












































Bioarchaeology International
Volume 8, Numbers 3–4: 182–215
DOI: 10.5744/bi.2023.0004

Copyright © 2024 University of Florida Press

Forgotten Children: The Fetal and Infant Skeletal 
Remains of the W. D. Trotter Anatomy Museum, 
New Zealand
Megan Southorn,#,a Siân E. Halcrow,#,*,a Stephie R. Lončar,a  
Emma L. Sudron,a,b Chris Smith,a and D. Gareth Jonesa

#These authors contributed equally to this work.
aDepartment of Anatomy, University of Otago, Dunedin, New Zealand
bAustralian Research Centre for Human Evolution, Griffith University, Gold Coast, Australia
*Correspondence to: Siân E. Halcrow, University of Otago, Anatomy, Great King Street, Dunedin 9054,  
New Zealand

E- mail: sian . halcrow@otago . ac . nz

ABSTRACT Fetal and infant skeletal remains in anatomical collections remain an underutilized yet important source of infor-
mation on the interactions of gender, class, and religion during pregnancy and infant loss. The W. D. Trotter Anat-
omy Museum at the University of Otago in New Zealand, founded in the nineteenth century, houses more than 
2,000 models and anatomical “specimens,” with many of the skeletal remains lacking provenience information. 
This research aimed to both provide an inventory of the fetal and infant skeletal remains and identify through 
archival analysis the social context of those whose remains were obtained by the museum. An osteological analysis 
was carried out to assess the minimum number of individuals (MNI), estimate age- at- death, and provide evidence 
for pathology and dissection. The results are interpreted in the context of the archival accession data and historical 
information at the time to provide the social context in which these people lived and therefore information that 
may be related to their deaths and acquisition of their bodies by the university. Most of the infants within the col-
lection died around the time of full- term birth, and some individuals have evidence for developmental pathology, 
birth trauma, and/or postmortem dissection. The historical context and legislation around body donation sug-
gests structural inequality played a role in the acquisition of these infants’ remains from mothers (primarily poor 
and/or unmarried women) and that these remains went through a process of commodification and objectification 
and were retained as developmental teaching “specimens” and examples of pathology.

Keywords: Anatomy Museum; infant osteology; structural violence

GERMAN Skelettüberreste von Föten und Säuglingen in anatomischen Sammlungen sind nach wie vor eine wenig ge-
nutzte, aber wichtige Informationsquelle über die Wechselwirkungen von Geschlecht, soziale Schicht und Reli-
gion während der Schwangerschaft und beim Verlust des Kindes. Das im 19. Jahrhundert gegründete W. D. 
Trotter Anatomy Museum an der University of Otago in Neuseeland beherbergt mehr als 2000 Exponate und 
anatomische „Präparate“, wobei es bei vielen Skelettüberresten keine Angaben zur Herkunft gibt. Ziel dieser 
Forschung war es, sowohl eine Bestandsaufnahme der Skelettüberreste von Föten und Säuglingen zu erstellen 
als auch durch eine Archivanalyse den sozialen Kontext derjenigen zu identifizieren, deren Überreste vom Mu-
seum erhalten wurden. Es wurde eine osteologische Analyse durchgeführt, um die Mindestanzahl der Per-
sonen (MNI) zu ermitteln, das Sterbealter abzuschätzen und Hinweise auf Pathologie und Sektion/Obduktion 
zu geben. Die Ergebnisse werden im Kontext der archivierten Zugangsdaten und historischen Informationen 
zu der Zeit interpretiert, um den sozialen Kontext zu ermitteln, in dem diese Menschen lebten, und damit In-
formationen, die mit ihrem Tod und dem Erwerb ihrer Körper durch die Universität in Zusammenhang stehen 

Received 25 January 2023
Revised 23 September 2023
Accepted 7 December 2023



Southorn et al. 183

Dedicated to the babies lost and subsequently 
kept in the W. D. Trotter Museum, whose life sto-
ries (albeit short) we hope to give a voice at least 
partially to here.

The study of historic human remains themselves pro-
vides vital information on the life experiences of past 
individuals and populations (Larsen 2015). Although 
the lives of individuals in more recent history are bet-
ter documented than the lives of earlier populations, 
specific subgroups of society are often forgotten in 
these narratives (i.e., women, children, the poor, dis-
abled or mentally ill) (Clarke 2012; Helleiner et  al. 
2001; Riley 1988). Historical anatomical human re-
mains are a unique source of information to assess 
the life experiences of individuals and communities 
in the past, and the study of infant remains from 
these contexts may give us an understanding of the 
development of medicalization of the body during 
pregnancy and childbirth (Dittmar and Mitchell 
2016, 2018; Muller and Butler 2018). Due to the close 
physiological relationship between mothers and in-
fants during pregnancy and breastfeeding, pathology 
that exists in fetal and infant skeletal remains can be 
evidence for nutritional deficiencies and infectious 
disease in mothers (Gowland and Halcrow 2020).

With the shift toward anatomy becoming a more 
humanistic field, ignoring the social power structures 
and sociocultural context that led to these individuals 
being anatomized and held in collections is no longer 
acceptable (de la Cova 2019; Muller et al. 2017; Muller 
and Butler 2018). Such studies may lend insight into 
the influences that led to them being anatomized, 
such as disparities in access to health care historically 
and the inequitable treatment of the dead. Perspec-
tives on the acquisition and use of human remains, 
their contribution to anatomy and biological anthro-
pology, and acknowledgment of their history of ac-
quisition have changed over time within the museum 
and anthropological contexts (Alberti 2011; Claes and 
Deblon 2018; Wilson 2015). The use and display of 
these remains can be conceptualized through the lens 
of the commodification of bodies for their continued 
use in medical teaching and as objects of curiosity, in-
cluding for the display and voyeurism of individuals 
with pathology (Claes and Deblon 2018; Hodge 2013; 
Ion 2022; MacDonald 2012).

Galtung (1969), who was the primary proponent of 
the theoretical model of structural violence, defined 
this as a way in which social structures, laws, and other 
social institutions cause harm to individuals and pre-
vent groups of people from meeting their full potential 

könnten. Die meisten Säuglinge in der Sammlung starben etwa zum Zeitpunkt der Geburtsreife, und bei eini-
gen Personen liegen Hinweise auf Entwicklungsstörungen, Geburtstrauma und/oder eine postmortale Obduk-
tion vor. Der historische Kontext und die Gesetzgebung zur Körperspende legen nahe, dass strukturelle 
Ungleichheit beim Erwerb der Überreste dieser Säuglinge von Müttern (hauptsächlich arme und/oder unverhe-
iratete Frauen) eine Rolle gespielt hat und dass diese Überreste einen Prozess der Kommerzialisierung und 
Objektivierung durchlaufen haben und als solche aufbewahrt wurden Entwicklungslehre- „Präparate“ und Ex-
ponate der Pathologie.

 Translation by: Stephie Lončar and Sara Otto

SCOT TISH Tha fuighill cnàimhneach leatrom anabaich is leanaban ann an cruinneachaidhean anatomach fhathast nan 
stòras fiosrachaidh nach eilear a’ cleachdadh gu leòr ach a tha cudromach a thaobh fiosrachaidh air eadar- 
obrachadh gnè, clas, agus creideamh tro leatromachd agus call leanaban. Ann an Taigh- tasgaidh Anatomy WD 
Trotter aig Oilthigh Otago ann an Sealan Nuadh, a chaidh a stèidheachadh san naoidheamh linn deug, tha còrr 
air 2000 modal agus ‘sampaill’ anatomach, le mòran de na fuighill cnàimhneach gun fhiosrachadh air tùs. Bha 
an rannsachadh seo ag amas air an dà chuid cunntas a thoirt air na fuighill cnàimhneach leatrom anabaich is 
pàiste a bh’ aig an oilthigh agus sealltainn, tro sgrùdadh tasglainn, an co- theacsa sòisealta. Chaidh mion- 
sgrùdadh osteologach a dhèanamh gus measadh a dhèanamh air an àireamh as lugha de leanabain fa- leth 
(MNI), tuairmse air aois- aig- bàis, agus fianais airson eòlas- ghlar agus gearradh na mhìrean. Tha na toraidhean 
air am mìneachadh ann an co- theacsa dàta sealbhachaidh tasglainn agus fiosrachadh eachdraidheil aig an àm 
gus an co- theacsa sòisealta anns an robh na leanabain beò a thoirt seachad, agus, mar sin, fiosrachadh a dh’ 
fhaodadh a bhith co- cheangailte ri am bàs agus mar a fhuaireadh na cuirp aca leis an oilthigh. Bhàsaich a’ 
mhòr- chuid de na naoidheanan taobh a- staigh a’ cho- chruinneachaidh aig àm breith làn- ùine, agus tha fianais 
aig cuid aca air eòlas- ghalair leasachaidh, trauma breith agus / no gearradh post- mortem. Tha an co- theacsa 
eachdraidheil agus an reachdas mu thabhartas bodhaig a’ nochdadh gun robh pàirt aig neo- ionannachd struc-
tarail ann a bhith a’ faighinn fuighill nan leanaban bho mhàthraichean (boireannaich a bha bochd agus/no gun 
phòsadh sa mhòr- chuid), agus gun deach na fuighill sin tro phròiseas bathair agus dìmeas agus gun deach an 
cumail mar ‘sampaill’ leasachadh teagasg agus eisimpleirean de eòlas- ghalar.

 Translation by: Annella Macarthur

GAELIC



Forgotten Children184

through the deprivation of basic needs through social 
forces of power. The amassing of anatomical skeletal 
collections has been understood through this theoreti-
cal model, with many works evoking this lens in the 
context of the treatment of the African American bod-
ies in anatomical and anthropological contexts (e.g., 
de la Cova 2019; Lans 2020; Nystrom 2014; Watkins 
2018; Watkins and Muller 2015). Like the United States 
and United Kingdom, in New Zealand, the change of 
legislation in the nineteenth century to reduce the in-
centive for graverobbing led to the legal right for the 
acquisition of bodies from public institutions by physi-
cians (Anatomy Act 1875). Research on these historical 
anatomical collections highlights social deprivation 
related to factors such as race and poverty that were 
central to the formation of these collections (de la 
Cova 2011; Jones and Whitaker 2012; Lans 2021; Rich-
ardson 1987; Sappol 2002). The very presence of vul-
nerable or marginalized individuals such as infants 
within an anatomical collection can be indicative  
of the structural violence they (and their parent/s) ex-
perienced during their short lives and after death  
(Zuckerman 2021). It has been suggested that most of 
the cadavers of adults received by the University of 
Otago Medical School historically were likely un-
claimed bodies from hospitals, societies for the poor, 
and an asylum, all of whom cared for or housed soci-
ety’s most vulnerable, those who faced societal struc-
tures that harmed them throughout their lives and 
after death (Jones and Fennell 1991).

