St. Louis Individual Reveals Structural Violence and Acute Bacterial Infections

An interdisciplinary investigation into the cause of death of St. Louis Individual, a 23-year-old Black or African American male who died in the 1930s, reveals evidence of structural violence and chronicles the impact of systemic racism in historically marginalized communities.
Published in Social Sciences
St. Louis Individual Reveals Structural Violence and Acute Bacterial Infections
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Equally written by Rita M. Austin, Molly K. Zuckerman, and Courtney A. Hofman.

Above image courtesy of the Missouri Historic Society.

Historical collections of human skeletons, which represent people who were dissected during medical training, are found at universities and museums across the world and have long been fundamentally important for teaching and research on human health and disease in medicine and anthropology. Partly because of this, these collections (aka historical documented collections) and the individuals within them have often been thought of as objects for scientific study, without consideration of their unique experiences, circumstances, and places within history. New research from a multi-institution, interdisciplinary team of researchers challenges this perspective, and the scientific dehumanization of individuals within historical documented collections, by tracing the complex history and experiences of a single individual, a 23-year-old Black, or African American male, called ‘St. Louis Individual’ (St. LI).

 According to the lead author on the study, Rita Austin, “combining information from DNA preserved within calcified dental plaque, or calculus, on St. LI’s teeth with historical documents that contextualizes their life, and information about their overall health gleaned from their skeleton has given us an extraordinary look into their life and how racism, poverty, and violence in 1930s St. Louis, MO shaped this person’s life.”

 St. LI is part of the Robert J. Terry Anatomical Collection, which is held at the Smithsonian Institution’s National Museum of Natural History. The Terry Collection includes about 1700 human skeletons, which represent individuals who lived and died around St. Louis between 1898 and 1967. Accumulated by the medical professor, Robert J. Terry, at the medical school at Washington University of St. Louis, most of these individuals were dissected and included in the collection without their permission. Most bodies dissected in medical schools in the US since WWII come from willed body donation programs, with the consent of donors. But prior to willed body programs, and especially from the mid-19th until the mid-20th century, cadavers used for medical training were the bodies of people who died in public institutions, like prisons and mental asylums. Most of these people were poor and recent European immigrants and from communities of color, such as Black and African Americans. Many times, they were dissected without their permission when family members could not claim their bodies for burial. St. LI’s Death Certificate shows that he died from pneumonia in St. Louis Hospital Number 2, an infamously underfunded, crowded, and segregated hospital and was then dissected.

Dental calculus studied from St. LI yielded bacteria that commonly caused pneumonia and hospital infections before antibiotics became widespread in the 1940s. Researchers found the complete genomes of pre-antibiotic-era strains of Acinetobacter nosocomialis, Acinetobacter junii, and Klebsiella pneumoniae—a common cause of death from pneumonia in the early 19th century. Indeed, pneumonia was one of the most common causes of death amongst humans in the past, especially for the poor, older adults, and other marginalized communities living in progressively crowded and cramped cities from the medieval period into the Industrial Revolution. But like many other short, acute infectious diseases that killed many humans in the past, such as the plague, pneumonia doesn’t leave marks on the skeleton and was often not well diagnosed by doctors and other medical professionals. According to Molly Zuckerman, an author on the study, “this means that despite being one of the biggest killers in history, pneumonia is largely invisible for the past. Indeed, it’s extremely rare that researchers can identify exactly what killed people in the past, or their cause of death. But the bacterial DNA in St. LI’s calculus precisely matches their recorded cause of death of pneumonia. This means that calculus, which dentists scrape off the teeth of the living, can give us an otherwise impossible window into what killed many people in the past and shed light into the end of their lives, which for many who were marginalized, such as those shuttered in institutions, have largely been lost to history.”

 St. LI’s skeleton shows many other traces of being battered by a hard, violent life. And historical documents from 1930s St. Louis reveal what circumstances he likely experienced. St. LI has a poorly healed fracture of his jaw, which study author Geoff Ward says is “indicative of an exposure to violence and other harm, and inadequate health care, throughout his short lifetime,” noting the “widespread political violence, occupational hazards, and interpersonal conflicts in the period and places where his life unfolded.” His teeth show numerous cavities and infections, like periodontal disease. He was also probably infected with Tuberculosis, which study author Hedwig Lee says “was common in the crowded, poor-quality housing Black and African Americans experienced in St. Louis and other cities in the late 19th and early 20th century, such as Philadelphia as evidenced in research conducted by W.E.B. DuBois during this time period.” Pneumonia typically doesn’t kill young adults, like St. LI. Extremely poor health and potentially suppressed immune function from these multiple conditions, brought on and worsened by the stresses of systemic racism and poverty, may have ultimately left St. LI vulnerable to infection. The disproportionate harm from respiratory infections, like the COVID-19 pandemic, for BIPOC communities in the US has some of these same deep historical roots.

 St.LI also didn’t have access to life-saving antibiotics, which weren’t widely available until after WWII. But DNA from the pneumonia-causing bacteria has antibiotic resistance markers. Importantly, according to Courtney Hofman, who led the team, “finding these markers before widespread antibiotic use shows that antibiotic resistance, which is an urgent, rising public health problem in present-day populations, is a long-standing phenomenon.”

 This research gives us insights into the otherwise invisible and forgotten experiences of St. LI, revealing how his life, death, and his final resting place within a historical documented collection were shaped by social forces such as poverty and racism, and enables researchers to identify one of the most common killers of humans in the past, especially in marginalized communities. But, says Austin, “researchers must recognize that the deeply personalized historical vignette of St. LI’s life and death made possible by this integration of DNA, skeletal, and historical information may not be welcome for many historically marginalized communities whose ancestors are found in historical documented collections and many other anthropological and medical research collections, like the Terry Collection.” This is because “poor and marginalized communities and communities of color have persistently been and continue to be harmed by scientific practices, including genetic analyses. This research represents a call to scientific communities to not only be more attentive to the historic and continuing harm that research practices can have on present-day communities, such as destructive genetic testing without the permission of descendent communities, or allowing public access to human genetic information in online databases.” The highly personalized narrative of St. LI’s life that researchers were able to reconstruct highlights that scientists working with historical documented collections, as well as skeletons in other, similar collections around the world, have to be conscious to the potential harm caused by their research; just as these collections are not scientifically neutral, scientific research is not either. Indeed, Austin, Hofman, Zuckerman, and other researchers on the team are actively working with the Smithsonian Institution and researchers at other museums and universities to usher in new guidelines for teaching, research, and care of individuals in these collections to produce scholarship and norms that pays attention to the origins of these individuals, the social and historical factors that led to their inclusion in collections, and recognizes and respects skeletal individuals and their living, descendant communities.

 

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