the resulting health disparities. The former have considered the relationship between embedded social inequalities and chronic infectious diseases such as HIV/AIDS and tuberculosis, while the latter have examined skeletal markers of systemic physiological stress (e.g., linear enamel hypoplasias, porotic hyperostosis) and traumatic injury. Here I focus on skeletal evidence of postmortem examination (i.e., dissection and AMERICAN ANTHROPOLOGIST, Vol. 116, No. 4, pp. 1–15, ISSN 0002-7294, online ISSN 1548-1433. C © 2014 by the American Anthropological Association. All rights reserved. DOI: 10.1111/aman.12151 autopsy) from the 19th-century United States relative to the concept of structural violence. While the use of socially marginalized groups for dissection is well documented in the historical literature (Humphrey 1973; Richardson 1987), I will here demonstrate how the reformation of poor relief and the adoption of anatomy laws in the United States became intertwined and how they reflect the embedding of structural vulnerability for poor and socially marginalized groups. Almshouse inmates were vulnerable to this form of violence as they did not have the political or economic means to effectively resist or stop the illegal, and eventually legal, acquisition of the unclaimed dead for anatomical study. Conceptualizing dissection as a manifestation of structural violence extends the concept to encapsulate postmortem manifestations of social inequality. 2 American Anthropologist • Vol. 116, No. 4 • December 2014 STRUCTURAL VIOLENCE Johan Galtung (1969:168) describes violence as present “when human beings are being influenced so that their actual somatic and mental realizations are below their potential realizations.” This broadens the concept of violence such that it can be the result of direct action taken by an individual or group or indirect or structural violence that “is built into the structure and shows up as unequal power and consequently as unequal life chances” (Galtung 1969:171). Structural violence manifests in disparate distribution of resources, wealth, and access to medical services—and above all when the “power to decide over the distribution of resources is unevenly distributed” (Galtung 1969:171). Researchers such as Didier Fassin (2003), Paul Farmer (2003), and Seth Holmes (2013) consider the health consequences of structural inequalities in the modern world. Fassin (2003) focuses on three interrelated structural features of the AIDS epidemic in South Africa: socioeconomic disparities that increase risk of infection, rampant institutionalized sexual violence, and migration. Farmer and colleagues (Farmer 2004; Farmer et al. 2006) discuss AIDS/HIV and tuberculosis epidemics in Haiti and how they are “rooted in the enduring effects of European expansion in the New World and in the slavery and racism with which it was associated” (Farmer 2004:305). Holmes (2013) describes the experiences of migrant workers in the United States and details inequalities that are deeply embedded in the labor organization of the farms, as well as the more distal geopolitical forces that affect workers (e.g., NAFTA). All are united in their focus on articulating the disparities in material resources, education, and job opportunities as they are structured by temporally and geographically distal, macroscale political-economic forces. The extension of structural violence into archaeological contexts is predicated on a relatively simple premise: socially derived disparities in access to and control over resources can have physiological consequences that can result in skeletal manifestations (Klaus 2012). While the connection between skeletal trauma and structural violence may seem more straightforward (e.g., an embedded politicaleconomic organization that normalizes racially motivated interpersonal violence), institutionalized social inequalities can have a myriad of other physiological consequences observable in skeletal and dental remains (Crandall 2014; Schug et al. 2013). Ryan Harrod and colleagues (2012) examined the skeletal remains of 13 individuals of Chinese descent from Carlin, Nevada, that date to between 1885 and 1923 in an effort to understand the structural violence experienced by Chinese immigrants during this period in U.S. history. The researchers observed high rates of trauma, activity-related changes, and pathologies such as bone infections. Grounding their interpretations in both regional and local history, and in comparison with skeletal material from contemporaneous groups, the authors concluded that these Chinese immigrants experienced hard labor, racially motivated violence, and poor living conditions. Haagen Klaus (2012) presents a case study of the bioarchaeology of structural violence from the Lambayeque Valley of Colonial Peru. He reports on the analysis of 870 skeletal remains recovered from the site of the Chapel of San Pedro de Mórrope that date to between 1536 and 1750. Klaus and colleagues (Klaus et al. 2009) collected data on a wide range of skeletal indicators of health including evidence of systemic physiological stress, diet and dental health, activity patterns, and traumatic injury. The results indicate statistically significant increases in many of these indicators (e.g., porotic hypersostosis, femoral growth velocity, degenerative joint disease), which were then discussed within a framework of the structural inequalities and