We acknowledge the sensitive nature of this study 
of these fetal and infant remains (Beiter et  al. 2019; 
Biers 2020; Bonney et al. 2020; Fourniquet et al. 2019; 
Squires and Piombino- Mascali 2022; Wilson 2015), 
both from the perspective of how they may have been 
acquired in the past and our reflections on the ethics 
of those practices today, and the potential to continue 
and compound this injustice through the osteologi-
cal investigation and objectification of these infants. 
Part of our intention here is to study the osteology 
and pathology of these infants to start to tell the sto-
ries of their (albeit) short lives and the experiences of 
their parents and to attempt to understand some-
thing about how they came to be in these collections. 
This analysis helps with elucidating the context of 
provenience, which is important when considering 
their use in teaching, research, and display and in-
forming students and researchers (Cormer 2022; Hil-
debrandt 2019). From a scientific paleopathological 
point of view, images are expected for verification of 
the observations. However, we are cognizant that 
these photographs could be disturbing for some and 
may be seen as objectification and continuation of 
this structural violence and inequitable treatment of 
these remains. We also recognize the personal 

sensitive nature of fetal and infant loss for some and 
the social taboo surrounding discussing and engag-
ing with pregnancy loss (Cox 2019). Therefore, we in-
clude the images of the infants as supplementary 
information, so if readers wish to refer to these, they 
have agency in their decision.

Infants in anatomical education

Literature on the role of the fetus and infant in ana-
tomical education is sparse (e.g., Armüller and Lenk 
2022; Dittmar and Mitchell 2016; Wilson 2015). The 
nineteenth and twentieth centuries were a formative 
time for anatomy and the collection of humans for 
their dissection and curation. In the United King-
dom, adult males were the preferred body for most 
dissections during the nineteenth century (Dittmar 
and Mitchell 2016), and for that reason, literature that 
focuses on the use of the human body in medical ed-
ucation largely ignores women, infants, and children. 
The primary reason male cadavers were preferred in 
medical education in the United Kingdom and other 
countries was their availability. Under the Act for 
Regulating Schools of Anatomy 1832 (United King-
dom), bodies legally available for dissection were ei-
ther executed felons or those who had died in 
workhouses, hospitals, or other charitable institu-
tions who had no family to claim their body for burial 
or cremation. Although this law meant that the bod-
ies of women and children’s bodies were legally avail-
able for dissection, their availability was restricted by 
the wardens of such charitable institutions. These 
wardens were known to refuse to hand over custody 
of women’s bodies to anatomists after death (Dittmar 
and Mitchell 2018) or would refuse to admit pregnant 
people into their care entirely (Clarke 2012; Dittmar 
and Mitchell 2018). Pregnant bodies from executions 
were also largely unavailable as their execution was 
incredibly rare: all pregnant people destined for the 
gallows were given a stay of execution until after the 
birth of their child (Dittmar and Mitchell 2018), thus 
rendering the bodies nearly completely unavailable 
to anatomists through that means. Evidence from 
other skeletal collections around the globe suggests 
that the rarity and importance of these bodies in ob-
stetric education has been a major incentive for the 
continued holding of the remains in museums for fu-
ture generations (Dittmar and Mitchell 2016; Kosenko 
et  al. 2022). Interestingly, in the New Zealand con-
text, the bodies of (likely not pregnant) women were 
readily made available for use in anatomy education 
at the University of Otago from institutions such as 
Seacliff Lunatic Asylum (Jones 2012) and in at least 
one case from the “gaol” (jail) (Sudron 2021).



Southorn et al. 185

As discussed, historical legislation in Great Britain 
meant that dissection was largely limited to crimi-
nals and impoverished adults (mostly men), making 
the presence of infants and perinates in a museum 
even more unusual (Dittmar and Mitchell 2016; Jones 
and Fennell 1991; Richardson 1987). Dissection or 
dismemberment of the body after death went against 
the Christian beliefs of the time, where in order to be 
resurrected when Christ returned to Earth, the phys-
ical body needed to remain intact (Knight 2018; 
Zuckerman et al. 2021). Therefore, the donation of re-
mains of a newborn or an infant to a museum is an 
unusual and unexpected choice for Victorian and 
Edwardian era parents in a predominantly Christian 
society such as historic Dunedin. More pragmatic 
justifications as to why these infant remains may 
have ended up in the care of the university, such as 
avoiding the cost of burial or religious doctrine pre-
venting the burial of unbaptized infants in conse-
crated ground (Dine 2019; Murphy 2011), are also 
problematic. Across Dunedin, there are many his-
toric stillbirths and infants buried in cemetery plots 
of all classes. For instance, the Northern Cemetery, 
one of Dunedin’s largest cemeteries, was secular and 
contained a large number of council owned “third- 
class” plots open for the burial of those who could not 
afford to purchase a plot themselves (Lane 2018). The 
University of Otago Medical School likely acquired 
the remains of fetuses and infants as the only reliable 
way of studying early human development at the 
time. What is not clear, however, is the social context 
that led to the donation or forced acquisition of the 
infant remains for retention in the museum.

The main aim of this research is to both provide an 
inventory of the fetal and infant skeletal remains and 
identify through archival analysis the social context 
of those whose remains were obtained and held in the 
W. D. Trotter Anatomy Museum. To do this, we com-
pleted an osteological analysis of the remains and un-
dertook archival research to investigate the social 
and historical circumstances for the inclusion of fetal 
and infant remains in this anatomical collection, in-
cluding medical approaches to childbirth and con-
sent to dissection for the purposes of medical 
education. There has been a growing awareness of the 
continuing impact of the profound lack of ethical 
standards in the collection, curation, and use of hu-
man skeletal remains for research and teaching pur-
poses. An investigation of the rich social and 
historical context and ethics of past acquisition prac-
tices of historical anatomical collections in institu-
tions is integral to starting this process of ethically 
engaging with these collections (Adams 2009). The 
historical collecting practices define, in most part, 
what remains are held within museums today as 

guided by what was seen as acceptable in their social 
and historic context. Fetal, infant, and child remains 
in these collections pose several ethical issues, and it 
is important to understand the historical acquisition 
and provenance for the consideration of their use in 
teaching, research, and display today (Wilson 2015).

The W. D. Trotter Anatomy Museum, 
University of Otago in Dunedin

This museum was founded in the late 1870s as part of 
the Medical School and houses more than 2,000 hu-
man and model anatomical "specimens" used in edu-
cation and research. In the museum is a collection of 
fetal and infant skeletal remains. No prior osteologi-
cal or historical archival analyses had been completed 
on these infant remains.

The city of Dunedin was founded in 1848 by Scot-
tish colonial settlers, and the university was estab-
lished less than 30 years later, in 1869. The land for the 
Dunedin settlement had been purchased from the 
local iwi (tribe) of Kāi Tahu (Carmalt Jones 1945), 
and the subsequent discovery of gold inland from 
Dunedin in 1861 made the city the industrial, finan-
cial, and commercial center of New Zealand, a fine 
city to found New Zealand’s first university (Carmalt 
Jones 1945; Hercus and Bell 1964; Trapeznik 2011).

Methods

Age definitions

All skeletonized infants (age- at- death of less than one 
year) in the W. D. Trotter Museum collection were 
analyzed, and all historical information pertaining to 
infants acquired by the University of Otago Medical 
School for dissection was included in this project. We 
refer to these individuals collectively as “infants,” in 
line with the World Health Organization definition 
of the first year of life. Other definitions used in this 
research are “fetus”, aged up to 37 weeks gestation; 
“perinate,” from birth to the seventh day of life; “neo-
nate,” from the eighth to twenty- eighth day of life; 
and “post- neonate,” from the twenty- ninth day of life 
to the end of the first year. The term “fetus” is used in 
bioarchaeology to refer to an individual older than 
eight weeks gestation but not yet born (Lewis 2007). 
We have used the term “fetus” in this research to re-
fer to an individual aged prior to when a pregnancy 
reaches “term” at the end of the thirty- seventh week 
of gestation, because any individual older than 37 
weeks of gestation may well have been born before 
their death and therefore cross the line of live birth 



Forgotten Children186

that marks the transition from “fetus” to “perinate.” 
All other definitions are concurrent with bioarcheo-
logical and clinical literature (Halcrow 2017; Halcrow 
and Tayles 2008; Lewis 2007).

Historical archival analysis

Available diaries, letters, and other forms of commu-
nication between undertakers, hospitals, medical 
practitioners, and university were investigated via an 
extensive search of materials associated with the 
Anatomy Department within the Hākena database. 
No mention of procurement of infant remains for use 
in anatomy was found from those sources.

The primary archival text for this study was The 
Register of Anatomical Material, which was supple-
mented with historic undertaker records from Hugh 
Gourley Ltd. (now Gillions Funeral Services). We ob-
tained the historical death certificates from the New 
Zealand Department of Internal Affairs. The infor-
mation obtained from these resources is described in 
Table 1 and below. A review of relevant historical lit-
erature and primary historical (archival) sources was 
used to identify any information available on when 
and why these remains may have been acquired, why 
they died, and to assess how aspects of gender, class, 
religion, and the concept of personhood may have in-
teracted to result in the curation of these within the 
W. D. Trotter Anatomy Museum.

The University of Otago Register  
of Anatomical Material
This archival book documents the acquisition of bod-
ies by the Department of Anatomy from the period of 
1876– 1941 and is held in the Hocken Collection | Uare 

Taoka o Hākena in Dunedin (Fig. 1). It is assumed that 
all bodies used in anatomy education at the Univer-
sity of Otago in this period were listed in this register. 
The register listed the name of the deceased, their age- 
at- death, the date the university received their body, 
the date any dissection commenced, the institution it 
was received from, the cause of death, the undertaker, 
the date of burial (if this occurred), any injections 
they received (e.g., to help with preservation), and any 
extra notes. Interestingly, in the case of infants, in-
stead of indicating the same undertaker was used for 
burial “do,” often a dash was written instead.

The entire register was read systematically, taking 
photographs of each entry for an infant. This infor-
mation was then digitally transcribed into a Micro-
soft Excel spreadsheet. At Gillions Funeral Services, 
which recorded many of the early body donations to 
the University of Otago (see Supplementary File 1), 
we assessed the ledgers from 1876– 1941 (as this was 
the period documented in the University of Otago 
Register of Anatomical Material), using the index to 
find all cases of bodies that were sent to the Univer-
sity of Otago by Hugh Gourley Ltd. We then cross- 
referenced the data from the Hocken Collection | 
Uare Taoka o Hākena, recording any instances of in-
fants being sent to the Medical School and recording 
any extra information about the infants noted in the 
Register of Anatomical Material. Examples of this in-
cluded costs associated with “supplying” the body of 
these individuals to the university and the date when 
dissection was commenced.

Hugh Gourley Ltd. Funeral Services Ledgers
The ledgers date from 1875, when the business was 
known as Hugh Gourley Ltd., to the present day (now 

Table 1. Historical Archival Accession Sources

Archival Sources Source Information Included

The Register of Anatomical Material Hocken Collection | Uare Taoka o Hākena 
in Dunedin

Acquisitions of human remains from 1876– 1941 includes 
name of the deceased, their age at death, the date the 
university received their body, the date any dissection 
commenced, the institution from which it was received, the 
cause of death, the undertaker, the date of burial (if this 
occurred), any injections they received (e.g., to help with 
preservation), and any extra notes.

