An Autopsy in Antebellum America:
Exhuming a Forgotten 19^th Century Halachic Debate on Cadaveric Dissection
Part I

By Shimon Garrel

Shimon Garrel is a current M.D. candidate at SUNY Downstate Health Science University. He is a graduate of Touro College and studied in various yeshivas in New York and Israel. 

Halachic Considerations

This article is part I of II that will seek to address two points. The first and primary goal is to bring to light a somewhat forgotten and unacknowledged controversy regarding the permissibility of cadaveric dissection of Jewish bodies that took place in the heart of New York in 1856. A secondary aspect of this study which will appear in Part II is to examine the primary halachic responses to this debate especially in light of the contemporaneous halachic literature on the subject of performing a Post-Mortem.

To fully appreciate the background of this controversy we will begin with a short review of some of the primary halachic positions on autopsies leading up to 1856. Any discussion on halachic autopsies begins with Rabbi Yechezkel Landau, author of the Noda Be-Yehuda. The Noda Be’Yehuda’s landmark teshuva, Tinyana Y.D. 210, was the first teshuva of a world renown posek to directly address the permissibility of autopsies. Since its publication, the body of teshuvos and literature addressing the subject has grown almost exponentially. The question posed to the Noda Be’yehuda, was whether the body of a patient who passed away from a suspected gallstone[1] may be dissected to understand the pathology of the disease.

Regarding your treatise, which you sent to me, and which offers a presentation of the issue that you were asked about by the holy community of London: It happened that someone was ill with a gallstone. The physicians performed surgery, as usual for such an affliction, but it did not cure him, and he died. The sages of that city were asked if it is permissible to dissect the cadaver in that place to see evidence of the root of the affliction, and to learn from it for the future practice of medicine, so that if such a case occurs again, they know how to perform the surgery necessary for a cure without incising him too much, thus minimizing the risks of the surgery. Is this prohibited because it constitutes desecration and disgrace of this corpse, or is it permitted because it leads to the future saving of lives, so that they may take the utmost caution in their craft.

…In our case, there is no ill person who needs this. Rather, they want to study this discipline in case they encounter a sick person who requires it. We certainly do not supersede any Torah prohibition or even a rabbinic prohibition due to such a slight concern. For if you call this concern “an uncertainty pertaining to a life,” then any task related to healing—grinding and cooking medicine or preparing a scalpel for bloodletting—will be permitted on Shabbat, perhaps they will encounter a sick person who requires it that night or the next day. It is also difficult to distinguish between concern for the need arising in the near future and concern for the need arising in the distant future. Heaven forfend that such a thing should be permitted. Even gentile physicians do not gain surgical experience with just any corpse, but only with those put to death by the law[2] or with those who themselves consented to it while living. If we, God forbid, are lax in this matter, they will operate on every corpse to learn anatomy and physiology, so that they may know how to cure the living. Therefore, this is all unnecessarily lengthy, and there is no lenient approach whatsoever.[3]

For the next century, many if not all halachic deliberations on the matter of autopsies centered around the conditions set by the Noda Be-Yehuda’s ruling. The Noda Be’Yehuda’s perspective on this is clear. An autopsy may only be permitted in a matter of life and death that is “lefanenu”, where performing the autopsy can immediately benefit a high-risk patient. Post-Mortem examinations with the intent of simply studying “ in case they encounter a sick person” does not rise to the level of pikuach nefesh which would permit violating various prohibitions of desecrating a body. The Chasam Sofer, Y.D. 337 commenting on the Noda Be’Yehuda’s psak, agreed to the essence of the teshuva and introduces another element not cited by Rabbi Landau, which is that of a dead body being forbidden to derive benefit from. Without a direct beneficiary of the knowledge gained by the medical autopsy, writes the Chasam Sofer, it is forbidden to conduct a dissection both on grounds of Nivul Ha-Meis, desecration of the dead, and Issur Hanah, the inability to derive any benefit from a dead body.[4]

Rabbi Yaakov Ettlinger, the famed German Talmudist and Posek, took an even more hardline approach than the Noda Be-Yehuda and the Chasam Sofer. In Teshuva 170 published in his Binyan Tzion, he quotes the Noda Be-Yehuda and argues that even if there would be a deathly ill patient who may benefit from the knowledge gleaned from the dissection of a Jewish corpse it is absolutely forbidden to save one’s self by desecrating another body.[5]

We have now seen a brief collection of the positions of some of the most widely respected poskim of the late 18^th and early 19^th century Europe. The consensus of these poskim with the notable exception of Rabbi Ettlinger, would be to allow an autopsy only in a case where there is a patient who will directly benefit from the anatomical and pathological knowledge derived from that dissection.