political-economic changes wrought by Spanish Colonial rule. The physiological consequences of institutionalization and poverty have been reconstructed from skeletal material from almshouses, including the Oneida Insane Asylum (Phillips 1997, 2001), Monroe County Almshouse (Higgins et al. 2002; Higgins and Sirianni 1995; Sirianni and Higgins 1995; Sutter 1995), Albany County Almshouse (Solano 2006), Dunning Cemetery (Grauer et al. 1998), Blockley Almshouse (Crist and Crist 2011), and the Erie County Poorhouse (Sirianni et al. 2014). While not explicitly articulated, the results of these studies most certainly reflect the structural violence of “social arrangements that put individuals and populations in harm’s way” (Farmer et al. 2006:1686). Although my focus here is also on skeletal samples derived from almshouse or poorhouse collections, I am not reconstructing the health consequences of lived experiences but, rather, the “death experiences” of social inequalities. While I would characterize the development and passing of anatomy laws that made it legal to dissect unclaimed bodies from almshouses and the resulting psychological stress associated with the fear of dissection as manifestations of structural violence, I would also extend the concept of violence to include “harm” done to the deceased. While a dead body is no longer an experiencing body, an intact living body is not necessary for a social identity, as the dead may still exist in a relational social network (Hallam et al. 1999; Tarlow 2008). Indeed, in her discussion of what she terms body love, Nancy Scheper-Hughes (2011:173) prefers to use the term person rather than body, “to emphasize that death does not destroy personhood but often intensifies it.” Scheper-Hughes (2011) provides powerful examples drawn from modern contexts of the continued significance of the dead and in particular the manner in which the fragmentation of the body is equated with the fragmentation of the person. Archaeological (e.g., Chapman 2000; Jones 2005) and bioarchaeological (e.g., Duncan and Schwarz 2014; Geller 2012) research also emphasizes the fragmentary, relational, dividual body and the idea that continued social existence or significance is not predicated upon an intact body. A methodological and theoretical focus on the reconstruction of lived social experiences to the exclusion of “death experiences” establishes a dichotomy between life and death that may not be appropriate (Hallam et al. 1999). Nystrom • Structural Violence and Dissection 3 Therefore, a bioarchaeology of structural violence must consider not only how inequality may be embodied as health disparities in the living but also “disembodiment” and the treatment and fate of the dead body. The intent to cause harm to deceased remains is well established (e.g., see Tarlow’s [2008] discussion of the postmortem history of Oliver Cromwell’s body). Dissection has been used as both a form of postmortem punishment and as a deterrent against crime (Hildebrandt 2008; Richardson 1987; Sappol 2002). In the early 16th and 17th centuries in both Britain and its North American colonies, dissection was meted out as postmortem punishment for executed criminals. This was first codified in 1789 by the New York legislature, which granted judges the power to add dissection to the sentence for particular crimes (Sappol 2002). Not only would this result in bodies being made available to medical schools, but it would establish dissection as a deterrent to crime. Beginning in the 1820s, anatomy laws extended this punitive association as a means of deterring indigence (Sappol 2002). For these laws to effectively employ dissection as a deterrent, they had to rest on a shared cultural understanding that there was a continued social significance attributed to the dead body and that the postmortem treatment of a corpse informs on the living identity. Considering these laws from this perspective destabilizes the life–death dichotomy and facilitates the reconceptualization of dissection as a form of violence. Further, there was a complex intertwining of contrasting themes (masculinity– femininity; dominance–submission, knowledge–ignorance, spirit–body) that grounded the cultural perception of dissection. Anatomists and medical doctors very much expressed their engagement with anatomy and the dead body in heroic, masculine terms: “They will hazard their own lives to detect the cause of death in others. Nor can infection nor contagion deter them from living examination or post mortem investigation” (Sappol 2002:80, citing an 1830 article in the New York Medical Inquirer). The dissecting room was portrayed as a dangerous, even liminal, space wherein the anatomist conquered the dead body. The act of dissection served as a rite of passage through which medical students had to traverse, emerging as members of the social and intellectual elite: it was the triumph of the spirit, of the mind, over the material, and inferior, body (Sappol 2002). Sappol (2002:85) notes that the “anatomical body had an erotic valence, whether positive or negative, and usually gendered as female.” Thus, while the corpse was potentially dangerous, powerful, and something to be conquered, it was simultaneously feminine, erotic, and in need of protection. Critics of the anatomy laws that were passed beginning in the 1830s articulated grave robbing and the dissection as a violation of the integrity of