Hugh Gourley Ltd. Gillions Funeral Home, private collection, 
Dunedin

Name of the individual being buried (or the person footing 
the bill in some cases), if the person was being buried by a 
trust, what funeral services they requested, place of death, 
sometimes date of death or burial, and any costs incurred 
(for example, for transport of the body).

Historical Death Certificates New Zealand Department of Internal Affairs 
| Te Tari Taiwhenua (NZDIA) 
The online historical search (https:// www 
. bdmhistoricalrecords . dia . govt . nz/) was 
used to find the registration number for 
historical records to be ordered from 
NZDIA.

Cause of death, date of death, age- at- death, parental marital 
status, father’s occupation, burial location, date of burial, 
and name of medical professional who attended illness  
and death.



Southorn et al. 187

Gillions Funeral Services). As Gourley was one of the 
two primary undertakers in the Dunedin region, it 
provides a representative insight into the context of 
individuals who were sent to the university. The ear-
lier ledgers were up to 500 pages long, with each book 
covering up to five years of finances for the funeral 
home. The books recorded the name of the individual 
being buried (or the person footing the bill in some 
cases), if the person was being buried by a trust, what 
funeral services they requested, place of death, some-
times date of death or burial, and any costs incurred. 
Each ledger had an index book of surnames or com-
pany names that indicated the page in which their 
transactions with Gourley Ltd. were listed. An exam-
ple of this is provided in Supplementary Figure 1. In-
stitutions such as the Dunedin Public Hospital and 
the University of Otago regularly had complete pages 
devoted to the bodies Gourley was involved with un-
dertaking, as shown in Supplementary Figure 2. The 
earlier historic entries were typically more detailed 
regarding place and context of death.

Death certificates
Historical death certificates are held by the New Zea-
land Department of Internal Affairs. We investigated 
the death certificates of the infants noted in the Univer-
sity of Otago Register of Anatomical Material. The 
death certificates provide further detail in addition to 
the registers such as parental marital status, father’s oc-
cupation, burial location, and date of burial. They were 
used to provide information on the social status of the 
parent/s of these infants as well as confirm age- at- death 
and cause of death (see Figure 2 as an example).

Skeletal analysis

All fetal and infant remains were analyzed from the 
skeletal collection. The osteological analysis focused on 
estimating the minimum number of individuals (MNI) 
within the collection, estimating the age- at- death from 
each individual skeletal element (where possible), and 
macroscopic identification, description, and differential 

Figure 1. University of Otago Register of Anatomical Material (with permission from the Hocken Collections  
| Uare Taoka o Hākena).

Figure 2. Example of a death certificate from the NZDIA. Name of the infant and their parent/s have been redacted.



Forgotten Children188

diagnosis of any pathology. No destructive analyses 
were undertaken on the remains.

MNI was important to estimate as most of the skel-
etal remains have been curated by skeletal elements 
(e.g., all loose infant and fetal frontal bones were cu-
rated together under one accession number), rather 
than by individual. There are some remains presented 
as complete individuals, either as articulated skele-
tons in anatomical position or laid out in glass cases, 
also in anatomical position. MNI can be calculated 
using the bone that is most frequently represented 
within the collection and the siding of these bones if 
they are paired. The most numerous bone within the 
infant and fetal skeletal remains of the W. D. Trotter 
Anatomy Museum collection was the squamous part 
of the occipital bone. As this is an unpaired bone, 
more than one in the collection represents more than 
one individual, regardless of age or sex.

An age estimation was obtained for each bone ele-
ment where possible. All measurements of long bone 
length and cranial size were assessed using the stan-
dards from Fazekas and Kòsa (1978). Fazekas and Kòsa 
(1978) is the most complete standard available for age 
estimation of perinatal remains. Although other stan-
dards may be considered more methodologically 
sound due to being developed from individuals with a 
known age- at- death, Fazekas and Kòsa (1978) is the 
most widely accepted standard for estimating age 
from single skeletal elements (Cunningham et al. 2016; 
Lewis 2017; Michel and Charlier 2011; Pap and Pálfi 
2011; Weidig et  al. 2011). Poor maternal health and 
physiological stress can cause growth disruption and, 
in extreme cases, intrauterine growth restriction 
(IUGR), which may lead to underestimation of the age 
of these skeletal remains (Hendrix and Berghella 2008; 
Hoppa 2000; Merwin and Harris 1998; Perkins et. al. 
2016). As growth disruption in fetal and infant skeletal 
remains is identified by comparing the age estimation 
from long bone length with age estimation from the 
dentition (Hodson and Gowland 2020), IUGR is un-
able to be conclusively diagnosed in this collection (or 
differentiated from younger fetuses who are a normal 
size) because the dental and remains are generally not 
curated together as individuals.

Age estimation based on dental development miti-
gates some of the limitations of skeletal aging meth-
ods as it is argued to be more tightly controlled by 
genetics and is therefore less susceptible to physio-
logical stress (Bolaños et  al. 2000; Liversidge and 
Molleson 2004; Thesleff 2000). For this research, esti-
mating age from dental development is more appro-
priate than dental eruption methods as dental 
development methods can be used for perinatal indi-
viduals whose teeth have not yet erupted. Radio-
graphs were taken to assess development of all dental 

remains. The standard used for this research was the 
London Atlas of Tooth Development and Eruption 
(AlQahtani et  al. 2010; AlQahtani et  al. 2014). Al-
though this standard may not be considered the most 
accurate in estimating age from dental development 
in a modern New Zealand population (Baylis and 
Bassed 2017), the reference population of historic 
British and European juveniles reflects the predomi-
nantly European origin population of nineteenth- 
century Dunedin. The inclusion of fetal standards 
and clear differentiation of stages in perinatal devel-
opment made the London Atlas of Tooth Develop-
ment and Eruption the most suitable standard to use 
in this research. Sex estimation was not attempted as 
sexually dimorphic morphological characteristics 
are not sufficiently developed for conclusive sex esti-
mation in preadolescent individuals (White and 
Folkens 2005).

Results

Analysis of the Register of Anatomical Materials 
showed 24 infants were acquired by the University of 
Otago from 1876– 1941. Twenty perinates, one neo-
nate, and three post- neonates were recorded as “sup-
plied” to the university between 1876 and 1941 
(Supplementary Table  1). There were six females, 12 
males, and six individuals who did not have their sex 
recorded. The individuals are listed as year of death 
to protect their identity. Only four individuals from 
the Register of Anatomical Materials appeared in 
Gourley’s ledgers, also listed with the cost of “supply-
ing” each individual to the university. Of the total 
number of infants, eight had prematurity or “imma-
turity” listed as cause of death. One who passed away 
from “prematurity” had a twin who survived (listed 
as “one breathes”). Two of the individuals died from 
trauma or birth complications, including hemor-
rhage. Two infants died of “inanition” and one of py-
loric stenosis malnutrition. Six had congenital or 
birth defects, which may have made their bodies par-
ticularly interesting for use in anatomy education. 
Two died from infectious diseases: tuberculous en-
teritis and congenital syphilis. Two individuals had 
no cause of death listed.

Source of fetal and infant bodies

The infants supplied to the University of Otago from 
1876 to 1941 were typically acquired from public insti-
tutions such as Batchelor Maternity Hospital (n = 11) 
and Dunedin Public Hospital (n = 9). Three individuals 
were supplied by the “Redroofs” Salvation Army Ma-
ternity home, one from Cook Maternity Home in 



Southorn et al. 189

Gisborne, and one individual from an unnamed ma-
ternity hospital (Supplementary Table  1). The most 
common source of infant bodies changes over time. 
Bodies predominately came from Dunedin Public 
Hospital in 1885– 1920, whereas from 1921– 1934, they 
were provided almost exclusively by Batchelor Hospi-
tal. Of the 24 infants in the University of Otago Regis-
ter, there were 18 who had death records available. 
Seven of the 18 infants have father “not recorded” on 
the birth certificate, indicating they were “illegitimate” 
children to unmarried mothers (all those historical re-
cords with “illegitimate” were typed out with that in-
formation retracted). Those with a father recorded and 
their father’s profession recorded were mostly working 
class (e.g., laborers, bricklayers). Four have “university” 
noted in their “burial details” section in the death cer-
tificate (e.g., Fig. 2). Although many of the infants in 
the University Register note that they have been buried 
at various dates, with cross- referenced entries in Gour-
ley’s registers reporting the location as Anderson Bay 
Cemetery, we find no evidence of burials of these indi-
viduals through the digitized burial records at the An-
derson Bay Cemetery.

Although we have data on the acquisition of in-
fants from the archival research, the skeletal remains 
in the museum are no longer linked to this informa-
tion, and thus we cannot match the remains to any 
specific individual identity.

Osteological results

Based on the skeletal analysis, the minimum number 
of individuals within the fetal and infant collection is 
32. The collection comprises different curation tech-
niques (Table 2).

Most of the nonarticulated skeletal elements are 
from the cranium. Ribs, vertebrae, and pelvic bones 
were only found in the articulated or mounted 
individuals.

The general preservation of the skeletal tissue is ex-
cellent. The delicate skeletal elements of the crania, 
including the cranial vault bones and bones of the 
face, have been subject to some postmortem damage. 
Damage to the parietal bones is most common, as 
well as unilateral or bilateral damage to the zygo-
matic processes of the temporal bones.

Age- at- death 
The age of the fetuses and infants ranges from 15 
weeks gestation to 3 months postnatal (Fig. 3). Most 
of the skeletal elements are aged to be within the fi-
nal month of pregnancy to full term (36– 40 weeks 
gestation). Aging for individual skeletal elements is 
shown in Figure 4. Some individual skeletal elements 
(n = 51/296) were unable to be aged for one of three 
reasons: inability to access the element (some were 
encased in perspex or resin); postmortem damage to 
the element, making accurate measurement impossi-
ble (i.e., ethmoid); or lack of an aging standard for 
the skeletal element. These age estimations are pre-
sented below as both the age of the identified indi-
viduals within the collection (MNI = 32), as well as 
the age estimations for every individual skeletal ele-
ment that was able to be analyzed. The skeletal ele-
ment age distribution (Fig. 4) is included as it is more 
representative of the age distribution of the entire 
infant skeletal collection in the W. D. Trotter Anat-
omy Museum.

Pathology
Six of the 19 articulated individuals (five represented 
by articulated crania and one articulated skeleton) 
exhibited some form of visible skeletal pathology. 
Two of the five individuals represented by crania that 
exhibited pathology had trauma possibly related to 
delivery (O3.D15 and O3.D6), and four individuals 
exhibited pathology consistent with congenital devel-
opmental abnormalities (O3.D7, O3.D14, O3.D180, 
and O5.D1). One of these individuals with evidence 
for developmental pathology (O5.D1) is a complete 
articulated skeleton. Detailed descriptions of the 
pathological observations, photos, and differential 
diagnosis for each individual are included in Supple-
mentary File 2.