Jews’ Hospital of New York

By the year 1848, the New York City Jewish population had swelled from an estimated count of 950 in 1826 to 13,000.[6] The increase in Jewish population in New York reflected the influx of Jewish immigrants that had begun making their way to the United States. This wave of immigration consisted mainly of Jews hailing from Central and Western Europe. Like many immigration stories, a mix of push and pull factors like political instability in the rapidly changing German confederacy, the economic needs of Jewish families due to the rapidly increasing industrialization, and perhaps a spirit of adventure, caused many German Jews to journey to America.[7]

Sampson Simson

With large amounts of immigrants settling in the slums of New York, it came to the attention of some of the wealthier Jews in New York, that a gaping medical void needed to be filled. While immigrant Jews requiring medical care could get it at city hospitals like Bellevue Hospital, many faced discrimination and it certain cases, may have even been refused treatment. With the unabated Jewish population growth, the urgency to open a Jewish hospital became more and more pronounced. On January 15^th, 1852, a small group of nine friends, most of them prominent members of “high society” as well descendants of some of the earliest Jewish families in America, gathered in the Trustees’ room of Shearith Israel, the historic Spanish Portuguese Synagogue, and incorporated “The Jews’ Hospital of New York”. The nine represented a cross section of some of the most important and connected Jews in New York who had worked together on other charitable causes. The leader and most senior member of the group was 72-year-old Sampson Simson. Simson, a Columbia College graduate who studied law under Aaron Burr, had been involved in many other charitable enterprises after his early retirement spent the rest of his life involved in public affairs and charity.[9] The other eight were each men of repute, Rev Samuel M. Isaacs, famous for being on of the officiating clergy men of President Lincoln’s funeral. The others, John I. Hart, Benjamin Nathan, John M. Davies, Henry Hendricks, Theodore J. Seixas, Isaac Phillips and John D. Phillips were wealthy businessmen who had participated in varies Jewish charities and were eager to contribute to this much needed project. With Sampson elected as president of the first board of Directors of the Hospital, the mission statement was defined as to provide “medical and surgical aid to persons of Jewish persuasion and for all other purposes appertaining to Hospitals and Dispensaries”.

Within a few months, funds were raised, and a location was purchased by Sampson on 28^th street between 7^th and 8^th Avenues, which at the time was away from the hustle of lower Manhattan and in the “rural” part of Manhattan Island. By Fall of 1853, the cornerstone had been laid and construction had commenced. On May 17^th 1855, the Jews’ hospital was opened in a religious ceremony that was led by Reverend Jacques Judah Lyons, the Suriname born rabbi of the Shearith Israel, as well as Ansel Leo, a nephew by marriage to Simpson and leader of congregation B’nai Jeshurun, the second oldest orthodox shul in Manhattan after Shearith Israel.[10] And finally, on June 5^th 1855, the first patient was accepted to Jews’ Hospital of New York. With great fanfare the first Jewish hospital in New York, and the second in the country,[11] was opened to the Jewish public.

Figure 2 From the Picture Collection of the New York Public Library. Jews’ Hospital in New York. Printed on border: “Incorporated February, 1866. 138 and 140 West Twenty-eighth Street, between Seventh and Eighth Avenues.” In 1866 the hospital ceased acting as a sectarian institution.

A “Dissection” for the sake of Heaven

The house staff of Jews’ Hospital consisted of what today would be called an all-star team. As detailed in “The story of the first fifty years of the Mount Sinai Hospital, 1852-1902”; pg’s 22 -23.

