The American Way of Death Revisited (11 page)

Dr. Carr has carried on his own campaign for a decent, commonsense approach to cadavers. The morgue in his hospital was formerly a dark retreat in the basement, “supposedly for aesthetic and health reasons; people think bodies smell and are unhealthy to have around.” Objecting strongly to this, Dr. Carr had the autopsy rooms moved up to the third floor along with the offices. “The bodies aren’t smelly, they’re not dirty—bloody, of course, but that’s a normal part of medical life,” he said crisply. “We have so little apprehension of disease being spread by dead bodies that we have them up here right among us. It is medically more efficient, and a great convenience in
student teaching. Ten to twenty students attend each autopsy. No danger here!”

A body will keep, under normal conditions, for twenty-four hours unless it has been opened. Floaters, explained Dr. Carr in his commonsense way, are another matter; a person who has been in the Bay for a week or more (“shrimps at the orifices, and so forth”) will decompose more rapidly. They used to burn gunpowder in the morgue when floaters were brought in, to mask the smell, but now they put them in the Deepfreeze, and after about four hours the odor stops (because the outside of the body is frozen) and the autopsy can be performed. “A good undertaker would do his cosmetology and then freeze,” said Dr. Carr thoughtfully. “Freezing is modern and sensible.”

Anxious that we not drift back to the subject of the floaters, I asked about the efficacy of embalming as a means of preservation. Even if it is very well done, he said, few cadavers embalmed for the funeral (as distinct from those embalmed for research purposes) are actually preserved.

“An exhumed embalmed body is a repugnant, moldy, foul-looking object,” said Dr. Carr emphatically. “It’s not the image of one who has been loved. You might use the quotation ‘John Brown’s body lies a-moldering in the grave’; that really sums it up. The body itself may be intact, as far as contours and so on; but the silk lining of the casket is all stained with body fluids, the wood is rotting, and the body is covered with mold.” The caskets, he said, even the solid mahogany ones that cost thousands of dollars, just disintegrate. He spoke of a case where a man was exhumed two and a half months after burial: “The casket fell apart and the body was covered with mold, long whiskers of penicillin—he looked ghastly. I’d rather be nice and rotten than covered with those whiskers of mold, although the penicillin is a pretty good preservative. Better, in fact, than embalming fluid.”

Will an embalmed corpse fare better in a sealed metal casket? Far from it. “If you seal up a casket so it is more or less airtight, you seal in the anaerobic bacteria—the kind that thrive in an airless atmosphere, you see. These are the putrefactive bacteria, and the results of their growth are pretty horrible.” He proceeded to describe them rather vividly, and added, “You’re a lot better off to be buried in an
aerobic atmosphere; otherwise the putrefactive bacteria take over. In fact, you’re really better off with a shroud, and no casket at all.”

Like many another pathologist, Dr. Carr has had his run-ins with funeral directors who urge their clients to refuse to consent to postmortem medical examinations. The funeral men hate autopsies; for one thing, it does make embalming more difficult, and also they find it harder to sell the family an expensive casket if the decedent has been autopsied. There are, said Dr. Carr, three or four good concerns in San Francisco that understand and approve the reasons for postmortem examination; these will help get the needed autopsy permission from the family, and employ skilled technicians. “It’s generally the badly trained or avaricious undertaker who is resistant to the autopsy procedure. They all tip the hospital morgue men who help them, but the resistant ones are obstructive, unskilled, and can be nasty to the point of viciousness. They lie to the family, citing all sorts of horrible things that can happen to the deceased, and while they’re usually very soft-spoken with the family, they are inordinately profane with hospital superintendents and pathologists. In one case where an ear had been accidentally severed in the course of an autopsy, the mortician threatened to
show
it to the family.”