Discussion

The main aim of this research was to provide an inven-
tory of the fetal and infant skeletal remains of the  
W. D. Trotter Anatomy Museum and understand the 
social context in which these remains were acquired  
by the museum. To achieve this aim, the osteological 
evidence needs to be interpreted within the maternal 
and infant health context, in concert with archival 
data on their provenance and the social context of 
class, gender, and religion at the time that may have led 
to their acquisition and use in the museum context.

Although our data do not allow for us to identify 
the infant skeletal remains to any specific individual, 
the general age distribution as well as the causes of 
death and evidence of pathology on the bones of the 

Table 2. The Number of Articulated Skeletons, Articulated Crania or 
Skulls, and Nonarticulated Skeletal Elements in the W. D. Trotter 
Anatomy Museum

Curation Type Number

Mounted or articulated skeleton, >90% complete 6
Articulated cranium or skull 13
Nonarticulated skeletal element 267



Forgotten Children190

fetuses and infants are similar between the skeletal re-
mains and the available archival data. For example, 
we have two infants with skeletal evidence for cerebral 
trauma, and there are two infants who are noted in 
both their death certificates and University Register 
that they died from birth trauma. Similarly, we have 
evidence for individuals with developmental skeletal 
defects and many who are premature, and these etiol-
ogies are also documented in the historical archival 
research. We believe that the individuals may have 

been collected due to their pathologies and as exam-
ples of development (e.g., the premature infants). 
However, this is obviously a biased sample whereby 
infants who are born prematurely and those with de-
velopmental disorders are more likely to pass away.

Infant and maternal mortality in New Zealand

Assessing the osteological evidence of age- at- death 
and pathology, using knowledge of historical causes 

Figure 3. Age-at-death distribution of the fetal and infant individuals of the W. D. Trotter Anatomy Museum 
collection. Those individuals older than 43 weeks gestational age are assumed to have been born alive and 
their death occurred within the neonatal or post-neonatal period.

Figure 4. Age-at-death distribution for individual fetal and infant skeletal elements of the W. D. Trotter Anatomy Museum collection. Those individu-
als older than 43 weeks gestational age are assumed to have been born alive and their death occurred within the neonatal or post-neonatal period.



Southorn et al. 191

of fetal and infant death in New Zealand is important 
in considering the possible causes of death for these 
infants in the W. D. Trotter Museum. Common causes 
of maternal death are important to explore also, as 
maternal and fetal health are inextricably linked 
(Lassi et al. 2013) and infants who lost their mother at 
birth tended to have poorer health outcomes (Atrash 
2011; Clarke 2012; Loudon 1991; Pavard et al. 2005; Sa-
detskaya and Oxley 2012).

In New Zealand, infant mortality peaked in 1875 at 
130 deaths per 1,000 live births and then began to de-
cline thereafter (Fraser 1928), similarly to other devel-
oped countries at this time (Loudon 1991; Sadetskaya 
2015; Sadetskaya and Oxley 2012). By 1920, this mor-
tality rate had more than halved due to the improve-
ments in maternal and infant care. It is argued, 
however, that this decline in infant mortality was 
only experienced by the Pākehā (white New Zea-
lander) population (Pool et al. 2007; Sadetskaya 2015), 
with the Māori mortality rates excluded in published 
data until 1920 (Sheehan 1878; Waldegrave 1901; Ward 
1905). Once introduced, Māori registration data con-
tinued to be of poor quality (Pool 1973), and therefore 
the true Māori infant mortality rate during the nine-
teenth and early twentieth centuries remains un-
known, with modern estimations placing it much 
higher than the Pākehā recorded infant mortality 
rate (Statistics New Zealand 2006). Despite improve-
ments in public health and medical treatment during 
the early twentieth century, the major causes of in-
fant death have not changed significantly since the 
nineteenth century, with the main causes being pre-
maturity and respiratory and diarrheal diseases 
(Clarke 2012; Fraser 1928; Loudon 1991). There was no 
formal requirement to register stillbirth in New Zea-
land until 1919, but some earlier parents chose to reg-
ister their stillborn child. Poor obstetric technique 
contributed to both infant and maternal mortality, 
with some of the methods developed for dealing with 
maternal health conditions such as eclampsia causing 
trauma for both mother and child (Bryder 1986; Drife 
2002; Loudon 1986; Sheikh et al. 2013). The use of ac-
couchement forcé, high forceps early in labor, and 
nonsterile techniques posed significant risk to both 
mother and child and were at times used without 
clinical need (Bryder 1986; Drife 2002; Loudon 1986; 
Sheikh et al. 2013). This risk is seen in the individuals 
who have evidence for forceps trauma from the skele-
tal evidence.

Societal reactions to infant and fetal loss

Assessing prenatal loss is especially important be-
cause the societal response to an individual who died 
before birth may have impacted the decisions made 

by parents after death regarding burial or donation of 
the remains of their baby, including dissection or do-
nation to a museum. The infants in the W. D. Trotter 
Anatomy Museum were not treated in the normative 
way in terms of religious and spiritual needs of burial 
on consecrated ground. This indicates that despite 
going against social norms, it was seen as imperative 
(by the medical community at least) for these bodies 
to be used in teaching and research context at the 
time and that their educational value overrode the 
need for normative burial.

Most of the infants in the collection are aged 
around full term (40 weeks) or younger. Defining 
stillbirth in a historic osteological context is difficult; 
in this research, any individual with an estimated 
age- at- death between 20 and 40 weeks gestation is 
considered a possible stillbirth. The role of religion in 
society can impact on the choices available for burial 
of stillborn children (Murphy 2011). In some reli-
gions, receiving God’s forgiveness before death 
(through baptism or other penitential rites) was a way 
to ease the road of the departed to Heaven (Murphy 
2011). Baptism was also often a criterion for burial in 
a religious burial ground but could only be performed 
on live children (Cootes 2021; Murphy 2011; Perry 
1983). If a child looked to be in distress after birth, 
emergency baptism could be performed by a layper-
son to ensure the safe passage of their soul to Heaven 
(Code of Canon Law 1983; Clarke 2012). Under the 
Cemeteries Bill (New Zealand) 1880, the consecrated 
areas of cemeteries were exclusively under the au-
thority of the church that consecrated them. This 
meant that children who were not baptized may not 
have been able to be buried in consecrated ground, 
depending on the doctrine of the controlling church 
(Murphy 2011). This could be a source of pain for a 
deeply religious family and potentially impact the de-
cisions they would make regarding the care of their 
child after death. While the burial of stillborn chil-
dren in consecrated ground may have been pre-
vented, public cemeteries and some denominations 
did allow for the burial of stillborn children (Ockwell 
1978, 1982), as was the case in Dunedin. Archaeologi-
cal evidence from Canada and the United Kingdom 
also indicates that burial of stillborns was not un-
common (Davis 2009; Herring et  al. 1991). In New 
Zealand, there was no framework for registering 
stillbirths until 1913 and no requirement to register 
stillbirths until 1919 (Birth and Deaths Registration 
Amendment Act 1912); consequently, nineteenth- 
century stillbirth rates are unknown. Experienced 
New Zealand physicians Ernest Rawson and William 
Sealy estimated that stillbirths made up 3% to 5% of 
the births they attended between 1859 and 1895 
(Clarke 2012).



Forgotten Children192

Infant loss and family grief

She has no Baby now to call her Mother. (Eliza 
White diary 1830, cited in Clarke 2012:223)

To understand the significance of the accession of the 
infants in the museum, a consideration of emotional 
responses to infant death and normative funerary 
ritual is important. Since the 1960s, some anthropo-
logical and archaeological literature has suggested 
that in times of high infant mortality, parents would 
restrain themselves from emotionally investing in 
their infants to prevent overwhelming grief if the 
child was to die and can be used to explain infant 
atypical burial (Ariès 1962; Cannon and Cook 2015; 
Jalland 1996; Parkes 1986; Pollock 1983; Stone 1977). 
The theory of withholding of grief does not fit with 
evidence for attitudes toward infant loss in historic 
New Zealand. Unfortunately, the relatively high in-
fant mortality rates of the late nineteenth century 
meant that the reality of infant death was something 
many families faced (Clarke 2012; Jalland 1996). 
During Victorian and Edwardian times, there are ob-
vious signs of public displays of grief, which can be 
contrasted to today’s stigma and silence surrounding 
pregnancy loss or the loss of an infant (Gowland 
2020). For instance, there are primary accounts from 
New Zealand that show that miscarriage, stillbirth, 
and the death of a child were all discussed in personal 
letters between friends and family and even an-
nounced in the newspapers (Clarke 2012; Clutha 
Leader 1894; Mount Ida Chronicle 1881; Porter and 
MacDonald 1996) (e.g., Fig. 5).

Pākehā funerary practices in nineteenth- century 
New Zealand followed those of Victorian England 
and were involved and elaborate (Bedikian 2008; 
Schafer 2007). Family involvement with the body of 
the deceased was common in the United Kingdom, 
with relatives often congregating in one room with 
the body for several days (Murdoch 2015). Postmor-
tem photography and large funeral processions 
would precede interment within the week after death 
(Murdoch 2015). Children’s deaths were seen as par-
ticularly tragic for the family (Jalland 1996) and were 

mourned accordingly, with the same funerary prac-
tices and interment rights afforded to children as to 
adults. One exception to this may have been inter-
ment rights for stillborn children, who were possibly 
restricted from burial in denominational areas of 
cemeteries, as discussed previously.

Although it is highly unlikely the infant and fetal re-
mains of the W. D. Trotter Anatomy Museum are of 
Māori ancestry, discussion of infant death and mortu-
ary treatment within Māori culture is relevant, even if 
to rule out this possibility. In Māori culture, the correct 
treatment of a stillborn child after death was impera-
tive, as the souls of stillborn children were believed to 
become malignant spirits (kehua) after death. Kehua 
could cause severe illness among members of the iwi 
(tribe) and so the burial rites were particularly import-
ant to ensure the passage of the soul to Rangi (heaven) 
or Te Po (the underworld) and prevent the soul staying 
on earth, where it could cause harm (Goldie 1904). The 
community would come together at the marae (meet-
ing house) for days of whaikōrero (speeches), waiata 
(songs), karakia (prayer), poroporoaki (speeches of 
farewell), and tangi (mourning) (Jacob et al. 2011). The 
entire community (including children) would take part 
in this process, and burial would only occur after all 
the marae rituals were completed (Jacob et al. 2011).