The first Staff, announced by the Board of Directors on May 21, 1855, included some of the most prominent physicians and surgeons practicing in New York. These men had faith in the efforts of Sampson Simson and his associates. There were four Consulting Physicians. One was Chandler R. Gilman, a witty conversationalist who in his younger days had supplemented the meagre earnings of his early medical career by writing.49 He was Professor of Obstetrics and Diseases of Women and Children at the College of Physicians and Surgeons, having been appointed in 1841; and in 1894 he was one of the few contemporary physicians to insist that there was such a thing as criminal insanity and that such criminals should have special treatment. Another was William Detmold, a German, who had introduced orthopedic surgery in New York, had founded an orthopedic clinic at the College of Physicians and Surgeons in 1841, and was to be the first President of the New York County Medical Association in 1884. William H. Maxwell was the third Consulting Physician, while the fourth was Benjamin W. McCready, a highly respected physician and an early contributor to the funds of the Hospital. The two Attending Surgeons were Israel Moses, an Army surgeon who also had contributed toward the building of the Hospital, and Alexander B. Mott, the son of Valentine Mott … He was an excellent surgeon in his own right, and the founder of Bellevue Medical College. There were three Consulting Surgeons: the great Valentine Mott; Thomas M. Markoe, one of the founders of the New York Academy of Medicine eight years earlier; and Willard Parker, a leader in surgery, a brilliant lecturer who had taught at Berkshire County Medical College and the College of Physicians and Surgeons, and a co-founder with Daniel Drake of the Cincinnati Medical College in 1835. The Resident and Attending Physician was Mark Blumenthal.[12] A member of the Portuguese Congregation, Mark Blumenthal was its official doctor in its help of the sick.

With an impressive roster of physicians and large financial backing from the Jews of New York, the Jews’ Hospital at the time of its opening was placed in the unique position of being unencumbered by prehistoric medical practices and policies while being run by some of the most forward-thinking and innovative physicians in New York. With a top-of-the-line staff, the introduction of some newer methodologies was not long in coming. On December 5^th of 1855, exactly 6 months after the hospital’s opening, a meeting was called at the behest of Dr. Blumenthal, the house physician of the hospital and important to note, a practicing Jew. Dr. Blumenthal asked for permission to perform a post-mortem dissection on a deceased patient, as a “justification” to defend himself against the consulting physician who disagreed with Dr. Blumenthal’s assessment on the cause of death.[13] The use of post-mortem examination to determine cause of death was a fairly new phenomenon for the 19^th century.[14] Advances in anatomic as well as histologic pathology had begun to take root in medical practice in Europe. French physician and “Father of Histology” Xavier Bichat (1777 -1802) famously wrote that “we should dissect in anatomy, experiment in physiology, and make necropsy in medicine; this is the threefold path without which there can be no anatomist, no physiologist, and no physician.”T[15] The spirit permeating western European hospitals especially was that a great physician wedded clinical medicine with knowledge gleaned from anatomic and pathologic examinations. Blumenthal, besides serving as the deputy coroner of New York city in 1853, spent part of 1854 visiting hospitals in London, Paris, and Munich.¹² There is no doubt he bore witness to some of the attitudes and practices present in these hospitals and took some of what he learnt back to New York.

At the convened meeting, Dr. Blumenthal’s request was discussed, and the Board of Directors approved the post-mortem examination. It wasn’t long before word of the autopsy began to circulate and the Board of the Jews’ Hospital met once again on January 14^th to appoint a committee to investigate whether a carte blanche policy to post mortems at the hospital should be allowed. The committee decided to submit the question to Rabbi Dr. Nathan Adler, Chief Rabbi of England, to decide whether autopsies should be permitted under “any circumstances.”[16]

