[from the medical records dept] Alas, Poor Yorick!

[this missive first appeared from The Alienist in early 2013]

“Bones are all that survive of the body. They are keys to our collective past and reminders of our own mortality, so it is no mystery that they have a magic aura for artists, for the faithful of many religions, for collectors, for all of us.”
~Barbara Norfleet (1993)

In the winter of 1983 I engaged in that time-honored rite of passage known as the campus visit. In this case it was pursuant to my applications to medical school. Of the schools I had tentatively chosen, all of the curricula were similar, and the work load at each appeared predictably onerous. But one thing that stood out almost immediately was the manner in which the respective schools addressed and dealt with the dead. And I don’t necessarily mean dead patients. I mean dead teaching tools and specimens.

Case in point: at one public university, as part of the prospective students’ tour, we were brought through the anatomy lab. I remember that it was a large antiseptic room with gurneys, tables, and bodies in zipped bags, along with some articulated skeletons on stands next to the walls. I didn’t sense anything lurid about the showing of this area to the applicants; it was just another part of the tour: “on your left, you see some cadavers, and over here on your right….”

However, later at a private university, it was entirely different. The prospectives’ tour stopped outside the doors to the anatomy lab, and the tour guide said, “here is the anatomy lab. I can’t take you inside because it would violate the sanctity of the area. Every day before we begin our dissection, we have a moment of silence and introspection to thank the deceased for their priceless gift to us and our ability to learn from them and assist in the care of those who are still living.”

What a contrast! It’s not that I’m advocating for disrespect, but the second institution struck me as utterly dour. Being accepted at both, I wound up going to the first school, and I didn’t regret the choice. And yes, I did later give my cadaver a name, one rather tongue-in-cheek and in keeping with the usual ‘whistling past the graveyard’ approach to death employed by many in the health professions.

So much for that moment of silence and introspection.

But I’ve pondered at length since then the manner in which we collectively interact with the dead in the 21st century. I’m not a policy-maker, a mortician, a crime scene investigator, or a hospice-worker. But I do think our society’s approach is rather schizophrenic, perhaps reflecting our own conflicted feelings.

Another case in point: later, as a second year medical student, one recurrent exercise in pathology class was known affectionately as the “pot case” or, better, “the man in a can.” Teaching assistants would obtain the leftovers from recent autopsies performed in the medical center and would place the offal in large plastic buckets. Hearts, livers, pertinent bones, brains, kidneys. Any part of a human body was potentially sloshing around inside. After pots were distributed, we would divide into groups and dump out the contents. We’d be told that we had an hour to look through the contents and then to report on our findings. It seemed entirely scientific and not in the least lurid. But while I remember the pathologies encountered in the pots quite well, I have no recollection of ever having pondered the ultimate question: “who WAS this person, and did she ever think that she was going to wind up like this?”

When one looks, human remains are everywhere. There are medical museums – the Armed Forces Institute of Pathology in Washington DC and the Mutter in Philadelphia come to mind – with vast collections of bizarre wet and dry specimens. The Smithsonian has anthropological exhibits of human skulls from around the world, and other academic and research centers possess similar holdings. There are the Capuchin ossuaries in Italy, charnal houses in Egypt, and bone chapels in Portugal that are filled with piles of skulls and stacks of femurs and pelvic bones upon which we gaze. Extant life-sized statuary of saints from the Middle Ages often employ real bones as accessories. And as a lapsed Freemason, I can personally attest that human crania do indeed find their way into lodge ritual more often than not.

So then there is the unavoidable question: how to treat those remains that are not in the ground? It’s not as easy a question as it might at first seem. Many answer by waffling on the age and apparent anonymity of the original owners – specimens from ancient Paleolithic sites rarely stir visceral emotions, whereas that difficult grey zone is encountered, skirting frank grave-robbery, when the remains at issue are nearly identifiable or at least bear an association with someone(s) still living.

For example, at legislative hearings in the 1990s over the fate of the Dickson burial mound in Illinois (active 9thc – 13thc CE), Professor Raymond Fogelson of the University of Chicago spoke for (a distinct minority within) the scientific community when he characterized the curated display of human remains from that site as “obscene pornography.” I prefer to think that another academic who testified, Professor William Sumner, also from the University of Chicago, was closer to accurate when he said that the display “fires the imagination of school children and adults alike…. It inspires a striking recognition of how the past is a continuation with the present and leaves a lasting impression that leads to an enriched intellectual life.”

Besides, it’s not as though such academic collections are spread out to gawkers like a carnival side show. As author Christine Quigley noted in 2001, “the bulk of institutional collections of human remains is rarely visible to the public, despite the fact that displays of [such] are among the most effective tools for luring people into museums.”