Acquisition of human remains for education 
in New Zealand

In many modern “Western” cultures, an individual is 
often imbued with personhood throughout gestation, 
and identity acquisition begins in the womb (Gow-
land 2020; Gowland et al. 2014). This concept of per-
sonhood in infants is enshrined in New Zealand 
legislation that governs modern collections such as 
the W. D. Trotter Anatomy Museum. Since 2008, in 
New Zealand, fetal and infant tissue has been unable 
to be acquired (Human Tissue Act 2008, section 8(b)). 
If modern legislation effectively bans the collection of 
fetal and infant tissue under the guise of the individ-
ual being unable to consent, why was the acquisition, 
preservation, and storage of infant and fetal tissue 
considered appropriate in nineteenth- century New 
Zealand? This can be understood within the different 
social context from when the remains were acquired. 
The fetal and infant skeletal remains were collected 
when the Anatomy Act 1875 was the governing legis-
lation for schools of anatomy. This act, modeled on 
the 1832 UK Anatomy Act, allowed for the dissection 
of human remains by the schools of anatomy if per-
mission for dissection was given by the individual 
with legal custody of the body after death (Anatomy 
Act 1875). This law theoretically allowed for any indi-
vidual to undergo dissection, including women and 

Figure 5. An example of an announcement of stillbirth; Mataura 
Ensign, 12 July 1887. Courtesy of The National Library of New Zealand | 
Te Puna Mātauranga o Aotearoa.



Southorn et al. 193

children, unless they had explicitly stated they did 
not want to undergo dissection (Anatomy Act 1875). 
In line with evidence from skeletal collections from 
other parts of the world, it is likely these remains 
were collected to study development and pathology 
(Dittmar and Mitchell 2016), and the continued pref-
erential holding of these remains over (anatomically 
normal) males dissected over the past 150 years at the 
Otago Medical School suggests they were valued for 
their rarity and role in education.

The purchase of skeletal remains was a fast and 
straightforward way to build a collection from the 
mid- nineteenth to late twentieth centuries during the 
formative period for anatomization of human mate-
rial (Hefner et al. 2016). India was the primary source 
of (adult) skeletal remains, which were unfortunately 
often robbed from graves, coerced from families, or 
taken under false pretenses such as for postmortem 
examinations and then processed for medical use 
(Hefner et al. 2016). However, acquisition records in-
dicate the primary sources of infant remains for the 
Medical School include being donated or acquired 
from the local community immediately after their 
deaths. It may be that the infants that were acquired 
for cadaveric dissection remain in the W. D. Trotter 
Anatomy Museum today. Of the four individuals also 
found in Gourley’s ledgers, three were listed as hav-
ing a cost for the “University” as a part of the entry, 
for “supplying” the body. The typical cost for supply-
ing a body to the institution was £5 (which translates 
to roughly $1,151 NZD in 2023), but the cost associ-
ated with one infant, who died in Dunedin from a 
cerebral hemorrhage, cost £31, which amounts to a 
modern $7,137 NZD. The willingness to pay the rela-
tively high cost associated with obtaining these re-
mains for anatomy education suggests the high 
demand for cadavers in Dunedin. There is no evi-
dence from any historical sources for widespread 
graverobbing of bodies for use in anatomical educa-
tion within the New Zealand context.

Body donation of infants, medical authority, 
and the intersection of class, stigma, and 
structural violence

Body donation in nineteenth- century New Zealand 
was almost unrecognizable from the modern body 
bequest program in place at the University of Otago. 
The current body bequest program at the University 
of Otago, in line with the New Zealand Human Tis-
sue Act 2008, requires informed, clear, written con-
sent from the individual and the individual’s family. 
One of the desired outcomes of the Anatomy Act 1875 
was to increase the availability of cadavers for medi-
cal education (Jones and Whitaker 2012). This was to 

prevent graverobbing, which had been a major prob-
lem in the United Kingdom (Dittmar and Mitchell 
2016; Jones and Whitaker 2012). The supply of cadav-
ers for education was increased by the law allowing 
the use of unclaimed bodies for dissection (Anatomy 
Act 1875). Once again, this law disproportionately af-
fected the poor and mentally ill (Jones and Whitaker 
2012). Those who had sought help during their life-
time (including poor pregnant women) and died 
while in care were now available for dissection at the 
discretion of the warden or surgeon, who were af-
forded a large amount of authority in this context.

Our historical analysis focusing on the accession 
registers and sources of bodies proves that this was  
indeed the case. Dunedin Public Hospital, the Otago  
Benevolent Institution, “Redroofs” Salvation Army 
House, the Batchelor Maternity Hospital, and Cook 
Maternity Home in Gisborne were the places of death 
on the records for these infants. These hospitals pro-
vided care beyond the immediate pre-  and postnatal 
period for poor women and their children (Clarke 
2012). “Redroofs,” alongside other Salvation Army 
Houses across the country, specifically aided single or 
unwed mothers for a brief period before and after birth. 
The marital status and socio-economic status informa-
tion that we have for these mothers is discussed below.

The Anatomy Act 1875 required consent only from 
the person who had legal custody of the body after 
death unless the prospective donor had objected to 
dissection either verbally or in writing during their 
lifetime. In most situations, the family would have le-
gal custody of an individual’s body after death and 
therefore familial consent would be required for the 
donation of the body to the university. If an individ-
ual died in hospital, prison, or an asylum, the sur-
geon or warden in charge of the institution had legal 
custody of the body. The University of Otago sought 
out these bodies; the first cadaver dissected at the 
University of Otago was that of a man who had died 
in Dunedin Public Hospital (Carmalt Jones 1945). 
Dunedin Public Hospital and the University of Otago 
were closely linked; many of the lecturers at the med-
ical school also worked in the hospital (Carmalt Jones 
1945; Hercus and Bell 1964), and it remains a teaching 
hospital to this day. It is likely that many of the re-
mains of the fetal and infant individuals within the 
collection were donated by the hospital physicians 
because the records show that all the infants acces-
sioned listed in the Register of Anatomical Material 
died while in a hospital.

In this case, the Anatomy Act 1875 disproportion-
ately affected poor families. In nineteenth- century 
New Zealand, hospital birth was seen as a last resort. 
Many towns refused to open a maternity ward at all, 
believing they were vectors for infection (Clarke 



Forgotten Children194

2012). Middle- class and wealthy women gave birth at 
home, attended by midwives or a doctor (Clarke 
2012), in which case, the family would maintain legal 
custody of the child should it pass away or be still-
born. The majority of women giving birth in hospi-
tals in the nineteenth century were poor or without 
familial support; therefore, the legal chain of custody 
meant that poor women were the most likely to be left 
without a choice in regard to the resting place of their 
children if they were stillborn or died soon after 
birth, which may have led to the acquisition of their 
infants for use in the Medical School and museum 
context. The presence of individuals with develop-
mental anomalies within the collection also suggests 
that hospital care may have been required for these 
individuals in their short life and they may have died 
in hospital. Some may also have been selectively cu-
rated within the collection as examples of pathology, 
a way to demonstrate abnormalities in development 
to medical students.

No further record of burial could be identified for 
any of the infants detailed in the Register of Anatom-
ical Material. While the register denotes a date of 
burial (for some, but not all the infants), there are no 
Dunedin City Council records of burial for these in-
fants. If in fact these infants were not buried, this is a 
major indication that they were treated differently in 
death than many of the adult cadavers who were bur-
ied. The collection and anatomization of fetuses was 
highly valued in the advancement of scientific careers 
and social prestige (Franzén 2022; Wilkie 2003), 
where curators and anatomists went through a phase 
of amassing “material” in the nineteenth century 
(Teather 1990). In the nineteenth-  and twentieth- 
century United States, women were given little to no 
agency in this process of the acquisition of their in-
fants in the anatomical context, and most were not 
aware that their baby had been taken away (Dubow 
2011; Noe 2004. Morgan (2002, 2004, 2009) has ex-
plored from a medical anthropological point of view 
the place anatomical collectors and preparers play in 
the transformation of embryos and fetuses in the so-
cial context of turning something that is mostly so-
cially unrecognizable (e.g., early pregnancy) into an 
object of cultural and social importance (Morgan 
2009:5). Franzén (2022) found in the context of ac-
quisition of fetal bodies by Uppsala University from 
ca. 1890– 1930 that mothers had different understand-
ings of fetal bodies and notions of their care than the 
physicians and anatomists.

Although the infant and fetal remains in the W. D. 
Trotter Anatomy Museum may have been donated by 
the surgeon of the hospital they died in, it is also pos-
sible that some of the families may have chosen to do-
nate the bodies of their children to support medical 

education or for other unspecified reasons, but this is 
unknown. The individual reasons behind body dona-
tion are varied and complex, and parents may have 
chosen body donation or to leave the remains of their 
child unclaimed for social, religious, or more prag-
matic reasons (Fennell and Jones 1992).

Structural violence toward women was a factor 
contributing to the acquisition of infant bodies for 
education. As stated, structural violence is harm per-
petuated against individuals or groups through the 
normalization of inequalities embedded within social 
structures and institutions (Galtung 1969; Rylko- 
Bauer and Farmer 2016), and this can be extended to 
the acquisition of human remains and dissection of 
these remains in anatomy (Nystrom 2014). A signifi-
cant proportion of the infants who were used in the 
W. D. Trotter Anatomy Museum were born to un-
married mothers, and those who were married were 
mostly from low- class families, as evidenced by the 
occupations of their husbands. There were many 
mechanisms through which structural violence im-
pacted women. The patriarchal society of colonial 
New Zealand placed blame for rape and coercive sex-
ual encounters on women (NZ Truth 1908). Social 
stigma surrounding pregnancy out of wedlock 
painted women as “shiftless and immoral” or “sin-
ners” (Garlick 2012; NZ Truth 1908) and forced 
women out of jobs, therefore making them reliant on 
social institutions (such as parishes and Benevolent 
Institutions, which often had discriminatory policies 
toward pregnant women) or family for material assis-
tance (Clarke 2012; Destitute Persons Act 1846; Gar-
lick 2012; Hospital and Charitable Institutions Act 
1885). Poor pregnant women, if not already institu-
tionalized, were forced to give birth without medical 
care or attend hospital (O’Donnell 1991). Mothers 
with financial means in nineteenth-  and early 
twentieth- century New Zealand would typically 
avoid giving birth in public hospitals, instead seeking 
maternity care in their own home from a private doc-
tor, midwife, or nurse (Clarke 2012). Some mothers 
had no choice but to give birth in the public hospital, 
either due to financial constraints or perceived social 
deviance (i.e., being a single mother) (O’Donnell 
1991). Hospital births could violate women’s auton-
omy, leaving them alone at the hands of male doctors, 
with no choice in their own birth experience, and le-
gally no custody of the body of their child should they 
die in hospital (the mother’s body would also remain 
in the custody of the surgeon, should she die while 
admitted) (Anatomy Act 1875). The social circum-
stances of a woman affected the health care she was 
able to access, the care she was entitled to, and the 
choices she was able to make for her own body and 
the body of her child.