the private interior of the body and linked it with rape, sodomy, necrophilia, and satanism (Sappol 2002). Again, the articulation of these negative associations suggests that the body was not just a container for the spirit and that after death it could still “experience” such violent violations, and this reflects “a submerged and unacknowledged recognition of the continuing presence of the deceased” (Crossland 2009:110). It was in this context that a “politics of class was conducted in the idiom of anatomy” (Sappol 2002:100). Beginning in the early 19th century, poverty was an increasingly significant and visible problem, prompting attempts to reform the system of social relief that focused principally on the actions of the individual as the cause of poverty rather than on the macroscale political economy that fostered structural inequalities. This ultimately set the stage for the passage of anatomy laws that identified the poor and the indigent as legitimate sources of cadavers for anatomical education. THE STRUCTURAL INEQUALITY OF THE POOR In the United States, while territorial expansion and technological advances opened land and created jobs, there was a shift from an agrarian, credit-based economy to one dependent on wage earning from industrial production (Prude 1999). As articulated by Michael Katz (1986:9–10), the “transformation of social and economic structure disrupted social relations and created a class of highly mobile wage laborers subject to irregular, seasonal, dangerous, unhealthy, often badly paid work.” This transformation was predicated on fundamental changes to the organization of labor. The industrialization of manufacturing and agriculture altered how people worked and earned their living. Contrary to home manufacturing by independent skilled artisans, people now worked for someone else for most of their lives as wage laborers. Gone were apprenticeships and journeymen artisans—skilled labor became less prominent as “the logic of production subdivided work into smaller components that required less skill and less time to learn” (Katz 1986:5). As the skills required for most jobs declined, the pool of laborers increased, which in turn led to a decrease in wages. Thus, it was difficult for most to save enough money to survive through episodic unemployment. As there were fewer jobs available, and as most could not afford public transportation at the time, people were forced to move around the country to find work. There was a nearly 1,000 percent increase in the size of urban populations in the United States between 1800 and 1850 (Curry 1981) with rates of mobility within the city as well (Herndon and Challú 2013). The work that was available was low paying, dangerous, and tended to be seasonal (Katz 1986), which created cycles of poverty that would have had negative health consequences and increased the likelihood that individuals would have to seek relief at almshouses. In the face of the escalating number of poor in the first decades of the 19th century, several states, including Massachusetts, New York, Pennsylvania, and New Hampshire, began investigating poverty as a “social problem, a potential source of unrest and the proper object of a reform movement” (Rothman 1971:156). In 1821, the Massachusetts state legislature created a committee (henceforth called the Quincy Report after the committee chair Josiah 4 American Anthropologist • Vol. 116, No. 4 • December 2014 Quincy) to investigate and document the methods of public relief in the state. Another influential report was the Yates Report of 1824, commissioned by the New York legislature. These committees found that the current state of poor relief, predominantly through “outdoor” relief (i.e., occurred outside the doors of an institution), was expensive and, even more troubling, was likely contributing to the problem of poverty (Rothman 1971). Ultimately, two classes of poor were identified: the able-bodied poor (i.e., those capable of working) and the impotent poor (i.e., those unable to work due to age, sickness, or disability). The latter were considered “worthy” and were seen as suffering poverty through no fault of their own. The able-bodied poor, however, were considered “unworthy,” and their condition was considered to be due to their own character and lack of agency. Outdoor relief was believed to only encourage the inherently lazy and indolent nature of the unworthy poor and to lead to the erosion of the incentive to work and creation of a sense of entitlement (Rothman 1971). While society should want to support the worthy poor, the problem was how to accomplish this without simultaneously supporting and encouraging pauperism. The almshouse was perceived to be the answer: by transferring social relief into the controlled environment of the alms or poorhouse, the worthy poor could obtain the assistance they deserved while also providing the opportunity to reform the character flaws of the pauper through labor. In the almshouse, when forced to work, “a degree of pride begins to operate in their bosom; this proves an incentive to exertion; they quit their station and shift for themselves” (Katz 1986:23, citing the Quincy Report). Labor and industry was the pathway out of poverty and toward upright citizenry. The almshouse failed soon after its implementation, however, and ultimately only exacerbated the structural vulnerability of the poor. Katz (1986:25) notes