Historical Craniotomy and Autopsy Practices at the Milwaukee County Institutional

Grounds Poor Farm Cemetery

Adrienne C. FrieDr. Patricia B. Richards

University of Wisconsin-Milwaukee

80th Annual Meeting of the Society for American Archaeology, San Francisco, 15-19 April 2015.

Symposium: People that no one had use for, had nothing to give to, no place to offer: The Milwaukee County Institution Grounds Poor Farm Cemetery

Goals1. Determine whether autopsy practices differed between the

Milwaukee County Coroner’s Office and the Milwaukee County Hospital to determine via which institution individuals came to the MCIG cemetery

2. Gain an increased understanding of historical autopsy practices, particularly craniotomy

3. Better understand the differing conceptions of the dead body that were circulating in the medical community at the time

How individuals with postmortem investigation came to be buried at MCIG

1. Residents of Milwaukee County InstitutionsMilwaukee County Hospital inquiry (autopsy)Sent to a local medical college for dissection

2. Unclaimed individuals from the Milwaukee County Coroner’s Office

Medicolegal autopsiesSent to a local medical college for dissection

3. Individuals anatomized by the local medical schoolsStandard burial – Ch. 406, 1871; Sec. 2 Ch. 406; Laws of

1903 Curated remainsNon-standard burial – medical waste

HypothesesCraniotomies and autopsies performed by the Milwaukee County

Coroner’s Office were more standardized due to the low number of active coroners and the standardization of postmortem intervention. Expect: Standard autopsy practices More particular investigations/interventions related to investigating

pathologies

Craniotomies carried out at the Milwaukee County Hospital by pathologists and local students may be more idiosyncratic due to their exploratory and pedagogical goals. Expect: Less skilled craniotomies and autopsies More idiosyncratic and apparently unnecessary repetition of

intervention Investigation/intervention of more elements than the standard cranium and torso

Individuals coming to MCIG from the Milwaukee County Hospital are more likely to have been buried with additional material, or missing elements

MCIG Cemetery 2 – 2013 excavations

Sample: Single Adult Burials with Craniotomies

Craniotomy recording: Lot 10,657

Key:Saw mark – transects cranium PathologySaw mark – does not fully transect cranium Perimortem cut markSaw mark – kerf Non-taphonomic breakage

Abscess

Perimortem cut

Abscess

*Only two perspectives are shown for ease of viewing

Craniotomy recording: Lot 10,657

Key:Saw mark – transects bone entirely Possible leverage pointNon-taphonomic breakage

Right Femur

Anterior Posterior

Possible leverage points

Craniotomy methods

From Hektoen 1894 The Technique of Post-Mortem Examination

Anterior incision

Posterior incision

Planar Craniotomies

“A circular incision is then made with the saw and the roof of the cranium removed. The incision in front should pass through a point three and a half inches above the root of the nose, behind through the occipital protuberance” Delafield 1872 A Hand-Book of Post-Mortem Examinations and of Morbid Anatomy: 9-10

Lot 10,537

Biplanar Craniotomies

“…the incision should follow a line which runs on both sides from the centre of the forehead to the base of the mastoid process and from these points backward and upward to a point a little above the external occipital protuberance, thus separating a wedge-shaped section of the calvaria…” Hektoen 1894 The Technique of Post-Mortem Examination: 53

Lot 10,623

Irregular Craniotomies

Abscess

Excised portion of calotte absent

Key:Saw mark – transects craniumSaw mark – does not fully transect craniumSaw mark – kerf Pathology

Lot 10,982

Most of the cranium was absent due to disturbance from the construction of the water pipe

Unknown Craniotomies

Key:Saw mark – transects cranium

Lot 10,966

Sex and Age of Single Adults with Craniotomies

Male Female Indeterminate Sex0

5

10

15

20

25

30

35

40

2 1

17

4 3

8

2

10

12

Indeterminate Age

Old Adult

Middle Adult

Young Adult

Non-Metric Sex

Nu

mb

er

of

Ind

ivid

uals

Types of Craniotomies

Planar Biplanar Irregular Unknown0

5

10

15

20

25

30

35

40

10

35

41

Type of Craniotomy

Nu

mb

er

of

Ind

ivid

uals

Planar versus Biplanar Craniotomies

Source: Box 1919 Post-Mortem Manual: A Handbook of Morbid Anatomy and Post-Mortem Technique: 239

Source: Hektoen 1894 The Technique of Post-Mortem Examination: 165

Planar Bilanar

Possible leverage points

Lot 10,302 Lot 10,626

Abscess

Excised portion of calotte absent

Lot 10,982

Key:

Saw mark – transects cranium

Saw mark – does not fully transect cranium

Saw mark – kerf

Non-taphonomic breakage

Possible leverage point

Pathology

Lot 11,003

Postcranial Evidence of Autopsies – 1

Lot 10,678Lot 10,689

Lot 10,692

Key:Saw mark – transects boneSaw mark – does not fully transect boneNon-taphonomic breakage

Postcranial Evidence of Autopsies – 2

Lot 10,699 Lot 10,765 Lot 10,792

Key:Saw mark – transects boneSaw mark – does not fully transect boneNon-taphonomic breakage

Distribution of Post-Cranial Cut Marks Unassociated with Autopsy

0-12-34-56+

ELEMENTS (n=24)

% N

Frontal4.2 1

Temporal, Left 4.21

Temporal, Right 8.32

Radius, Left 4.21

Ulna, Left 4.21

Femur, Left 8.32

Femur, Right 25.06

Femur, Left 8.32

Patella, Left 4.21

Tibia, Left 8.32

Tibia, Right 8.32

Fibula, Left 16.64

Fibula, Right 8.32

Foot, Left 4.21

Foot, Right 4.21

Missing Elements and Parts of Elements

Lot 10,623

Lot 10,643

Lot 10,968

Lot 10,798

Key:Saw mark – transects bone

Saw mark – does not fully transect bone

Non-taphonomic breakage

19th and 20th Century Autopsy

Milwaukee County. Institutions and Departments- Photographs Box 2 Folder 17A: Medical ActivityCollections of the Milwaukee County Historical Society

19th and 20th Century Dissection

Source: Warner and Edmonson 2009 Dissection: Photographs of a Rite of Passage in American Medicine 1880-1930. Front piece, Unattributed.

Medical Waste in Burials

Lot 10,982

Thank you.Patricia Richards would like to acknowledge the aid of several individuals who facilitated this research and provided valuable insight:Carrie JonesEmily Mueller-EpsteinTom ZychThe MCIG Analysis TeamBrooke DrewNick RichardsEmma Richards

Adrienne Frie would like to acknowledge the aid of several individuals who facilitated this research and provided valuable insight:Dr. Patricia RichardsCarrie JonesEmily Mueller-EpsteinTom ZychThe MCIG Analysis TeamKevin Garstki