Southorn et al. 195

There is evidence for the abandonment of infants 
and infanticide at the end of the nineteenth century 
and early twentieth century in Dunedin, with many 
of these infants remaining unidentified (e.g., Fig. 6). 
Clarke (2012) reviewed several cases, many of whom 
were from Dunedin, which was the biggest center in 
New Zealand at the time. These infants would have 
been likely candidates for medical dissection and cu-
ration in the museum. Many of the infants who were 
identified in these circumstances were “illegitimate” 
(Clarke 2012) and therefore victims of structural vio-
lence through lack of social support for women 
within a patriarchal society where being an unmar-
ried mother meant you could be shamed and unsup-
ported at various levels in society.

Conclusion

Little research has focused on the fetal and infant  
remains of anatomy museums around the globe 

(Dittmar and Mitchell 2016; Muller and Butler 2018). 
In the museum and education environment, bodies 
have, especially in the past, been objectified as ana-
tomical specimens rather than the individuals these 
remains belong to, nor has the social context been as-
sessed that culminated in their curation in these in-
stitutions’ collections. Fetal and infant remains from 
historical anatomical collections can provide import-
ant insight into the lives of mothers and infants 
during the time the remains were acquired and their 
social context. The osteological analyses found that 
there is a range of bones from individuals of different 
ages and the presence of developmental pathology, 
emphasizing their value as developmental resources 
at the time of acquisition and the authority afforded 
to the physicians in collecting them. Most individu-
als were aged at around full- term, mimicking the 
normal age- at- death distribution of infants. There is 
osteological evidence for two individuals dying 
around the time of death from birth trauma, one in-
cluding the possible use of forceps during birth, and 
there is evidence for dissection on some individuals. 
There is also osteological evidence for four individu-
als with skeletal developmental anomalies whose 
skeletal remains may have been kept for dissection 
and education as examples of anatomical “oddities.” 
The archival evidence on age- at- death and cause of 
death is similar to the osteological evidence. How-
ever, because of the loss of provenience information 
for individuals still housed in the collection, we are 
unable to identify the human remains to specific in-
dividuals. The archival evidence and social historical 
context give us insight into their acquisition through 
the consideration of structural violence at the nexus 
of factors including class and social stigma of unwed 
pregnant people, affecting the treatment of parents 
and the treatment of their deceased infants, with 
marginalization in death as they had during their 
short life. These factors should be addressed in the re-
tention of these remains and in their use in education 
and research.

Ethics Statement

We approached the University of Otago Ethics Com-
mittee and the New Zealand Department of Internal 
Affairs | Te Tari Taiwhenua for our archival research 
using the publicly available ledgers and death certifi-
cates and were advised that no ethical review was re-
quired so long as our data collection and publications 
of this information comply with all relevant legisla-
tion (i.e., Privacy Act 2020, Births, Deaths, Marriages 
and Relationships Registration Act 2021, Health In-
formation Privacy Code 2020, Human Tissue Act 
2008, etc.). Permission from the Hocken Library | 

Figure 6. Newspaper article on verdict of infanticide by abandonment, 
with mother unknown. Source: Greymouth Evening Star, 18 June 1904, p. 4.



Forgotten Children196

Uare Taoka o Hākena was obtained for the use of Fig-
ure  1. Ethics approval for the osteological research 
was gained from the University of Otago Department 
of Anatomy Body Ethics Committee.

Acknowledgments

Thank you to Gillions Funeral Services Ltd. for access 
to the archives and to the Hocken Librarians for their 
help with access to the collection and their copying of 
Figure 1. Part of the archival work was funded by the 
Department of Anatomy Summer Scholarship from 
the University of Otago awarded to ES and funding 
from the Performance Based Research Fund awarded 
to SH. We also thank Annella MacArthur, Sara Otto 
and Stephie Lončar for their language expertise in 
translating the abstract. We are especially grateful to 
Annella MacArthur for her expertise in translating 
the abstract into Scottish Gaelic, a language with a 
rich cultural heritage that remains a vital part of our 
history. We thank the Associate Editor, Co- Editor- in- 
Chief (Gwen Robbins Schug), and reviewers for their 
constructive comments challenging us to reflect on 
how to appropriately present these infants housed 
within the W. D. Trotter Museum, which is not an 
easy story to tell.

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Southorn et al. 201

Supplementary File 1

Images of the records of 
Hugh Gourley (undertaker)

Figure S1. Example of Index of Gourley’s 1925–1927 ledger. Name has been redacted.

Figure S2. Example of page of transactions with the University from Gourley’s 1908–1910 ledger. Names have 
been redacted.



Forgotten Children202

Supplementary File 2

Details of Postmortem 
Modifications, Pathological 
Descriptions, Images, and 
Differential Diagnoses
Postmortem Modifications

Pathological Descriptions

Individual O3.D15

An articulated crania of an individual with an esti-
mated age of 38 to 40 weeks gestation (accession iden-
tification O3.D15) had an 11- mm overlap of the parietal 
bones at the sagittal suture (Supplementary Figure 5). 
Overlap of the parietal and occipital bones at the 
lambdoid suture was also visible, but the amount of 
overlap was unable to be measured due to the articu-
lation of the cranial bones (Supplementary Figure 6). 
This overlap was likely the result of head molding 
during delivery. If an infant is in the correct position 
for delivery (head down), a large amount of pressure is 
distributed across the cranial vault as the fetus passes 
through the pelvis (Chasler 1967; Sorbe and Dahlgren 
1983). The flexible cranial sutures and open fontanelles 
of the fetal skull allow the bones of the cranial vault to 
shift and overlap as the fetus moves through the pelvis 
during delivery (molding) and reduces the circumfer-
ence of the skull, allowing for an easier passage 
through the birth canal (Ami 2019; Chasler 1967; 
Sorbe and Dahlgren 1983). Trauma to the brain from 
head molding can occur even in a “normal” delivery 
with no visible head molding from the birth process 
(Ami et  al. 2019; Rooks et  al. 2008). Severe cases of 
head molding can lead to intrapartum or neonatal 
death (Sorbe and Dahlgren 1983). Significant head 
molding during delivery may indicate cephalopelvic 
disproportion, when the size of the head of the infant 
and the size of the pelvic outlet are incompatible for 
birth (Buchmann and Libhaber 2008; Iversen et  al. 
2020; Munabi et al. 2016; Stewart and Philpott 1980). 
Without treatment, cephalopelvic disproportion may 
result in an obstructed labor and could be a death sen-
tence for both the mother and child (Dolea and Abou-
Zahr 2000; Shirley et  al. 2020). Treatments such as 
symphysiotomy and craniotomy were available but 
either required long convalescence postprocedure or 
resulted in the death of the infant (Jardine 1904). Cae-
sarean sections were not commonly performed in 

nineteenth- century New Zealand (Clarke 2012), and 
so an obstructed labor may have meant death or life- 
changing disability for both mother and child (Drife 
2002; Jardine 1904). It is possible that cephalopelvic 
disproportion and the resulting obstructed labor was 
the cause of the molding observed in individual 
O3.D15 and may have been the primary trauma re-
sulting in their death.

Individual O3.D6

Another individual (O3.D6) with an estimated age of 
40 weeks has perimortem trauma to the right parietal 
bone (Supplementary Figure 7). The trauma site mea-
sures 40.4 mm from anterior to posterior and lies im-
mediately superior to the right parietal eminence. 
This bone fracture displays a stellate pattern, with 
multiple fractures radiating from a middle area of 
wastage 22.3 mm in width (anterior to posterior). 
There is some plastic deformation of the remaining 
bone around this area of wastage and one fracture 
extending to but not crossing the coronal suture an-
teriorly to the trauma. Superiorly, there is another 
smaller area of wastage (11.6 mm from anterior to 
posterior). The plastic deformation of bone around 
an area of fracture indicates that the trauma occurred 
before the organic collagen component of the bone 
had degraded and so could have occurred around the 
time of death (Kemp 2016; Ubelaker 1991). Plastic de-
formation is the permanent bending of bonds be-
tween atoms in bone, caused by slow loading stress 
(Love and Wiersema 2016). A lack of remodeling or 
new bone growth around the fracture also supports 
the argument that this is perimortem trauma. Given 
this infant’s age and the nature of the blunt- force 
trauma, one possible cause of this trauma is from the 
use of forceps during delivery (Chasler 1967; Dupuis 
et al. 2005; Kendall and Woloshin 1952). Instrumen-
tal forceps deliveries were common at the time for 
both prophylaxis and intervention in obstructed la-
bor (DeLee 1920).

Individual O3.D7

This individual is represented by an articulated cra-
nia with an estimated age- at- death of younger than 
one month post- birth. Age estimation from the den-
tition and the cranial size were consistent. This indi-
vidual is well preserved except for postmortem 
damage to the maxilla and mandible, exposing the 
dentition. Individual O3.D7 exhibits bilateral fusion 
of the coronal and squamous sutures (Supplementary 
Figure 4). The coronal suture had also begun to oblit-
erate. Fusion of these cranial sutures normally begins 
in adulthood (Cunningham et al. 2016).



Southorn et al. 203

Individual O3.D14

Individual O3.D14 is represented by an articulated cra-
nia with an estimated age- at- death of one to three 
months post- birth. Estimations of age from the denti-
tion and the cranial bone size were consistent. Individ-
ual O3.D14 exhibits significant postmortem damage to 
the left and right parietal bones, exposing the dura ma-
ter that has been preserved inside the cranium. This 
damage has likely occurred to the thin bones during 
the use of the individual in medical and anatomical ed-
ucation at the University of Otago. This individual has 
evidence for developmental pathology in the form of 
bilateral fusion of the squamous and coronal sutures 
without total obliteration and abnormal frontal bossing 
(Supplementary Figure  8). In addition, approximately 
midway down, and either side of the metopic suture, 
there is an area of irregularity. At this level, on the right 
frontal bone, there is a small area of exposed dura; to 
the left in the same location appears to be an area of 
thinning bone (Supplementary Figure 9).

Individual O3.D180

The third individual represented by an articulated 
skull displaying pathology, individual O3.D180, was 
38 to 40 weeks gestation with evidence for develop-
mental abnormalities. This individual has an abnor-
mally large anterior fontanelle (Supplementary 
Figure 10), one large intrasutural bone in the medial 
part of the lambdoid suture (Supplementary Fig-
ure 11), an underdeveloped face, and many very small 
intrasutural bones (Supplementary Figures 11 and 12).

Individual O5.D1

Individual O5.D1 is an articulated full skeleton. Age 
estimation from the dentition was not possible due to 
the remains being encased but is likely a neonate 
based on the individual’s size. Analysis found the 
frontal bone sits significantly inferior (~1 cm) to the 
parietals at the level of the anterior fontanelle, and 
the occipital contained three extra bone ossicles (in-
trasutural bones) in the superior portion around the 
level of lambda extending right and inferiorly (Sup-
plementary Figure  13). As well as this, the anterior 
fontanelle appeared unusually large. Post- cranially, 
the axial skeleton exhibited an anteriorly protruding 
sternum and ribcage. The pelvis is narrow and inter-
nally rotated on the left with the developing sacrum 
and coccyx curving around through and above the 
pelvis inlet. On the appendicular skeleton, the hu-
merus is angled medially bilaterally, creating a high 
carrying angle at the elbow, and there is a left devia-
tion of both femora in the acetabulum. There is 

bilateral medial deviation of the feet from the meta-
tarsals to phalanges. The left first metatarsal sits 
slightly under the second metatarsal. The right foot 
exhibited postaxial polydactyly type A (Benjamin 
et al. 2022) with a broad fifth metatarsal bone and no 
shaft duplication, but with duplication at the phalan-
geal level, creating six phalanges.

