Acromegalic gigantism, physicians and body snatching. Past or present?

The skeletons of 2 famous acromegalic giants: Charles Byrne (1761–1783) and Henri Cot = Joseph Dusorc (1883–1912) and the embalmed body of the famous acromegalic giant Édouard Beaupré (1881–1904) all ended up in the medical collections of museums despite the fact that these patients had never donated or even refused to donate their corpses, nor had their relatives given permission. The corpse of the acromegalic giant John Aasen (1890–1938) was voluntarily donated to a physician annex collector of trivia from acromegalic giants. The autopsy on the acromegalic giant John Turner (1874–1911) was performed during his funeral ceremony without the relatives being informed. Only recently, the acromegalic giant Alexander Sizonenko (1959–2012) was made a financial offer during his life in exchange for his body after his death. The case-histories of these 6 patients and also the circumstances that led to the (in-) voluntary donation of their bodies are reviewed.


Introduction
In a recent article in the British Medical Journal by Len Doyal, emeritus professor of medical ethics, and Thomas Muinzer, lawyer, the authors make the case for the removal of the skeleton of Charles Byrne from the Hunterian Museum in the Royal College of Surgeons in London, U.K., where it is on display. Subsequently it should be buried at sea, according to Charles Byrne's original wish [1]. The article has raised a very lively discussion [2][3][4].

Case histories
(1) Charles Byrne ( Fig. 1) was born in 1761 in Littlebridge (Northern) Ireland. During childhood he ''grew like a cornstalk''. He reached a final height of 2.31 m. (7 ft. 7 in.) tall. As a teenager, Charles Byrne was exhibited at local fairs and markets. His manager was convinced that Charles Byrne, alias the ''Irish Giant'', could attract a much larger audience and thus make more money in England. After 1782, Charles Byrne had adopted the name ''O'Brien'' and started entertaining the public in London.
Rumours of Byrne's financial success also inspired other giants to try their luck in London. The ''Gigantic Twin Brothers'' Knipe were from a village in Ireland just a few miles from Charles Byrne's birthplace. They once even claimed to be cousins of Charles Byrne. Surprisingly, this might have been true as well (see below). Another Irish giant, Patrick Cotter, was born 1760 in Kinsale, County Cork, Ireland. He also chose ''O'Brien'' as his stage name and was also exhibited at side shows in nearby towns. He was known as the ''Bristol Giant'' and the ''Irish Giant''. He died at Hotwells, Bristol on 8 September 1806 [5]. In December 1972, his bones were retrieved from his grave and it was determined that, while alive, he measured approximately 2.46 m. (8 ft. 1 in.) [5].
Around 1783, the public became fed-up with Charles Byrne-O'Brien and began to frequent other entertainments. Overtaken by his fame and wealth, Charles Byrne had started drinking huge quantities of alcohol. He possessed 2 banknotes, one £700 note and a £70 note. Charles Byrne foolishly chose to carry these banknotes on him. According to newspaper reports he was out drinking when he was robbed of his £700 banknote. In less than 1 year after his arrival in London, Charles Byrne had lost almost everything. It is also known that at this point he had contracted ''consumption'' (tuberculosis). The combination of his alcoholism and tuberculosis weakened him. As a result, by May 1783, Charles Byrne realized that he was a dying man.
Death itself was not Charles Byrne's greatest fear but rather it was the physicians. A number of them were eager to obtain his body after his death for dissection. One of them was the surgeon Dr. John Hunter (1728-1793) [6], who is presently also known as the ''Godfather of Modern Surgery'' [7][8][9].
Determined to stay out of the physicians' hands and especially those of Dr. John Hunter, Charles Byrne started making precautions. After his death, his body was to be sealed in a lead coffin and to be watched day and night by his loyal friends until it could be sunk deep in the sea. Using the remains of his saving money, Charles Byrne prepaid the undertaker to ensure that his will would be carried out. Meanwhile, Dr. John Hunter had employed a detective to keep a close watch on Byrne's whereabouts as well as on his deteriorating condition. On 1 June 1783, Charles Byrne died at the age of 22 [10]. After obtaining an oversized coffin, Charles Byrne's friends kept watch over the corpse for 4 days. First, they exhibited the enormous casket for money to the public. Finally, on 6 June 1783 they began their 75 miles voyage to transport the coffin with the corpse of Charles Byrne to the seaside town of Margate, England. Once they arrived, a boat was chartered and the massive coffin was plunged into the sea. Soon after, rumours speculating on what actually happened to Charles Byrne's body began to circulate.
