Life After Death 

How Virginia is changing the face of medicine through a revolutionary embalming technique.

click to enlarge cover36_cadavers_no_headlines.jpg

There is a woman in Richmond who does not age.

She spends her days on a table a block north of the Greater Richmond Convention Center, patiently awaiting her fate. She is known as Lady Thiel, and for the past two years, not a single new wrinkle has crept onto her nearly 90-year-old face.

Lady Thiel may be deceased, but her body's color, structure and flexibility are practically unchanged from when researchers first encountered her.

Her identity, like those of others who have donated their bodies to science, remains anonymous. But she's a medical marvel, a pioneer. She represents a new way of preserving bodies, which is opening a world of possibilities for medical research and putting Virginia's State Anatomical Program at the forefront of the field.

While Lady Thiel lies in a sealed container at room temperature, she and her preservers are waiting to see what will happen next.

 

click to enlarge The roughly 300 cadavers donated to science in Virginia each year are embalmed in the program’s preparation laboratory. The State Anatomical Program, established in 1919, is north of the convention center at 400 E. Jackson St. - SCOTT ELMQUIST
  • Scott Elmquist
  • The roughly 300 cadavers donated to science in Virginia each year are embalmed in the program’s preparation laboratory. The State Anatomical Program, established in 1919, is north of the convention center at 400 E. Jackson St.

It was about a decade ago that a change came over Jane Gilbert. Known for her intellect and talkative nature, Gilbert was an active person, serving as a special-education teacher, a founding member of the town council in Leland, N.C., and a mother of five.

In her 70s, Gilbert started having trouble putting sentences together. At first, her family thought it was sleep deprivation caused by grief over the recent death of her son, but the culprit was ruled Alzheimer's disease.

Though she retained her love of old movies, she eventually lost the ability to speak, and died a few weeks shy of her 84th birthday a year ago in August.

As long as anyone can recall, Gilbert had talked about donating her body to science.

"I think she saw herself as a cadaver at a medical school," says her daughter Ann Graziano, who lives in Warsaw. "She didn't like the idea of preserving a body in the ground, especially if she could do something for someone else."

Gilbert's body became one of roughly 300 that the Virginia's State Anatomical Program accepted last year. Founded in 1919, the program helps medical schools acquire cadavers for anatomy and surgery instruction. It relies entirely on donations.

For medical schools, donated bodies help surgeons practice techniques and teach students about anatomy. Receiving a first cadaver is considered a rite of passage for medical students, giving them hands-on training and in some cases providing a first experience with death.

For research centers, the bodies provide realistic testing for new safety equipment, such as helmets and seat belts. Virginia Tech and the University of Virginia have labs that use cadavers for that purpose, helping make life safer for the living.

No taxpayer funds directly support the State Anatomical Program, which runs on an annual budget of roughly $400,000. All the program's expenses — including salaries, materials and transportation of bodies — are covered by a $1,500 fee per cadaver, which is charged to schools and research centers.

For the state to accept a body, it must fit the criteria established by medical schools, taking into account the body's size and condition after death. Only about half of the bodies intended for donation are accepted, forcing some schools to acquire cadavers from other states.

"If we're not able to place the individual, we won't accept them," operational director Rick Sikon says. "Even with 300, we still don't have enough to satisfy the need."

 

click to enlarge The program’s operational director, Rick Sikon, says he’s always been captivated by the human body. He’s helped refine the new embalming method. - SCOTT ELMQUIST
  • Scott Elmquist
  • The program’s operational director, Rick Sikon, says he’s always been captivated by the human body. He’s helped refine the new embalming method.

Sikon has made a career out of death. Standing in the program's preparation laboratory, it's likely he's one of the few people who'd feel right at home.

Surrounded by florescent lights and sterile whites, he and his team practice their craft: staving off decay by injecting cadavers with chemicals. On the four hospital beds in front of him, a door down from the city morgue, bodies are prepped for placement across the state.

At the age of 23, as a recent biology graduate from Virginia Commonwealth University, Sikon took a summer job at Woody Funeral Home. He was captivated, and began studying mortuary science at John Tyler Community College.

"The human body itself is so amazing to me," Sikon says. "It's the ultimate machine."

After working as a funeral director and head of John Tyler's funeral services program, Sikon was hired by the State Anatomical Program to oversee the preservation of these cadavers.

But Sikon doesn't refer to these specimens as bodies or cadavers. To him they are donors. "It's out of respect to them," he says. "Ultimately, they are donors. It's a gift."

It wasn't always this way.

Before programs like Virginia's, desperate medical schools in the 19th century often gave way to unscrupulous methods. They dug up the recently buried, or bought cadavers on the black market. Known as body snatching, the practice was widespread, causing public outrage and occasionally rioting when it was uncovered.