Differential Diagnosis

Individuals O3.D7 and O3.D14

Premature fusion of the cranial sutures or craniosyn-
ostosis is a relatively common developmental anom-
aly, affecting around 1/2,500 children (Aleck 2004; di 
Rocco et  al. 2009). Untreated craniosynostosis can 
lead to abnormal growth of the cranium and in-
creased intracranial pressure (Governale 2015). Most 
cases of craniosynostosis are isolated and are not 
usually inherited. These cases are known as primary 
nonsyndromic craniosynostosis and typically affect 
one cranial suture only, most commonly the sagittal 
suture (Aleck 2004; Governale 2015; Ranger et  al. 
2010). Due to the number of sutures involved in the 
cases of craniosynostosis in individuals O3.D7 and 
O3.D14, primary nonsyndromic craniosynostosis is 
an unlikely diagnosis (Aleck 2004; Governale 2015).

Syndromic craniosynostosis results from genetic 
mutations, most commonly in the fibroblast growth 
factor receptor (FGFR) genes (Aleck 2004; Governale 
2015). Although syndromic genes can mutate sponta-
neously, most cases of syndromic craniosynostosis 
have a familial component (Governale 2015). The 
most common conditions that cause syndromic cra-
niosynostosis are Crouzon syndrome, Jackson– Weiss 
syndrome, Apert syndrome, and Pfeiffer syndrome 
(Aufderheide and Rodríguez- Martin 1998). All these 
conditions present with craniosynostosis, along with 
variable cranial and midface deformities, and usually 
with specific diagnostic features in the post- cranial 
skeleton. As O3.D7 and O3.D14 are only represented 
by skulls, any post- cranial skeletal pathology is un-
able to be assessed, leaving the diagnosis inconclusive 
for these two individuals (Supplementary Tables  2 
and 3, respectively).

Individual O3.D180

The differential diagnosis for this individual focused 
on conditions that result in abnormally large fonta-
nelles and an underdeveloped face, as well as disorders 
of bone development and ossification, including achon-
droplasia, increased intracranial pressure, rickets, con-
genital hypothyroidism, Down syndrome (trisomy 21), 



Forgotten Children204

Edwards syndrome (trisomy 18), and intrauterine 
growth restriction (Supplementary Table  4). As with 
the previous individuals discussed, the absence of post- 
cranial remains means a more conclusive diagnosis of 
congenital disorders is not possible. The congenital 
conditions consistent with most of the pathology pres-
ent of this individual are Edwards syndrome (trisomy 
18) or congenital hypothyroidism. Edwards syndrome 
is a rare genetic condition caused by the presence of 
one extra partial or full chromosome 18 and occurs in 
approximately 1 in 8,000 live births (Cereda and Carey 
2012). Individuals with trisomy 18 have low birth 
weight, growth restriction, an underdeveloped face, a 
wide anterior fontanelle, and a narrow forehead with a 
“strawberry- shaped” skull that is brachiocephalic with 
a flattened occipital bone and pointed frontal bones, all 
consistent with O3.D180’s morphology (Supplementary 
Figure 10). Edwards syndrome is associated with a very 
high fetal and infant mortality rate, where almost 40% 
of affected individuals who make it to term die during 
labor (Cereda and Carey 2012).

Congenital hypothyroidism (CH) occurs when 
there is a lack of the hormones triiodothyronine and 
thyroxine, which stimulate metabolism and are im-
portant in the formation and maturation of bone 
(Rastogi and LaFranchi 2010). Congenital hypothy-
roidism can be permanent or transient. Permanent 
CH is the result of thyroid abnormalities or errors of 
thyroid hormone biosynthesis, while transient CH 
can occur due to thyroid- stimulating hormone defi-
ciency or congenital hypopituitarism. Maternal io-
dine deficiency can also cause transient CH (Rastogi 
and LaFranchi 2010), which is important within the 
New Zealand context as the soil is naturally low in 
iodine, and goiter was common in the population 
prior to the introduction of iodized salt in the 1920s 
(Hercus et al. 1925). Signs of CH typically arise in the 
soft tissue, but CH can also cause abnormal develop-
ment in skeletal tissue, resulting in wide anterior and 
posterior fontanelles, open sutures, and epiphyseal 
dysgenesis (Rastogi and LaFranchi 2010; van Vliet 
et al. 2003).

There is a discrepancy of estimated skeletal age of 
this individual (34– 36 weeks gestation) compared 
with a dental age estimation of 38 to 40 weeks gesta-
tion. It is possible that this individual suffered intra-
uterine growth restriction as the result of a genetic 
condition or concurrently with a genetic condition as 
a result of maternal health and placental conditions 
(Hendrix and Berghella 2008; Sharma et al. 2016).

Individual O5.D1

When considering individual O5.D1, there are clear 
developmental anomalies, and diagnoses considered 
focused on the postaxial polydactyly, including triso-
mies 13 and 18, Ellis– van Creveld syndrome, and 
Greig cephalopolysyndactyly syndrome. While no 
diagnosis was definitive, O5.D1 has features sugges-
tive of trisomy 13 (also known as Patau syndrome), 
chondroectodermal dysplasia (Ellis– van Creveld 
syndrome), and hydrolethalus syndrome (Supple-
mentary Table 5).

Trisomy 13 presents as a multiple congenital anom-
aly pattern and occurs in approximately 1 in 10,000 
live births (Carey 2022). First described in 1960, tri-
somy 13 is caused by the translocation of all or part of 
chromosome 13, resulting in an individual with 47 
chromosomes. The cardinal signs of trisomy 13 are 
orofacial clefts, microphthalmia/anophthalmia, and 
postaxial polydactyly of the hands and feet, but these 
features only have 60% to 70% occurrence in the syn-
drome, making diagnosis challenging (Carey 2022). 
Soft tissue defects and organ malformations can add 
weight to the diagnosis, but obviously not in skeletal 
material such as O5.D1. The lethality of trisomy 13 
depends on the degree of malformation and can vary 
between individuals.

Chondroectodermal dysplasia, also known as 
Ellis– van Creveld syndrome, was first reported in 
1940, with more than 200 cases now identified. O5.D1 
shares some features with chondroectodermal dys-
plasia, such as polydactyly of the feet, short middle 
phalanges, and abnormal rib development (Jones 
et  al. 2021), but once again, diagnosis is limited as 
clinical diagnoses make use of abnormalities in the 
soft tissue. Approximately half of children born with 
chondroectodermal dysplasia die in early infancy, 
usually as a result of cardiorespiratory malforma-
tions (Jones et al. 2021).

Two disorders of primary cilium structure were 
also considered: Meckel– Gruber and hydrolethalus 
syndrome. Both syndromes are the result of genetic 
mutations in the genes encoding the primary cilium, 
and a common feature is postaxial polydactyly (Carey 
2022; Hartill et  al. 2017; Salonen and Herva 1990). 
Meckel– Gruber and hydrolethalus are considered le-
thal, with most infants with the disorders stillborn or 
dying within a few days of birth (Carey 2022; Hartill 
et al. 2017; Salonen and Herva 1990). Meckel– Gruber 
and hydrolethalus syndromes primarily manifest in 
the organs, with some skeletal features present.



Southorn et al. 205

Figure S3. View of the left side of the skull of individual O3.D6. The cranial vault has been opened 
using a postmortem transverse cut. (A) Arrow indicating an example of the postmortem shallow 
demarcation kerf mark on the left lateral frontal bone. (B) Arrow indicating the kerf marks 
crossing the left squamosal suture.

Figure S4. View of the left side of the skull of individual O3.D7 showing fusion and partial obliteration of the 
coronal and squamous sutures. Arrow indicating an example of the shallow demarcation kerf marks on the 
left parietal bone.



Forgotten Children206

Figure S5. The overlap of the left parietal bone over the right parietal 
bone at the sagittal suture in individual O3.D15.

Figure S6. The overlap of the parietal bones over the occipital bone at 
the lambdoid suture in individual O3.D15.



Southorn et al. 207

Figure S7. Trauma to the right parietal bone of individual O3.D6.

Figure S8. View of the right side of the cranium of individual O3.D14 showing fusion of the squamous suture 
and frontal bossing. Bone fracturing is postmortem.



Forgotten Children208

Figure S9. Anterior view of individual O3.D14 showing abnormal parietal bossing due to the premature fusion of the squamous and coro-
nal sutures. Arrow indicating the area of irregularity in the region of the metopic suture.



Southorn et al. 209

Figure S10. The extremely wide anterior fontanelle of O3.D180. Figure S11. The lambdoid suture of individual O3.D180, with one large 
and many small intrasutural bones.

Figure S12. The left side of the cranium of individual O3.D180, showing the open lambdoid, sphenoparietal 
and occipitomastoid sutures, and intrasutural bones. The small midface is also visible.



Forgotten Children210

Figure S13. Posterior view of the cranium of individual O5.D1, showing 
the three wormian bones at the level of lambda.

Figure S14. Left lateral view of individual O5.D1, showing the frontal bone sitting inferiorly to 
the parietal bone, as well as the abnormally protruding ribs and sternum.



Southorn et al. 211

Figure S15. Posterior view of individual O5.D1, showing the high carry-
ing angles in the upper limb, internal rotation of the pelvis, and left de-
viation of the femur.

Figure S16. The feet of individual O5.D1, with post-axial polydactyly 
type A (Benjamin et al. 2022) of the right foot.



Forgotten Children212

Supplementary Table S1. Death information for the babies listed in the University of Otago Register for Anatomical Material, supplemented with 
information from official death certificates.