And admittedly, not all displays of human remains fall into the academic realm. The successful Bodies tour that has been viewed by hundreds of thousands in cities all across the U.S. is one example of the (some would say crass) commercialization of the dissected dead. There are businesses that specialize in providing “osteological specimens” – certainly a sanitized description – to just about anyone with interest and cash. Prominent auction houses have sold remains when they have historical interest. And human skulls and other bones are freely available online to anyone, no questions asked, as long as the items are listed as “medical teaching tools” to circumvent purported bans on selling body parts on the Internet.

This dichotomy is perhaps easier to understand when viewed through the prism of the early modern age, a time when the scientific method was blossoming alongside P.T. Barnum. Or as Alberti and Hallam presciently noted, “the macabre seeds sewn in the Enlightenment bore their morbid fruit in the Victorian era. Medical collections founded in the late 18th and 19th centuries were at the intersection of a number of cultural and scientific currents: the development of pathology and comparative anatomy as disciplines, the formalization of medical education, European colonial expansion, and the spread of popular shows and exhibitions.”

There is a wonderful book entitled Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930, by Warner and Edmonson. Based on the vintage collection of the Dittrick Museum of Case Western Reserve University, the book illustrates a surprisingly common form of group photography that became popular around the turn of the 20th century – medical students and house staff posing with skeletons and cadavers. If you search ‘cadaver’ and ‘antique’ and ‘photograph’ on Google Images, you’ll find dozens of these pictures. It seems that just about every American medical school and hospital of the day had students and staff posing openly with the dead.

This ‘art form’ died out after WWII – students would risk expulsion were they to try this today – but even when viewed through the lenses of modern sensibilities, the photos, at least to me, do not seem exploitative or pornographic. Instead the scenes appear innocent, good natured, and in a manner, curious and inquisitive.

But the question remains answered, if at all, unsatisfactorily. It is still unclear what has changed in our collective consciousness of, and appreciation for, the dead. Is it political-correctness run amok? Or something deeper that we are only now coming to understand?

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

The House Of The Rising Sun


There is a house in New Orleans
They call the Rising Sun
And it’s been the ruin of many a poor boy
And God I know I’m one

I have always loved The Animals’ House of the Rising Sun, a haunting rock ballad that was released in this country in 1964, and went to the top of the Billboard chart in the U.S., U.K., Canada, Sweden, and Finland in short order. Interestingly, this version known to most Americans today – the first British Invasion #1 not connected to the Beatles, and one currently listed amongst the 500 greatest arrangements of all time by both Rolling Stone and the Rock ‘n’ Roll Hall of Fame – was performed in one (unpracticed) take on May 18th of that year in a London studio, and was not re-recorded a single time before release.

The Animals' Album

The Animals’ Album

Having spent time in New Orleans at Charity Hospital as a resident, and being quite familiar with the seedier side of The Big Easy, I have long believed that the song lamented a young man ruined by a life spent in the song’s namesake house of ill repute. Except now, it appears that such is not the case.

The score and lyrics have also been known as the Rising Sun Blues before The Animals’ best known release. It’s had a long and storied existence on both sides of the Atlantic. The earliest known version of the song in this country was recorded by Appalachian folk artist Tom Ashley in 1934. When asked about it, Ashley merely noted that he had learned the song from his late father, and he had no idea from where his father had learned it. The tune has been covered by Georgia Turner (1937), Woody Guthrie (1941), Josh White (1947), Lead Belly (1948), Pete Seeger (1958), Frankie Laine (1959), Andy Griffith (1959), Joan Baez (1960), Mirian Makeba (1960), Bob Dylan (1961), Nina Simone (1962), the Chamber Brothers (1967), Frijid Pink (1969), Jody Miller (1973), Dolly Parton (1981), and Five Finger Death Punch (2014), to name only some; the gender of the song’s subject varies by the artist, suggesting either a ruined man or fallen woman. And there is even a Spanish language version released by Los Speakers (1965).

Paradoxically, Dylan – who arguably attained greater lasting fame – stopped playing the song in concert after The Animals’ smash hit because he was tired of being accused of plagiarism even though he did it first!

A persistent urban legend exists that both The Doors and Led Zeppelin covered the song as well, but as of this writing, no such recordings from either group are known.

Musicologists have opined that the song’s authorship is murky at best, and that it is derived from 18th century folk ballads such as The Unfortunate Rake, about a prodigal son dying of syphilis. These musical scholars suggest that the song was only adapted to a Louisiana setting after crossing the Atlantic with early immigrants.

