HHH column: Waste or want by Noortje Jacobs

The HHH column is a blog in which History, Health & Healing members share their thoughts: on research, current affairs, and anything to do with medical history. Each author will invite a new author to participate in the conversation. Last time, Mieneke te Hennepe, curator medical collections at Rijksmuseum Boerhaave and assistant professor at Leiden University Medical Center, passed the pen on to Noortje Jacobs, researcher at Erasmus MC – University Medical Center Rotterdam.

Noortje Jacobs

In August 1989, children playing on the streets of Venlo found a mysterious keg that had fallen of a truck. They brought it to the police, who first thought that they were dealing with some sort of chemical waste. Upon further inspection, however, it became clear that the keg was filled to the brim with meninges, the membranes that line the skull and vertebral canal. The Criminal Investigation Force was called in, which traced the keg back to two hospital departments in Breda. As it turned out, the meninges had been removed from the bodies of deceased patients during post-mortem examinations, and had been on their way to Germany, where they were to be used in reconstructive surgery. As far as the Criminal Investigation Force could tell, neither the patients nor their family had ever given their permission for this.

“Not more than a bottle of wine for human meninges.”
Newspaper clipping from Het Vrije Volk, 1989 (source: Delpher.nl).

At first, journalists eagerly reported on the story as a sensational incident, but it quickly became clear that this was not that uncommon in the Netherlands. In September, newspapers could report that Braun Medical, a Dutch medical technology company, processed 500 to 600 meninges for medical use every year, from hospitals all over the Netherlands. “During a dissection, the brain membrane is damaged anyway. It is not possible to put it back.” As to them the meninges were medical waste, pathologists were often quite willing to provide the membranesfor free. To thank them for their services, Braun Medical sent them a bottle of wine with Christmas. The same went for placenta’s: instead of being thrown away after a hospital birth, they were often collected for cosmetic companies. The few pennies that were paid, were used to “fund the coffee pot of the nursery room.”

As a historian of medicine and medical ethics, I often come across this type of stories. From our twenty-first century perspective, it is hard to imagine that bodily products, plucked from the bodies of non-consenting patients, were so easily “trafficked” only a few decades ago. But they often were, because no regulation or methods of inspection existed for them, and simply because many of those involved did not consider this practice to be illegal or unethical.

Brain: base and meninges. Colour lithograph by Brocades Great Britain Ltd. (Wellcome Collection)

Currently, I am collecting these stories for a new research project I am envisioning, called “Waste or Want. A moral history of human bodily materials in the twentieth century.” Towards the end of the twentieth century, the use of human bodily materials in medicine became the subject of heated ethical and political debate. As the Dutch Health Council wrote in 1994: “The body is so closely connected to the person, that we do not just have a body, that we are our body.” The “intrinsic value” of our bodies mandated that donors have the absolute right to control what happens to their bodily materials, even after they have long been severed from the body. And to trade them, or use them in any commercial sense, is simply apprehensible in all cases.

I wonder, however, how common this moral measure was before the late twentieth century. Historically, human bodily materials have fulfilled all sorts of functions in medicine and science. And in the twentieth century, with the advent of blood transfusion, organ transplantations, and body banking, they have only grown more important. I am interested, therefore, in the changing moral status of human bodily materials in the twentieth century – and how this was impacted by new technoscientific developments and the changing social standing of medicine and science in precisely this period. As part of this project, I hope to develop the concept of “moral taxonomies” in the history of medicine and science, and use this to address wider questions about the public governance of human bodily materials in medicine – a longstanding hot-button issue in political circles, both in the Netherlands and internationally, that will only intensify with the ongoing “datafication of medicine.” I look forward to discussing these ideas with the members of our History, Health and Healing network!

Noortje Jacobs is a historian of medicine and science whose work centers around the history of medicine, morality, and modern society. She teaches and researches at the Erasmus MC in Rotterdam, where she will be appointed assistant professor in July 2021. In 2022 her first book will be published with The University Of Chicago Press, entitled Ethics by Committee. A History of Reasoning Together about Medicine, Science, and Society.

Noortje passes the pen on to Eva Andersen, PhD candidate at the University of Luxemburg.