Embalming dates back to ancient Egypt, where priests mummified bodies for the afterlife. The same techniques were used later by anatomists of the Middle Ages and Renaissance, who dissected bodies for anatomical and pathological study.

In its modern context, embalming gained popularity during the Civil War. Instead of burying soldiers where they fell, the Union Army embalmed several thousand bodies to be shipped home by train. Those efforts, coupled with the 1865 preservation of President Abraham Lincoln's body for burial in Illinois, popularized funereal embalming.

But not much has changed in the past 150 years. While the chemical makeup of modern embalming fluid varies, it typically includes formaldehyde, a substance with strong antibacterial, antifungal and antiviral properties. It kills pathogens and arrests decay caused by bacteria.

Formaldehyde also has its drawbacks. In addition to drying out and hardening tissue, the compound is toxic, requiring the use of masks and protective gear for those working with it. If it comes in contact with a pregnant female, it also can cause birth defects.

Most cadavers embalmed for dissection are used within six months and can last a year before starting to decay. But using a revolutionary technique, some of Virginia's cadavers now have the ability to last years — and it's all because of ham.

In the 1960s, Austrian anatomist Dr. Walter Thiel had had enough of standard embalming techniques. While visiting his local butcher shop one day, he noticed that the wet-cured ham for sale had a much better texture than the stiff cadavers in his lab.

He wondered: By using a salt-based process, could he replicate this outcome with human bodies? He spent the next three decades finding out.

Starting with cuts of meat and working his way up to more than a thousand donated bodies, Thiel perfected a method that resulted in cadavers with the look and feel of living people. After Thiel retired, the process was further refined by his protégé Dr. Friedrich Anderhuber. The technique is gaining popularity among anatomists.

Instead of injecting a formaldehyde-based solution through the arterial system, Thiel's method uses a mixture of salt compounds with low levels of formaldehyde and formalin, and doesn't distort, dehydrate or discolor the body's tissue the way traditional embalming does. The technique mixes two solutions for injection into the body, adjusted for each cadaver.

"Though it's essentially the same chemicals, it's a different process," Sikon says. "It's more like curing."

While the Thiel method was talked about in anatomical circles, few scientists attempted it. The method had been published only in German, and reputedly was difficult to undertake.

But the possibilities that the technique opened up intrigued Dr. Noel Boaz, an anthropology professor at Virginia Commonwealth University. He was driven to find out more, and traveled to Austria to learn the method.

Tall and scholarly, Boaz says his fascination with the human body and its ancestors originally sprung out of his childhood love of dinosaurs. Holding a medical degree and a doctorate in anthropology, Boaz's study of early man has sent him throughout Africa and China to seek out fossil remains. His Indiana Jones-like existence has seen him found the Virginia Museum of Natural History and flee Libya after helicopters began firing outside his building during the Arab Spring.

click to enlarge Dr. Noel Boaz, who brought the new technique to America from Austria, plans to use Thiel cadavers in the medical school he’s opening in Martinsville. - SCOTT ELMQUIST
  • Scott Elmquist
  • Dr. Noel Boaz, who brought the new technique to America from Austria, plans to use Thiel cadavers in the medical school he’s opening in Martinsville.

Boaz first encountered of the Thiel method after attending a conference at the Graz Anatomy Institute in Austria 10 years ago. He studied the method with Anderhuber, and translated Thiel's writings from German to English.

"I was amazed," Boaz says of seeing his first soft-embalmed cadaver. "These cadavers are very flexible, they're very lifelike."

But measuring and mixing the solutions was no easy feat, as Boaz discovered during his first attempt in the United States. Working with an embalmer in Arizona, there was some confusion over the solution's chemical measurements, resulting in a partially unsuccessful embalming. Later attempts in Arizona were successful, but since Boaz brought the technique to Virginia there have been no failures, which he attributes to Sikon's skill.
Sikon also has altered the method, skipping the step of submerging bodies in an expensive liquid after embalming. While other soft embalming methods exist, Boaz says they're inferior to Thiel, because those cadavers begin to mold within weeks.

For medical schools seeking more lifelike specimens, there are other options. One way is to freeze the recently dead until time for dissection. This fresh-frozen technique is more logistically problematic, and a cadaver's tissues are altered through freezing. At the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, bodies forgo any process to preserve the body — they're dissected soon after death.

Because these other options are difficult to maintain, anatomists have much to gain by using the Thiel method.