The precise details on how the remains of Charles Byrne came into Dr. John Hunter's possession are not known [11]. The most popular account of what had happened is as follows: after receiving the news that Charles Byrne had died, Dr. John Hunter located the undertaker who was responsible for executing the will of Charles Byrne. Dr. John Hunter bribed the unscrupulous undertaker at the price of £500 to obtain the corpse of Charles Byrne. The undertaker's accomplices switched the corpse of Byrne for stones in a barn outside a tavern on the route to the coast, while the undertakers were having a drink. The corpse of Charles Byrne was taken back to London and delivered to Dr. John Hunter. Dr. John Hunter was terrified of retribution from Charles Byrne's friends. Wanting to escape from public scrutiny, the skeleton of Charles Byrne was put on display in Dr. John Hunter's museum 4 years after his death, after the public's interest in him had waned. Charles Byrne's skeleton now still resides in the ''Hunterian Museum'' at the Royal College of Surgeons in London, UK.
However, Dr. John Hunter could also have been the first to describe pituitary enlargement in gigantism/acromegaly, if only he would have opened the skull of the Charles Byrne [12]. But, as stated by the famous neurosurgeon Dr. Harvey Williams Cushing (1869-1939)-the ''Godfather of Neurosurgery''-, ''his passion as a collector exceeded his thirst for knowledge'' [13,14].
Although Charles Byrne was 22 years old when he died, radiographic images of his wrist bones showed that the distal epiphysial lines were still open. In 1980, Drs. Alex(ander) M. Landolt and Milo Zachmann estimated his ''bone age'' at the time of his death to be only about 17, indicating that he was still growing at the time of death and this is suggestive that Charles Byrne was suffering from (hypogonadotropic) hypogonadism [18].
In 2010, Dr. Harvinder S. Chahal and co-workers from the Department of Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London UK extracted DNA from a tooth of Charles Byrne and identified a germ-line mutation in the aryl hydrocarbon-interacting protein gene (AIP). Four contemporary Northern Irish families who presented with gigantism, acromegaly, or prolactinoma have the same mutation and haplotype associated with the mutated gene. Using coalescent theory, they infer that these persons share a common ancestor who lived about 57-66 generations earlier [19].
(2) Canada's tallest man (Joseph) É douard Beaupré (Fig. 2), was born on 9 January 1881 in Willow Bunch (Saskatchewan, Canada). He was the first-born in a very poor family which was to reach a total number of 20 children, of whom several died as infants. His parents, Gaspard Beaupré and Florestine Piché were of average height. His growth spurt started already after the age of 3. At the age of 9, he was already 1.83 m. ( [20,21]. In this publication a skull radiograph shows an enlarged sella turcica [measuring 1.6 9 1.2 cm. (0.6 9 0.5 in.)] and overgrowth of the frontal bones [20,21]. After a legal procedure, started by his relatives, the body of Edouard Beaupré was finally returned to his family in 1989 and subsequently cremated on September 28, 1989 in order to prevent future exposition. On July 7, 1990, his ashes were buried under the lawn near his statue in front of the Willow Bunch Museum [22].
(3) Henri Joseph Cot (Fig. 3) was born at the village Le Cros, close to Belmont sur Rance in the Aveyron district, France, on 30 January 1883 [23]. He was the 7th and youngest child in a very poor farmer's family. All other family members were of average size. Initially, his physical development was normal. His growth spurt started before the age of 8 years. At the age of 8 years, he was already 1.50 m. (4 ft. 11 in.) tall, at the age of 12 he was 1.70 m.  Because of his height and strength he was a celebrity in Le Cros and famous for showing his great strength. For example, he would lift a donkey onto his shoulders and carry it around the village. The stories about him attracted his future manager who eventually persuaded him to join the show business. He appeared at many fairs and shows, starting in France and Algeria. In 1906 he started touring the UK and Canada [23].