Endnotes

[1] While frequently assumed to be referring to gallstones, Rabbi Dr. Edward Reichman has convincingly argued that it is in fact a case of bladder stones. See Reichman, E. (2021). The anatomy of Jewish law: A fresh dissection of the relationship between medicine, Medical History & Rabbinic literature. OU Press. pg’s. 344 -350. Although mention should be made of the work of the French anatomist and Surgeon Jean-Louis Petit who reported and advocated for performing cholecystostomy in the early part of the 18^th century. See Clark BB., Livingston WT. Evaluation of Cholecystostomy. AMA Arch Surg. 1956;72(2):218–223. For an overview of Jean-Louis Petit’s life, see Markatos, K., et al; Jean-Louis Petit (1674–1750): a pioneer anatomist and surgeon and his contribution to orthopaedic surgery and trauma surgery. International Orthopaedics (SICOT) 42, 2003–2007 (2018). I have left “אבן בכיס” as gallstones to maintain the original Sefaria translation.
[2] Interestingly, criminal bodies were the most common source of cadavers in England beginning with the English Murder Act of 1752. England of the early 18^th century was experiencing concurrently a growth in the number of medical schools in the country as well as a perceived rise in crime. Hoping to “kill” as it were, two birds with one stone, Parliament passed the Murder Act in which bodies of executed criminals were to be used as medical cadavers. The hope was that this would both serve as a deterrent to criminals as it preyed on commonly held Christian religious sentiment about the need for proper burial. Similar laws were soon passed throughout parts of Europe and no doubt the Noda Be’Yehuda was aware of these codes. Understanding this also helps provide important perspective into the psak of the Noda Be’Yehuda. For a comprehensive legal and historical background on the passing of the Murder Act See Tarlow S, Battell Lowman E. Harnessing the Power of the Criminal Corpse (2018). Cham (CH): Palgrave Macmillan; 2018. Chapter 4, Murder and the Law, 1752–1832.
[3] Translation taken from Sefaria.
[4] Regarding the Chasam Sofer’s psak that studying medicine from dissections is considered Issur Hanaha see שו“ת נצר במטעי סי‘ לא and She’elot U’Teshuvot Be’er Moshe(Danishevsky) Y.D. 52 who discuss and challenge this assumption.
[5] The novel ruling of Rabbi Ettlinger, that one may not be saved by way of desecrating a dead body has been challenged by many other Poskim. See the direct response of the Maharam Schick to Rabbi Ettlinger in She’elot U’Teshuvot Maharam Schick 336. See further Rabbi Ettlinger’s reply in She’elot U’Teshuvot Binyan Tzion 171.
[6] Oppenheim, S. D. (1918). The Jewish Population of The United States. The American Jewish Year Book, 20, 31–74. http://www.jstor.org/stable/23600990
[7] On the German Jewish immigration to America, see generally Barkai, Avraham. Branching Out: German-Jewish Immigration to the United States, 1820-1914. New York: Holmes & Meier, 1994 and Diner, Hasia R. A Time for Gathering: The Second Migration, 1820–1880 (1992).
[8] Isaacs, M. S. (1902). SAMPSON SIMSON. Publications of the American Jewish Historical Society, 10, 109–117. http://www.jstor.org/stable/43059667
[9] Mount Sinai Hospital (New York, N., Benedict, J. (1944). The story of the first fifty years of the Mount Sinai Hospital, 1852-1902. New York. See pages 5 and 6 for a detailed account of each of the founding directors.
[10] Ibid. pg 9.
[11] The first “Jewish” hospital in the United States was the aptly named Jewish Hospital of Cincinnati. It was founded around the year 1850. See pg. 4 of the December 9^th 1853, edition of the Asmonean, a 19^th century Jewish weekly, for an amusing letter to the editor by the board of the Cincinnati Jewish Hospital “clearing up” that they were the first Jewish hospital incorporated in the United States.
[12] See the entry on Blumenthal from the Jewish Encyclopedia available at https://jewishencyclopedia.com/articles/3434-blumenthal-mark for more information.
[13] Jews’ Hospital Minutes of the Board of Directors December 5th, 1855. Arthur H. Aufses, Jr., MD Archives, Mount Sinai Hospital.
[14] With the publication of the first serious work on pathology, De Sedibus et causis morborum per anatomen indagatis “Of the seats and causes of diseases investigated through anatomy” in 1761 by Giovanni Battista Morgagni, the connection between anatomy and disease had just begun to solidify.
[15] King LS, Meehan MC. A history of the autopsy. A review. American Journal of Pathology. 1973 Nov;73(2):514-44.
[16] The Occident, Vol XIV, Nu. III, pg 128.