In a 1959 symposium in
Mortuary Management
on the attitudes of funeral directors towards autopsies, some of this hostility to doctors erupts into print. One undertaker writes, “The trouble with doctors is that they think they are little tin Gods, and anything they want, we should bow to, without question. My feeling is that the business of the funeral director is to serve the family in the best way he knows how, and if the funeral director knows that an autopsy is going to work a hardship, and result in a body that would be difficult to show, or that couldn’t be shown at all, then I think the funeral director has not only the right, but the duty, to advise the family against permitting an autopsy.” Another, defending the pathologists (“After all, the medical profession as a whole is reasonably intelligent”), describes himself as a “renegade embalmer where the matter of autopsies is concerned.” He points to medical discoveries which have resulted from postmortem examination; but he evidently feels he is in a minority, for he says, “Most funeral directors are still ‘horse and buggy undertakers’ in their thinking and it shows up glaringly in their moronic attitude towards autopsies.”

To get the reaction of the funeral men to the views expressed by Dr. Carr now became my objective. I was not so much interested, at this point, in talking to the run-of-the-mill undertaker, as in talking to the leaders of the industry, those whose speeches and articles I had read in the trade press—in short, those who might be termed the theoreticians of American funeral service. They, I felt, would have at their fingertips any facts that might bolster the case for embalming, and would be in a position to speak authoritatively for the industry as a whole.

In this, I was somewhat disappointed. The discussions seemed inconclusive, and the funeral spokesmen themselves often appeared to be unclear about the points they were making.

My first interview was with Dr. Charles H. Nichols, a Ph.D. in education from Northwestern University, who became the educational director of the National Foundation of Funeral Service. Among his published works are “The Psychology of Selling Vaults” and “Selling Vaults,” which appeared in the
Vault Merchandiser
in 1954 and 1956 respectively. His duties at the foundation include lecturing to undertakers at the School of Management on such subjects as “Counseling in Bereavement.”

Dr. Nichols readily volunteered the information that embalming has made an enormous contribution to public health and sanitation, that if done properly it can disinfect the dead body so thoroughly that it is no longer a source of contamination. “But
is
a dead body a source of infection?” I asked. Dr. Nichols replied that he didn’t know. “What about foreign countries where they do not as a rule embalm; is much illness caused by failure to do so?” Dr. Nichols said he didn’t know.

Mr. Wilber Krieger was an important figure in funeral circles, for he was not only managing director of an influential trade association, National Selected Morticians, but also director of the National Foundation of Funeral Service. To my question “Why is embalming universally practiced in the United States?” he answered that there is a public health factor: germs do not die with the host, and embalming disinfects. I told him of my conversation with Dr. Jesse Carr, and of my own surprise at learning that even in typhoid cases, embalming is ineffective as a safety measure against contagion; upon which he burst out with, “That’s a typical pathologist’s answer! That’s the sort
of thing you hear from so many of them.” Pressed for specific cases of illness caused by failure to embalm, Mr. Krieger recalled the death from smallpox of a prominent citizen in a small Southern community where embalming was not practiced. Hundreds went to the funeral to pay their respects, and as a result a large number of them came down with smallpox. Unfortunately, Mr. Krieger had forgotten the name of the prominent citizen, the town, and the date of this occurrence. I asked him if he would check on these details and furnish me with the facts; however, he has not yet done so.

I had no better luck in a subsequent conversation with Mr. Howard C. Raether, executive secretary of the National Funeral Directors Association (to which the great majority of funeral directors belong), and Mr. Bruce Hotchkiss, vice president of that organization and himself a practicing undertaker. In this case, our conversation was recorded on tape. I asked what health hazard is presented by a dead body which has not been opened up, for purposes of either autopsy or embalming.

Then I asked, “Can you give any place, then, where the public health has been endangered—give us the place and the time?”

They could not. We talked around the point for several minutes, but these two leaders of an industry built on the embalming process were unable to produce a single fact to support their major justification for the procedure. I told them what Dr. Carr had said about embalming and public health. “Do you have any comment on that?” I asked. Mr. Raether answered, “No; but we can take a look-see and try to give you some instances.”