In order to launch a new career in show business in 1910, his manager rearranged his nickname, ''le géant du Cros'' [''the giant of Cros''] into a kind of anagram ''dusorc''. Joseph Dusorc, as he now was called, grew a beard and was a so-called ''veteran of the 3rd Napoleonic war'' and was dressed-up as a drum master [23]. Joseph Dusorc was supposed to have been born in Garic, Béarn, France. His reported height varied from 2.38 to 2.48 m. ( (1102 lbs.), being lowered down and immediately noticed that the coffin was shorter that the semi-official giant's length. When the coffin tipped slightly a thud of stones could be heard. This convinced almost everybody who attended the funeral that the body of Henri Cot was not inside the coffin, but only stones [23]. Apparently after his manager had realized he had lost his income, he had the idea of selling Henri Cot's body to a professor of medicine in Montpellier (France) to make money from him one last time.  [25] (Fig. 4).
Interestingly, the published post-mortem exam findings in 36-year-old John Turner are prefaced by a cryptic statement by Dr. Harvey Cushing, describing ''inauspicious circumstances''. Namely, after Dr. Harvey Cushing had paid $50 to the undertaker, the autopsy was performed in Washington by his close colleagues, the surgeons Drs. Samuel J. Crowe and William Sharpe. But this was done without permission of the family in the undertakers establishment, while the funeral service was going on  [14,26,27]!!!! According to Dr. Sam Crowe, this story shows how Dr. Harvey Cushing ''would stop at nothing to gain his ends. He was so eager for accurate knowledge that he was entirely ruthless as to how he got them'' [27]. ). However, evidence for this is not available. By 1917, John Aasen started his circus career. Also known as ''Johnny the Gent'', he travelled the world with several circus side shows [28].
Perhaps seeking competition with another American giant of Norwegian descent, Cliff(ord Marshall) Thompson (1904-1955-2.26 m., 7 ft. 5 in.), John Aasen and/or his impresarios rewrote his life story. He changed his birthplace to Numendahl, Norway and said he was educated at the prestigious [but nonexistent] ''University of Norway''. John Aasen also stated that family background was the cause of his extraordinary proportions. According to John Aasen, his father was 2.28 m. (7 ft. 6 in.) tall and his mother was 1.91 m. (6 ft. 3 in.) tall. He also made up that his paternal grandfather was the Norwegian giant Henrik Brustad (23 May 1844-5 January 1899), alleged to be 2.52 m. (8 ft. 3 in.) tall but actually 2.26 m (7 ft. 5 in.), who had worked for Phineas Tailor Barnum. According to John Aasen, Henrik Brustad died at the age of 88 years! He thought the prospect of tall people dying young was nonsense, and pointed to Henrik Brustad as proof. (In reality, Brustad died at the age of 55 years) [28].
In 1922, silent film star/director, Hal Roach, needed a tall man for a role in his next silent movie with Harold Lloyd, ''Why Worry'' (finally released in 1923). This was Although living on a very small monthly pension, he rejected a money offer by the German anatomist Gunther von Hagens to cover his expenses in exchange for publicly displaying his ''plastinated'' remains after his death.

Discussion
The life stories of 6, once famous, acromegalic giants who died, respectively, in 1783, 1904, 1911 1912, 1938 and 2012 are presented. The data show that our colleagues who ''took care''of, or who were particularly interested in these patients overstepped the (ethical) mark to obtain their corpses. Only one patient voluntarily donated his body to science = a collector and one patient refused to do so despite a very attractive financial offer. Many other skeletons of acromegalic giants have ended up in medical collections of museums all over the world and certainly most did not do so after previous informed consent by the patient during life or their relatives. Several acromegalic giants in the past, while alive, feared the same fate and they, or their relatives, made precautions by trying to guarantee that they would be buried in a very secure fashion (like the giantess Ella Ewing (1872-1913) from La Grange, Missouri, USA and the giant Robert Wadlow  from Alton, Illinois, USA), or cremated. Should endocrinologists therefore continue to warn their acromegalic giants for body snatchers, since still these seem to be amongst us even after more than 2 centuries??!