4) The Disappearance of Death

In the early 19th century, dead bodies became crucially important in the new understanding of disease as an organic response to internal, anatomical lesions. Well into the 18th century, death was seen as something to always bear in mind. So, cemeteries were built at least in view of, if not in, towns and villages. This was because death was seen as the gateway into another, more important life. So, people always had to remember their impending death and act accordingly. This meant there was something morally suspect about attempts to defeat death's toll (for example in life insurance where someone was being kept alive after illness, cheating death), and life was regarded as a 'dance with death'.

This understanding of death shaped medical understanding of disease as being interrupted by death. From this perspective, lesions found in dead bodies weren't understood as signs of disease during life, but of the corruption of the body brought about by death's intervention. It is because of this that medical teaching had insisted dead bodies told very little about disease. In both lay and medical understanding, life and death were radically different and opposing figures and forces.

When Public Health Officers' statistical methods were introduced into the hospital, they began to change the understanding of health and illness from a qualitative to a quantitative distinction. This meant that every patient was different. For example, diagnosing a patient with fever because they were hot and thus treating them with blood-letting to cool them down could be dangerous if the patient was naturally warmer than other people.

Parisian physicians, like Pierre Louis, asked how 'hot' a person should be to be considered so 'feverish' as to justify the use of bloodletting. They insisted that, in seeking to evaluate the usefulness of bloodletting, the patient's hotness had to be properly pathological, that is not normal. Normality became a statistical concept, relating an individual's temperature to the statistical norm for all individuals. So, the individual was replaced by the average individual as the foundation for all anatomo-pathological investigations and medical diagnoses.

Importantly, this redefinition of disease in quantitative terms made death become the extreme value of any vital statistic, like temperature or pulse. There was no longer a thing as death itself as it was no longer an external force opposing life, it was just the extreme numerical point on the continuum of vital functions. This redefinition of death was also a matter of great public concern.

After the introduction of the Murder Act in 1752 which made the bodies of executed criminals the chief legal resource for medical teaching and investigation, the horror of execution had become intensified as it would be impossible for them to be resurrected on the Day of Judgement. But, at the same time, as anatomical dissection ceased to be just for the purposes of illustration and became critically important in understanding disease, the demand grew, especially as disease became understood as a process unfolding over time and across anatomical space. Attempts to bring some form of regulation to the market for healthcare resulted in the Apothecaries Act in 1815 that required apothecaries to obtain a minimum training in medicine, including instruction in anatomy.

The supply of dead bodies became insufficient to meet the demand, creating an illegal market where the bodies of paupers, and those not buried in supervised areas like cemeteries in church-yards, were readily bought and sold. The bodies were bought off the people responsible for them. For example, paupers who died alone were bought off their landlord. The most famous British case of body-snatching was that of Burke and Hare (1828), which came to light in the context of a heated political debate over the obligations of the state towards the working classes and the poor.

This trade in bodies became the focus of increasingly radical political discontent when people began speaking up for the poor. The workhouse was one of the most detested symbols of the injustice of the world. In workhouses, the poor and working classes were subjected to the harsh and arbitrary power of often corrupt guardians and supervisors. Disease and death was often the consequence of such power. Supporters of reforming the Poor Laws insisted on the appointment of Poor Law Inspectors and Medical Officers who, among other things, would police sanitary conditions in workhouses. Under the new conditions, some treatments given to those in workhouses was the same given to paying customers, paid for by the Poor Laws.

The illegal trade in bodies of paupers and working classes (sometimes abetted by guardians and supervisors who sold the bodies of 'unclaimed' dead to make ends meet) brought the medical profession into disrepute. Anatomists were held up to public ridicule as they seemed to be treating cadavers as if they were from the slaughter house. So, anatomists were at the forefront of the campaign for reform, insisting that something had to be done to regulate the market in medical education, by bringing it within a legal framework and including only officially-sanctioned anatomists in medical schools attached to universities. The resulting Anatomy Act (1832) stipulated that bodies of 'unclaimed' dead from workhouses and hospitals would be sent to officially-sanctioned anatomists in such medical schools. So, it tried to limit the right to practice and teach anatomy while increasing the fear of workhouses. It was then integrated into the Poor Law (Amendment) Act (1834).

The irony of the Poor Law (Amendment) Act was that, despite improving sanitary conditions and medical care in workhouses, it came at the cost of the poor sacrificing their bodies to medical progress. More importantly, the medical profession was now not only advancing a new understanding of death, but a social and cultural transformation of death too, as it was now the responsibility of the Medical Inspector to certify death, and of the Police to properly dispose of the dead body.

During the cholera years (from the mid-1830s to the late-1840s), the increasing importance of medical officers to the regulation of mortuary procedures came to include deciding on the proper site and manner of burial, which increasingly emphasised the removal of cemeteries from within the confines of the village and town. The industrial North started building cemeteries away from the centre just in case whatever killed the person was contagious. This progressive removal of symbolic meaning and medicalisation of death has prompted historians like Philippe Ariés to write of the 'disappearance of death' in the modern era.