that while early-19th-century institutions appear to have been succeeding in their mission, by the mid1800s nearly every one “had lost its original promise” and thus exposed the poor to conditions that directly, and negatively, affected health. By this time, reports indicate that living conditions were deplorable and that institutional management was inept. In 1857, a New York Select Committee visited every city and county almshouse in the state and reported that the poorhouses were “badly constructed, ill-arranged, ill-warmed, and illventilated” (Rothman 1971:198, citing a 1857 New York Select Committee Report). The committee concludes that the majority of the almshouses are “disgraceful memorials of the public charity. Common domestic animals are usually more humanely provided for than the paupers in some of these institutions” (Rothman 1971:198). While proximally the living conditions experienced by almshouse inmates represent violence, macroscale politicaleconomic forces were operating that also contributed to their vulnerability and the violence they could experience. The changing societal perception of poverty, coupled with the demand for cadavers generated by the emergence and expansion of the medical profession in the United States, created a context in which the poor became vulnerable to the postmortem violence of dissection. ANATOMY LAWS The following discussion focuses on the events surrounding the passing of anatomy laws during the midto late 1800s in the United States, though the overall scope, focus, and influences on the development of anatomy laws parallel what is observed in Britain (Richardson 1987). Both countries experienced a rapid growth in the number of medical schools and a concomitant increase in the demand for anatomical specimens. Simultaneously, both countries were experiencing the political-economic effects of industrialization and the resulting inequities that fostered widespread poverty. Both countries ultimately came to much the same solution to both problems: reformation of the social-relief system and the passage of legislation that legalized the acquisition of the unclaimed dead of the poor. While the process was more sporadic and occurred on a state-by-state basis in the United States, ultimately the result was the same: the codification of inequality that put particular groups in harm’s way. While dissection and autopsies were fundamental to the advancement of medical science, dissection as a form of postmortem punishment, however, first appeared in Britain in 1540. A royal decree of Henry VIII granted the newly chartered company of Barbers and Surgeons the bodies of four (later increased to six) executed criminals per year. This law, in addition to a 1752 act that added dissection as an alternative to gibbeting (postmortem hanging) in chains, remained the law in Britain until 1832 (Richardson 1987). In the North American colonies, the first statutes that explicitly allowed the dissection of executed criminals were passed in 1641 and 1647 in Massachusetts (Sappol 2002). During the 17th and 18th centuries, with common law providing “a hazy license to disinter and dissect,” the demand for anatomical specimens was not great (Sappol 2002:102). But as the number of medical schools increased during the 19th century (from four to 160), the legal supply of available cadavers began to fall short of the demand, and a market for illegally acquired, “resurrected” bodies began to emerge (Hildebrandt 2010; Sappol 2002). The public anxiety and fear generated by grave robbing boiled over on a number of occasions, leading to a series of anatomy riots (20 such riots between 1785 and 1855; see Sappol 2002:106) that often targeted medical schools. Of particular note is the 1788 Doctor’s Mob in New York City. In 1787, a group of free blacks petitioned the city’s common council to stop the removal of the dead from the Negro Burying Ground. The petition was ignored, and it was not until a year later when the body of a white woman was reported stolen from Trinity Church that public sentiment resulted in action. The riot that ensued lasted for three days, during which the City Hospital was ransacked, medical students took refuge in the city jail, and six people were killed in confrontations between the mob and a mobilized militia (Sappol 2002). Nystrom • Structural Violence and Dissection 5 In the aftermath of that riot, New York passed the 1789 “Act to Prevent the Odious Practice of Digging up and Removing for the Purpose of Dissection, Dead Bodies Interred in Cemeteries or Burial Places” (Sappol 2002). Many states subsequently passed anti–grave robbing legislation (Connecticut in 1810, Massachusetts in 1815, New York in 1819, Maine in 1820, Ohio in 1846), often coupling such efforts with the legal ability to dissect criminals (federal government in 1790, Michigan in 1844, New Hampshire in 1869, Vermont in 1870). In reality, these laws did little to curb grave robbing and were effective only in mollifying white middleand upper-class fears and had little significance for those groups generally targeted for such activity: African Americans, Native Americans, immigrants, and the poor. In the quest to distance itself from the taint of associating with grave robbers and resurrectionists, while also providing medical schools with a steady supply of anatomical specimens, the medical profession became enmeshed with the reformation of social