Every doctor alive today learned anatomy by cutting open a dead body. This is not optional in medical training. Textbooks and digital models can teach the names of structures, but nothing substitutes for the physical experience of separating fascia, tracing a nerve through tissue, or discovering that no two human bodies are arranged in quite the same way. Somewhere between 20,000 and 25,000 bodies are dissected in American medical schools each year. Almost nobody outside of medicine asks where they come from, and the honest answer has a much darker history than most people assume.
For most of the eighteenth and nineteenth centuries, medical schools in Britain and the United States relied on grave robbing. The legal supply of bodies was limited to executed criminals, and that supply never came close to meeting demand as medical education expanded. Anatomy schools paid "resurrectionists" to dig up freshly buried corpses, usually within a night or two of burial, and deliver them under cover of darkness. Poor cemeteries and burial grounds for enslaved and Black Americans were disproportionately targeted, since these graves were less likely to be watched or defended. In Scotland, the case of Burke and Hare in the 1820s went further than robbery. The two men murdered at least sixteen people and sold the fresh bodies directly to an Edinburgh anatomy school, which paid handsomely and asked few questions. The scandal that followed helped push Britain toward the Anatomy Act of 1832, which tried to create a legal supply of bodies by allowing unclaimed corpses from workhouses and hospitals to be used for dissection.
The American solution followed a similar path and inherited the same underlying injustice. Through the nineteenth and much of the twentieth century, medical schools relied heavily on unclaimed bodies, meaning people who died without family able or willing to claim them, often the poor, the institutionalized, and the incarcerated. Historical records from American anatomy schools show a stark pattern: the people whose bodies ended up on dissection tables were rarely the people being trained to become doctors. They were largely poor, disproportionately Black, and had no say in what happened to them after death. Consent, in any meaningful sense, was absent. The body became a teaching resource because the person attached to it had no power to refuse.
The modern system looks entirely different on paper. Nearly all cadavers now used in American medical education come through voluntary body donation programs, in which a person signs paperwork during their lifetime agreeing to donate their remains to science after death. Anatomical gift programs run through universities, and the process is regulated, documented, and framed around informed consent. This shift represents genuine ethical progress. It also raises a question that gets less attention than it should: who actually donates, and why.
Body donation, like most decisions shaped by circumstance, is not evenly distributed across the population. People without family to arrange and pay for a funeral are more likely to donate, in part because donation programs typically cover cremation costs afterward, which a traditional funeral does not. Economic pressure still shapes who ends up on the dissection table, even within a system built on formal consent. The coercion is quieter now. Nobody is digging up graves. But a person choosing donation because they cannot otherwise afford to be buried is making a decision constrained by circumstances that have not fully disappeared since the era of unclaimed bodies.
Medical schools have started to reckon with this history more openly. Many now hold memorial services for donors, invite students to write letters of gratitude, and refer to cadavers as "first patients" rather than specimens, a shift meant to restore some of the personhood that earlier eras stripped away. These gestures matter, and they represent a real change in how medicine relates to the dead. But gratitude toward a donor does not erase the structural reality underneath the numbers. Anatomy remains one of the few places in medicine where the people who benefit from a body and the person the body belonged to are almost never the same kind of person. Understanding that history does not mean rejecting the practice. It means recognizing that even a system built on consent can still carry the weight of who has historically had the least power to refuse.