Age at 
Death Year

Official Death 
Certificate

Father 
Recorded

Father 
Occupation Place of Death*

Cause of Death 
(Death Certificate)

Cause of 
Death 
(Register of 
Human 
Material)

Record of 
Burial

3 days 1885 No — — Hospital (Register) — — Not found
15 days 1903 Yes Recorded Groom Nelson St, South 

Dunedin (Dunedin 
Hospital)

Malformation, 
inanition

Heart Not found

6 hours 1913 Yes Not 
recorded

— Maternity Hospital 
Forth Street (later 
renamed Batchelor 
Hospital)

Prematurity Premature Not found

6 days 1915 No Recorded — Hospital (Register) — Spina bifida Not found 
(found birth 
certificate, 
not death 
certificate)

14 days 1916 Yes Not 
recorded

— Salvation Army Home, 
Dunblane St, Roslyn 
("Redroofs")

Congenital heart 
disease

— Not found

3 days 1916 No — — Dunedin Hospital 
(Register)

— Syphilis Not found

10 hours 1917 Yes Not 
recorded

— Salvation Army Home, 
Dunblane St, Roslyn 
("Redroofs")

Cerebral 
compression 
during delivery

Cerebral 
hemorrhage

Not found

6 weeks 1918 No — — "Redroofs" (Register) — TB enteritis Not found
1.5 hours 1919 No — — Dunedin Hospital 

(Register)
— Prematurity Not found

5 weeks 1920 Yes Not 
recorded

— Dunedin Hospital Pyloric stenosis Pyloric 
stenosis 
malnutrition

Not found

2 days 1921 Yes Recorded Bricklayer Batchelor Hospital Congenital defect 
in heart

Congenital 
defect in 
heart

Not found

2 days 1921 Yes Not 
recorded

Maternity Hospital 
Forth St (Batchelor 
Hospital)

Immaturity Prematurity Not found

2 days 1925 Yes Recorded Carpenter Batchelor Hospital Immaturity Prematurity Not found
1 days 1926 Yes Recorded — Batchelor Hospital Tracheal 

obstruction
Large thyroid 
gland, 
tracheal 
obstruction

Not found

20 minutes 1926 No — — — — Prematurity Not found
6 days 1926 Yes Recorded Clerk Batchelor Hospital Hemorrhage 

neonatorum
Hemorrhage Not found

32 hours 1928 Yes Recorded Blacksmith Batchelor Hospital Anencephalous Malforma-
tion

Not found

2 days 1928 Yes Recorded Driver Batchelor Hospital Immaturity Prematurity 
(?), debility, 
etc.

Not found

2 day 1929 Yes Not 
recorded

— Batchelor Hospital Prematurity Prematurity, 
debility, 
cardiac 
condition

Not found

28 hours  1930 Yes Recorded Laborer Batchelor Hospital Immaturity Immaturity Not found
6 day 1931 Yes Not 

recorded
— Public Hospital 

Dunedin
Inanition Inanition Not found

4 hours 1934 Yes Recorded Laborer Batchelor Hospital Neonatal asphyxia Congenital 
defects

Not found

6 hours 1934 Yes Recorded Laborer Maternity Home, 
Gisborne

Imperfect 
development 
monster

Imperfect 
development. 
Anencephaly. 
Monster

— 

9 days 1936 No — — Dunedin Hospital 
(Register)

— Inanition Not found

*Register in parentheses is denoted if there was no information on the death certificate and information was obtained from the University of Otago Register 
of Human Material.



Southorn et al. 213

Supplementary Table S2. Features considered in the differential diagnosis for individual O3.D7.

Possible Diagnosis Skeletal Features
Present (✔), Absent (x), or 
Unobservable (– ) in O3.D7 Source

Primary nonsyndromic 
craniosynostosis

Single suture synostosis 
(normally sagittal)

x Aleck 2004 
Aufderheide and Rodríguez- Martin 1998

Crouzon syndrome (not 
typically recognizable until 
end of the first year)

Craniosynostosis 
Underdeveloped midface 
Prominent forehead 
Shallow orbits 
Receding maxilla 
C2/C3 or C5/C6 fusion 
Sacrococcygeal tail

✔ 
x 
x 
x 
x 
–  
– 

Aleck 2004 
Al- Namnam et al. 2019 
Aufderheide and Rodríguez- Martin 1998

Jackson– Weiss syndrome Craniosynostosis 
Shallow orbits 
Midfacial retrusion 
Foot abnormalities

✔ 
x 
x 
– 

Tartaglia et al. 1997

Apert syndrome Craniosynostosis 
Acrocephaly 
Underdeveloped midface 
Shallow orbits 
Symmetrical syndactyly

✔ 
x 
x 
x 
– 

Liu et al. 2013 
Aufderheide and Rodríguez- Martin 1998

Pfeiffer syndrome Craniosynostosis (coronal and 
sagittal) 
Shallow orbits 
Underdeveloped midface 
Syndactyly

✔ (coronal only)
 
x 
x 
– 

Giancotti et al. 2017

Supplementary Table S3. Features considered in the differential diagnosis for individual O3.D14.

Possible Diagnosis Skeletal Features
Present (✔), Absent (x), or 
Unobservable (– ) in O3.D14 Source

Primary nonsyndromic 
craniosynostosis

Single suture synostosis 
(normally sagittal)

x Aleck 2004 
Aufderheide and Rodríguez- Martin 1998

Crouzon syndrome (not 
typically recognizable until 
end of the first year)

Craniosynostosis 
Underdeveloped midface 
Prominent forehead 
Shallow orbits 
Receding maxilla 
C2/C3 or C5/C6 fusion 
Sacrococcygeal tail

✔ 
x 
✔ 
x 
–  damaged postmortem 
–  
– 

Aleck 2004 
Al- Namnam et al. 2019 
Aufderheide and Rodríguez- Martin 1998

Jackson– Weiss syndrome Craniosynostosis 
Shallow orbits 
Midfacial retrusion 
Foot abnormalities

✔ 
x 
x 
– 

Tartaglia et al. 1997

Apert syndrome Craniosynostosis 
Acrocephaly 
Underdeveloped midface 
Shallow orbits 
Symmetrical syndactyly

✔ 
x 
x 
x 
– 

Liu et al. 2013 
Aufderheide and Rodríguez- Martin 1998

Pfeiffer syndrome Craniosynostosis (coronal and 
sagittal) 
Shallow orbits 
Underdeveloped midface 
Syndactyly

✔ (coronal only)
 
x 
x 
– 

Giancotti et al. 2017



Forgotten Children214

Supplementary Table S4. Features used in the differential diagnosis of individual O3.D180.

Possible Diagnosis Skeletal Features
Present (✔), Absent (x), or 
Unobservable (– ) in 03.D180 Source

Achondroplasia Macrocephaly 
Wide anterior fontanelle 
Midfacial retrusion 
Prominent forehead 
Short limbs

x 
✔ 
x 
x 
– 

Pauli 2019 
Lewis 2019

Increased intracranial pressure Macrocephaly 
Wide fontanelles

x 
✔

Vertinsky and Barnes 
2007

Rickets (features usually visible 
after four months of age)

Thin bone 
Posterior flattening of the cranial vault 
Subperiosteal bone deposition 
Delayed fontanelle closure 
Bending of long bones 
Thickening of long bone shafts

x 
x 
x 
✔ 
– 
– 

Brickley and Ives 2008 
Ortner 2003

Congenital hypothyroidism Wide anterior fontanelle 
Wide posterior fontanelle 
Open sutures 
Flat nasal bridge 
Macrocephaly 
Femoral epiphyseal dysgenesis

✔ 
✔ 
✔ 
x 
x 
– 

Rastogi and LaFranchi 
2010 
Aufderheide and 
Rodríguez- Martin 1998

Trisomy 21 (Down’s syndrome) Delayed ossification 
Wide anterior fontanelle 
Brachycephaly 
Bulging forehead 
Small nose 
Flat nasal bridge 
Short lower limb bones

x 
✔ 
x 
x 
x 
x 
– 

Barden 1983 
Aufderheide and 
Rodríguez- Martin 1998

Trisomy 18 (Edwards’ syndrome) Prominent occiput 
Narrow bifrontal diameter 
Wide anterior fontanelle 
Cleft palate 
Low- set, malformed auricles 
Short hallux, frequently dorsiflexed 
Small oral opening 
Narrow palatal arch 
Micrognathia 
Small pelvis 
Overlap of second and third fingers 
“Rocker bottom” feet

✔ 
✔ 
✔ 
x 
–  
–  
x 
x 
x 
–  
–  
– 

Cereda and Carey 2012 
Jones et al. 2021

Intrauterine growth restriction 
(IUGR)

Macrocephaly (not in symmetrical IUGR) 
Poor formation of bone 
Wide anterior fontanelle

x 
✔ 
✔

Sharma et al. 2016



Southorn et al. 215

Supplementary Table S5. Features used in the differential diagnosis of O5.D1.

Possible Diagnosis Skeletal Features
Present (✔), Absent (x), or 
Unobservable (– ) in O5.D1 Source

Trisomy 13 (Patau Syndrome) Sloping forehead 
Spinal malformations 
Wide anterior fontanelle 
Presence of a cervical rib 
Absence of the 12th rib 
Anomalies in rib morphology 
Low acetabular angles 
Long distal phalanges 
Malformation of fifth finger and toe 
Polydactyly 
Prominence of the nasal bridge and tip 
Orofacial clefts 
Microphthalmia/anophthalmia

x 
x 
✔ 
x 
x 
✔ 
–  
x 
✔ toe 
✔ 
✔ 
x 
x

Kjaer et al. 1997 
Jones, Jones and Del Campo 2021 
Carey 2022

Trisomy 18 (Edwards’ syndrome) Prominent occiput 
Narrow bifrontal diameter 
Wide anterior fontanelle 
Cleft palate 
Low- set, malformed auricles 
Short hallux, frequently dorsiflexed 
Small oral opening 
Narrow palatal arch 
Micrognathia 
Small pelvis 
Overlap of second and third fingers 
“Rocker bottom” feet

x 
x 
✔ 
x 
x 
x dorsiflexion 
x 
x 
x 
✔ 
x 
x

Cereda and Carey 2012 
Jones et al. 2021

Chondroectodermal dysplasia 
(Ellis– van Creveld syndrome)

Small stature of prenatal onset 
Disproportionate extremities 
Polydactyly 
Short, broad middle phalanges and 
hypoplastic distal phalanges 
Malformed carpals 
Fusion of capitate and hamate, and 
extra carpal bone 
Narrow thorax with short, poorly 
developed ribs 
Hypoplasia of upper lateral tibia 
Pelvic dysplasia 
Neonatal teeth

–  
x 
✔ 
✔ broad middle on hand 
 
–  
✔ abnormal ribcage 
development 
x

–  
x

Jones et al. 2021

Greig cephalopolysyndactyly 
syndrome

High forehead 
Frontal bossing 
Macrocephaly 
Broad nasal root 
Postaxial polydactyly (hands only) 
Broad thumbs 
Syndactyly 
Preaxial polydactyly (feet only) 
Broad halluces 
Syndactyly 
Broad, late closing cranial sutures 
Trigonocephaly

x 
x 
x 
x 
x (feet only) 
x 
–  not complex 
x (postaxial polydactyly) 
x 
–  not complex 
x 
x

Jones et al. 2021 
Malik 2012 
*simple syndactyly cannot be 
observed without soft tissue, and 
therefore cannot be excluded. 
Complex syndactyly can be excluded 
due to the normal bone formation of 
the hands and feet with the exception 
of the polydactyly*

Meckel– Gruber syndrome Postaxial polydactyly of hands and 
feet 
Bowing and shortening of the long 
bones 
Cleft lip and palate

✔
 
x
 
x

Hartill et al. 2017

Hydrolethalus syndrome Occipital bone defect 
Micrognathia 
Polydactyly 
Club feet 
Short limbs

x 
x 
✔ 
✔ 
x

Salonen and Herva 1990