relief and the problem of poverty. It was the utilitarian philosopher Jeremy Bentham who explicitly linked poor law reform and anatomical study and whose influence is observed in the development of anatomy laws in both the United States and Britain (Richardson 1987; Sappol 2002). Bentham argued from a position that a person’s value is based on their contribution to society and the public good. Bentham and his followers argued that poorhouses should be punitive in nature, intentionally designed to dissuade people from seeking public assistance (Sappol 2002); those individuals that did not or could not contribute to society should be made to work and, upon their death, should repay their debt to society. This utilitarian ethos infused the Benthamite perception of the corpse as well: any sentiment associated with the corpse was an “obstacle to the rationalization of society and culture” because a dead body should only be valued based on its usefulness to the living (Sappol 2002:118). While these anatomy laws explicitly focused on “unclaimed” bodies, masking an inherent classism, in reality the majority of such bodies came from economically depressed and racialized groups (Halperin 2007). Beginning in the 1820s, states began to debate, and to sporadically pass, anatomy laws that allowed medical schools to acquire unclaimed bodies from almshouses. In 1831, Massachusetts was the first state to enact an anatomy law, though it was limited to Boston. In New York, attempts were made to pass anatomy laws in 1831, 1832, 1843, and 1844, though it was not until 1854 that the “Act to Promote Medical Science and Protect Burial Grounds” (commonly referred to as the “Bone Bill”) was passed (Sappol 2002). While on the surface these acts had the principal goals of stopping grave robbing and the advancement of medical science, they also reframed dissection as a deterrent against indigence and as a means of social control. DISSECTION AS STRUCTURAL VIOLENCE That dissection is a manifestation of structural violence does not require a significant intellectual leap and is reflected, though perhaps not explicitly, by research in both modern and historical contexts. Gareth Jones and Maja Whitaker (2012:246) criticize the medical profession for the continued use of “unclaimed” bodies as a form of exploitation because such bodies are, both historically (Halperin 2007; Humphrey 1973; Savitt 1982; Schultz 1992) and in modern settings, principally from poor and marginalized groups. Large numbers of unclaimed bodies are used in medical training in several countries in Africa, as well as in India, Brazil, and Bangladesh (Ajita and Singh 2007; Chakraborty et al. 2010; Gangata et al. 2010; see also Jones and Whitaker 2012). While not as prevalent as in these countries, Neela Dasgupta (2004) reports that nearly 20 percent of anatomy laboratories in the United States and Canada use unclaimed bodies for anatomical education. There are a number of sites in Great Britain (Mitchell 2012) and the United States (see Table 1) in which there is skeletal evidence of postmortem examination. In the latter, such evidence has been observed in a number of different contexts including medical schools, public cemeteries, institutional contexts such as almshouses, and even privies. While I focus in this article on the institutional contexts, we cannot ignore what was occurring in the other sites (e.g., public cemeteries, medical schools) listed in Table 1. The structural inequality experienced by African Americans is well documented (e.g., Smedley and Smedley 2011), and skeletal evidence of postmortem examinations has been recovered from both public cemeteries (e.g., Freedman’s Cemetery) and from medical schools (e.g., Medical College of Georgia). While not interpreted or articulated as a form of violence, this evidence has been used to discuss structural vulnerability based on race and the embodiment of social inequality politics (e.g., Blakely and Harrington 1997; Davidson 2007; Nystrom 2011). However, skeletal evidence of postmortem examination should not be universally interpreted as a manifestation of structural violence; it is very much dependent upon the distinction between dissection and autopsy. Dissection and autopsy can be differentiated based on intent and focus. The former is a procedure in which the primary focus is anatomical study, while the latter specifically refers to determination of cause of death. While this distinction may be quite fine, this masks a much deeper cultural significance and, as discussed above, is based on the perception of the body. During the 18th and 19th centuries, dissection was widely regarded as a violation of the body and was generally punitive in nature. While it stripped the individual of their social identity and transformed the body into an object, it simultaneously reinforced a living social identity (Crossland 2009). In contrast, the same stigma was not associated with autopsies. Rather than signifying an estranged, marginalized identity, autopsies marked an individual as important enough as to warrant an investigation of their death (Crossland 2009; Martensen 1992; Sappol 2002). Thus, as argued here, dissection would reflect structural violence whereas autopsy would not carry the same connotations. As 6 American Anthropologist • Vol. 116, No. 4 • December 2014 TABLE 1. Samples with Known Skeletal Evidence of Dissection or Autopsy from the United States