To further muddy the (Mississippi) waters,
• Alan Price of The Animals has said in at least one interview that he was told the song was about a now-defunct Soho brothel, but he wasn’t entirely certain; he claimed that he first heard it when touring with Chuck Berry, and decided to incorporate it into their repertoire “because it was distinctive.”
• Extant records from Orleans Parish do not document any bawdy houses of the late 18th through early 20th centuries – yes, they were usually licensed and recorded back then – by the name of Rising Sun. There was, however, a small hotel thus named on Conti Street in the French Quarter that burned down in 1822 (sidebar: archaeologists have found a large number of cosmetic containers at this site). There was a coffee house with the title next to the Quarter in the 1860 census. There was a Rising Sun on Decatur Street in the late 1860s that has been variously described as a restaurant, a café, or a saloon. And there was a dance hall with the moniker in the Carrollton district of the city in the 1890s. Whether any of these businesses offered a secondary line of services upstairs is not entirely clear.
• Maybe the reference isn’t to a brothel at all, but to a proprietor of same? There was a suspected bordello at 1614 Esplanade Avenue from 1862-74 that was owned by one Madam Marianne LeSoleil Levant, her name being French for “Rising Sun.”
• And the reference to “ball and chain” in the fifth stanza suggest that the house in question may, in fact, be a jail. The front door of the old Orleans Parish Women’s Prison is said to have had a rising sun motif on the cornice. That noted, the phrase is often used as a euphemism for the bonds of holy matrimony, leading credence once again to the (frustrated husband in the) brothel angle.

Not everyone believes that there necessarily even exists a discoverable American historical antecedent to the song, especially given its apparently murky roots in Old Country folklore. Pamela Arceneaux, a librarian working at the Williams Research Center in New Orleans, has been quoted as saying, “to paraphrase Freud, sometimes lyrics are just lyrics.”

Oh mother tell your children
Not to do what I have done
Spend your lives in sin and misery
In the House of the Rising Sun

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Size Matters

There’s that old adage of Lone Star narcissism and self-indulgence that everything in Texas is bigger. In the antebellum South, the diameter of a woman’s hoop skirt usually reflected wealth and status. Sumo wrestlers are the rock stars of Japan. The number of annular rings in a cross section of a giant redwood reveals its age. European royalty and judicial luminaries of the 18th century competed to don the most luxuriant and elaborately curled perukes. And in the adult film industry, well… let’s not go there.

In short, size (or whatever parameter of magnitude you desire) does matter.

[quick sidebar: customization matters too. In the American Civil War, common military conscripts were issued frumpy outerwear called sack coats, their similarities to the canvas potato bags of the day being unavoidable. Those stylish enlistees of means and middle rank, however, paid extra for a tailored version known as the shell jacket, that which men often are seen wearing in formal portraits of the day as the antebellum females swoon]

Combining those two observations brings me to an unmistakable ‘fact’ about the doctor’s white coat.

When I was a student, and later intern, we were issued the medical version of the sack coat. Formless, hip-length, off the rack, of coarse scratchy fabric, and with sleeves that were always ill-fitting, these atrocities made us look like the kids’ toy Weebles (who wobble but don’t fall down). Before long, they all looked dingy despite the number of washings. The young women in my class, and those few men regarded as clothes-horses, however, bought their own jackets of higher quality and had them tailored to fit and regularly drycleaned. All, though, were hip length. And by late intern year, many hold-outs had chucked their sack coats and opted for something more fitting albeit still utilitarian and of acceptable length.

As one progressed up the food chain, the quality of the coats and length improved (and, I would posit, the cleanliness). Upper level residents wore longer coats. Junior attendings a bit longer. And eminent attendings had coats of regal length – the perception magnified if that doctor was of short stature – with stylish pleating, belts, and fabric buttons in lieu of the cheap plastic ones on the government issued varieties.

As a psychiatrist, I only wore a white coat as an intern. After that point, at least at my medical center, psychiatrists tried to eschew the fearful “I’m the doctor and you’re not” phenom on the mental health wards and opt for the warmer and fuzzier Mr Rogers approach – khakis and sweaters. I know that’s a stereotype, but it’s true. And that’s how I’ve dressed for the past quarter century. Until recently.

I took a new inpatient position at a nearby medical center, and found that the psychiatric attendings there often, albeit not universally, opted for the classic white coat.

I know that much has been written about this tradition, but given all of the above, imagine my surprise when my intern arrived on the unit the very first day of the rotation… sporting a flowing and long bright white coat (with embroidered name in script, no less!) Her coat was far nicer than mine. For a moment, I couldn’t figure out who was this person until she introduced herself. She had been a physician at that point for less than five weeks.

Double my shock when I saw other allied disciplines – nursing, social work, pharmacy, technicians – donning the same attire!

I would have been shamed out of my residency program had I tried that back in the late 1980s.

Should it matter? No. Does it matter? I suspect in some ways, yes.

And while the egalitarians applaud, I doubt that the protocol at Mass General – where I am told that attendings wear short coats to symbolize that they are students for life – will catch on elsewhere anytime soon.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]