When the results of the look-see arrived, eight weeks later, in the form of an impressive-looking document titled “Public Health and Embalming,” I was surprised to find that it was the work not of a medical expert but of Mr. Raether (who is a lawyer) himself. The approach was curiously oblique:

What
is
contended? We are not told. An authority is cited that seems vaguely irrelevant. It is recommended that I read
Public Health in Boston
,
1630
–
1822
; I am assured that the dean of the American Academy of Funeral Service “has documented proof,” but no further evidence is offered. This reminds me of the old trial lawyers’ maxim: “When the law is against you, argue the facts; when the facts are against you, argue the law; when the law and the facts are against you, give the opposing counsel hell.”

A health officer, in the single reference to a source outside the funeral industry, is quoted as advancing a startlingly novel argument for embalming. It is efficacious, he declares, not only from a public health standpoint but “from the standpoint of man’s ages-long concern with life after death,” a proposition that is hard to argue against.

The only specific information offered Mr. Raether by spokesmen for the National Funeral Directors Association (NFDA)—to support the contention that embalming has value as a sanitary measure—concerned “the procedures followed at the famous Mayo Clinic, where they have a standing rule that no autopsy shall be conducted on a body unless that body is embalmed—unless they need tissue immediately. This is a standing rule for the protection of doctors and pathologists who might be working with the body.”

Unversed though I am in the procedures of doctors and pathologists, this sounded very strange to me. I wrote to the clinic in question to ask if it was true. Their answer: “Unfortunately, it appears that Mr. Raether has been misinformed concerning the attitude of the Mayo Clinic toward the embalming of bodies. We have no rule which requires that bodies be embalmed before an autopsy is performed. It is true that frequently bodies are embalmed prior to the performance of an autopsy, but this is done more for the convenience of the funeral directors than because of any insistence on our part.”

Kenneth V. Iserson is a professor of surgery and director of the bioethics program at the Medical School of the University of Arizona. After twenty years in practice treating dying patients and counseling professionals and families about sudden death, he realized, when preparing an ethics paper on teaching with donated remains, that there were huge gaps in his knowledge about what happened to dead bodies. He was prompted to investigate, and the results of his exploration were published as
Death to Dust: What Happens to Dead Bodies?
(Galen Press, 1994).

Dr. Iserson’s massive, comprehensive volume is easily the best work on the subject that has appeared in recent years, and it is written with a fluency that makes it accessible to the lay reader as well as the professional.

He was initially stymied by what he felt was a cover-up by a funeral industry that systematically conceals its methods. He says now, in words which have a familiar ring to me, “At the time I was writing, I had to work with several Deep Throats.”

Like Dr. Carr, Dr. Iserson has no patience with the argument that embalming is necessary because of the health hazard posed by unembalmed bodies. He quotes with approval Dr. Carr’s discussion with me, adding that the Arizona Auditor General’s Office, in a review of funeral industry practices, concluded that “the public health risks associated with the disposal of human remains are minimal”; also, a Canadian health minister, “Embalming serves no useful purpose in preventing the transmission of communicable disease.”

The clincher for Dr. Iserson is the acknowledged failure of embalmers universally to apply measures for their own protection. If embalmers are not concerned about protecting themselves, he reasons, what message does that send to the public about the claim that embalming is necessary as a public health measure? The true purpose of embalming, he suggests, is to facilitate an open-casket funeral—with the emphasis on
casket
. Embalming, he suggests, is a procedure that boils down to sales and profits.

The only “authoritative” voice the industry has been able to produce in rebuttal belongs to one John Kroshus, identified only as having a connection with the University of Minnesota’s program of mortuary science. Mr. Kroshus is quoted in
Funeral Monitor
(April 1996) as denouncing “the book” (again a phrase familiar to me) by
posing the question: “If embalming is taken out of the funeral, then viewing the body will also be lost. If viewing is lost, then the body itself will not be central to the funeral. If the body is taken out of the funeral, then what does the funeral director have to sell?”