"The Virginia State Anatomical Program deserves a lot of credit for taking the lead in [this]," Boaz says. "Virginia is undoubtedly first. There have been some experiments elsewhere — Montreal is experimenting — but Virginia is now accepted as the place if you want Thiel embalming. … The response to the program around the world has just been tremendous."

To explain the drastic difference between the bodies preserved using this method and those preserved using traditional methods, Boaz recalls showing a Thiel-embalmed cadaver to a school's anatomy chair. Boaz dissected a limb, and the anatomist jumped. "Do you think he's really been embalmed?" he asked.

"That's the reaction — they can't believe that the body's been embalmed," Boaz says. "The other reaction is wonderment. ... The tissue is beautifully embalmed. The tissues are red, the fat is yellow."

click to enlarge SCOTT ELMQUIST

These soft-embalmed cadavers allow surgeons to practice joint surgery and test methods with soft tissue. They allow gynecologists to locate the urogenital diaphragm, which is nearly impossible to find in a traditionally embalmed cadaver. They allow for breast imaging studies that would expose a woman to radiation. They also give medical students the opportunity to practice ultrasounds, intubations and intravenous lines.

"You can't do them on living patients, obviously, because they are pretty invasive procedures," says Boaz, adding that a botched intubation can permanently damage a patient's vocal chords. "You can't do them on formaldehyde-embalmed cadavers easily either, because you can't manipulate them. The tissues are too tough and inflexible."

As a tribute to the Austrian anatomist, Sikon and Boaz nicknamed their first soft-embalmed cadaver Lady Thiel, who lies in the lab today.

"She was the perfect specimen," Sikon says. "With her range of motion, she had the body of a 40-year-old. Because of her condition, she has allowed us to expand upon what we did and learn what was possible with donor preparation."

The soft-embalming technique is starting to get attention in America, and researchers in other states are trying to replicate Virginia's success. Howard University has ordered Thiel bodies from Virginia, and the University of South Carolina transported a body to Richmond to undergo the procedure. Four of the state's five medical degree-granting schools — all but VCU — have used Thiel cadavers in some capacity. Through a new undergraduate anthropology course, Boaz says VCU soon may use Thiel cadavers.

Of the roughly 50 cadavers that Eastern Virginia Medical School in Norfolk uses each year, somewhere between six and 12 are Thiel cadavers. They are well worth the fee of $2,000 each, says Dr. Craig Goodmurphy, director of the anatomy lab and programs at the school.

"The soft-embalmed cadavers open up an entire realm of postgraduate and pre-graduate training," he says. "With a soft-embalmed cadaver, the joint mobility, the tissue softness, is much more similar to that of an unconscious patient — as opposed to the stiff, grayed materials of a traditionally embalmed, fixed cadaver."

At Eastern Virginia Medical School, Thiel cadavers are used in a number of fields, including ultrasound, general surgery, obstetrics, laparoscopy, orthopedics and podiatry. As with all bodies donated to medicine, little is wasted.

"We try to maximize the utility of each cadaver," Goodmurphy says, "and minimize the number of cadavers as much as possible."

This innovation comes at a time when the medical world weighs, as it does from time to time, whether it needs cadavers to teach anatomy, the backbone of medical study. With technological advances, people wonder if the cost and logistical issues associated with acquiring bodies for dissection are worth it. Goodmurphy says there's no comparable learning aid.

"We use the cadavers to teach the medical professionals about humanity and frailty and pain and disease and suffering," Goodmurphy says. "It's been around for 400 years because we haven't been able to figure out any way better than that experience, and it doesn't matter that we've added computers."

Boaz can't imagine it any other way. "It's a mistake in my opinion to think that computers can ever take the place of an actual body, because computers are limited by whoever programmed [them]," he says. "These programs are very useful, but they're not a substitute."

Boaz will use only Thiel cadavers in the new school he's launching in Martinsville. The College of Henricopolis School of Medicine is scheduled to open in fall 2015, and Boaz will serve as its president and temporary director of the board.

By using Thiel cadavers, the school's anatomy labs will save money by foregoing much of the complicated ventilation equipment necessary for formaldehyde-embalmed cadavers.

As for Lady Thiel, she'll rest on her table for the time being. But the cremated remains of most donors are given back to families in two to five years, and Sikon plans to return Lady Thiel in the next year or so.

And the gifts from other donors, such as the late Jane Gilbert, become more valuable because of the advances that Virginia's program is making. Gilbert's family is happy to know her body is being put to good use. Her daughter Ann Graziano says she'll probably donate her own body to science when the time comes, as does Jane's husband, Don Gilbert, who's 86.

"It was just something that we wanted to do: donate our bodies instead of just putting them in a hole in the ground," Don Gilbert says. "It's providing life for somebody else." S

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