The professors of anatomy in Dublin's three medical schools are all agreed on one thing; the dissecting of bodies is vital to the teaching of good medicine and the making of good doctors. Without bodies, they say, the understanding of the student suffers. The act of dissecting increases respect for the human body and gives an awareness of the fragility and complexity of what's inside. It helps the would-be doctor learn about anomalies and variations in a way no textbook or computer could. Knowledge, say the professors, is enforced by seeing and feeling.
Problem is, there just aren't enough bodies to go around. There never have been, according to Prof John Bannigan of UCD, but now it has reached crisis point. Medical student numbers have risen sharply and continue to increase - but there has been no corresponding increase in the number of bodies being donated for research and teaching.
The result, in the view of Prof Moira O'Brien of TCD, is that the colleges "need double the numbers required a few years ago". A more sanguine Prof Stanley Monkhouse of the College of Surgeons admits that "we could certainly do with more".
The problem has also, in part, to do with donated bodies being divided between the Republic's five medical schools: TCD, UCD, College of Surgeons, and the NUIs in Cork and Galway. As Bannigan explains it: "In somewhere like they've no problem because there's only one medical school in the whole of Wales. This is also the experience of the university of Vienna where there's only one university. If Dublin had only one medical school we'd get 40-50 bodies per year."
He adds: "My policy is to take anyone from Leinster. If they're from Connacht or Munster, I'll suggest Galway or Cork."
The issue is not without an historical dimension too. Bannigan says that until about 30 years ago the majority of cadavers used by the medical schools here were unclaimed bodies.
"Relatively few Irish people gave their bodies," he says, "since to do so was associated with poverty. But in the last 20 to 30 years all of the bodies we get are donated." Most come from members of the clergy, Protestant usually, and medics themselves. Medical research also depends on donated bodies. In UCD, for instance, engineers and research workers in the very active bio-mechanical engineering centre make careful examinations of bodies with a view to designing artificial joints and the like. Bodies are important too for the development of surgical techniques.
The anatomy departments are very appreciative of all donated bodies and anxious to encourage people to donate them.
"I would never refuse any body," says Monkhouse, "since you just cannot get good doctors without dissection. Those few medical schools which attempted to get by without bodies went back to using them." Hugely sensitive to the mythology and popular misconceptions surrounding dissection, he and his colleagues want to make clear the dignity afforded donated bodies and just how much they are valued.
"It's explained to students on the very first day," says Monkhouse, "that the body is there as the result of extraordinary generosity on the part of the donor."
In UCD a "sensitivity is encouraged among students" says Bannigan. He regrets that "the writings of such as Flann O'Brien - and Joyce to a certain extent - have created the image of the bawdy student. Then there's the folklore of Frankenstein and the creation of bodies. . . The reality is that students behave with the utmost decorum. Disrespect is the one thing which would get a student expelled".
There are strict rules too in the dissecting rooms with, according to O'Brien, "everyone white coated and some even wearing gloves. It has to do with a courtesy and respect for those who have given their cadavers."
The courtesy extends to the departments of anatomy having a common burial plot for donated bodies in Glasnevin cemetery. "We've erected a cross there in recent years," Monkhouse explains, "and we're currently assessing it for landscaping." The cost of burial, naturally enough, is undertaken by the departments and if relatives of the dead prefer a private, family burial, this will be arranged too.
Such consideration for families of donors contrasts with that operating in England and the US. In England the body goes to a central pool and relatives are not told which school of medicine receives it nor where the remains are buried afterwards. "Once donated over there, that's it," says Monkhouse.
Individual memorial services are held here too, at regular intervals. It's a way of thanking the relatives, O'Brien says, but it is also, according to Monkhouse, "very important for the students. It brings a sense of realisation that, in a way, their first patient is the donor's body." The memorial ceremonies are multi-denominational. UCD's is held in the John Field room of the National Concert Hall where prayers are recited by students. There are representatives of the major world religions and, according to Bannigan, "usually enough musical talent amongst students to have a small ensemble playing. We make an effort to contact every single relative. It seems to be greatly appreciated because one of the things families miss out on is the ceremony of grieving after the church. This makes up for it in some small way".
This is because the donated body, after the church ceremony, is taken to the relevant department of anatomy instead of going on for burial or cremation. Embalmed, it remains in the care of the department for two to three years, during which it is carefully dissected with some small bits of tissue removed too for research purposes. After that time it may be buried in the special plot in Glasnevin, cremated if that's what the family prefers, or buried in a private family plot. In the first two instances the costs are borne by the colleges.
The final reality of the value to medicine of donated bodies is spelt out by Moira O'Brien. "If students have never felt and looked, as in dissecting, they will never, quite literally, have a feel for it."
