Forensic Science, Medicine, and Pathology
Copyright © 2005 Humana Press Inc.
All rights of any nature whatsoever are reserved.
ISSN 1547-769X/05/1:277 284/$30.00 eISSN 1556-2891
DOI: 10.1385/Forensic Sci. Med. Pathol.:1:4:277
FOSSICKINGS
A Bite Into the History of the Autopsy
From Ancient Roots to Modern Decay
Julian L. Burton
Academic Unit of Pathology, University of Sheffield Medical School, Sheffield, UK
Address for correspondence
and reprints:
Abstract
Julian L. Burton
The autopsy has had a checkered history, much of which has been surrounded by
Academic Unit of Pathology
controversy. The roots of human dissection are found in the ancient world where
E-Floor
rumors flourished that the prosectors of the day were engaged in vivisection as
University of Sheffield Medical
well as dissection. Bound up with the prevailing religious and political systems
School
of the day, the autopsy has alternately been prohibited and encouraged, used to
Beech Hill Road
explore the nature of disease, and conceal questionable political policy. This
Sheffield
review explores the history of the autopsy from its ancient roots in Egypt,
S10 2RX UK
Mesopotamia, Alexandria, and the Far East through the dark ages to medieval
E-mail: [e-mail]
times and beyond into the renaissance. The development of the autopsy in Europe
during the 17th to 19th centuries is discussed before briefly considering the
Accepted for publication:
decline of this diagnostic tool in the 20th century.
September 8, 2005
Key Words: Autopsy; history of medicine; necropsy; dissection.
(DOI: 10.1385/Forensic Sci. Med. Pathol.:1:4:277)
external examination, with no effort being made to examine
INTRODUCTION
the internal organs (2,5), or indeed to an interview with rela-
To investigate the causes of death, to examine
tives of the deceased, with no attempt to examine the body
carefully the condition of organs, after such changes
(6,7). Although dissection now has a limited meaning confined
have gone on in them as to render existence impos- to the cutting apart or separating of tissues and organs one
sible and to apply such knowledge to the preven- from one another for further study, it once was synonymous
with the examination we designate as an autopsy today. By
tion and treatment of disease, is one of the highest
contrast, anatomization, a term now rarely used, suggests an
objects of the physician.
extreme dissection similar to that undertaken by medical stu-
dents learning anatomy, in which the body is slowly reduced
 Sir William Osler (1849 1919); Extracted from
to its component parts.
his Graduation thesis  Pathologic Anatomy (1)
Humans have always been repulsed and/or fascinated by
Autopsy (derived from the Greek autopsia) means  to see the prospect of examination of the internal workings of the
for oneself (2,3) (literally  to look at the dead [4]) and is human body. As seen here, this fascination has not always
synonymous with the terms postmortem, postmortem exami- been confined to a dissection of the deceased. Such attitudes
nation, and necropsy. None of these terms have specific mean- have been inextricably linked with the prevailing religious and
ings that allow the extent or precise nature of the investigation political climates of the time, and, furthermore, reflect the
to be inferred from their use. In current practice, autopsy indi- epistemological advances in our understanding of medicine
cates a detailed examination that includes (but is not limited and disease. Auguste Comte (1798 1857) argued that the
to) the external examination of the cadaver, and the eviscera- human mind has progressed from a theological stage, through
tion and subsequent careful dissection of the contents of the a metaphysical stage, to a final positive stage. In the theolog-
cranial, thoracic, abdominal, and pelvic cavities (although the ical stage, primitive attempts were made to explain behavior
examination may be restricted to particular body cavities by in terms of spiritual or supernatural entities. The metaphysical
relatives wishes or because of some infectious hazard). In stage was a modification of this and explained behavior in
some countries, the postmortem may consist solely of an terms of abstractions, essences, or forces. The positivistic stage
277
278 ___________________________________________________________________________________________Burton
dispensed with these concepts and turned to observation and limited their knowledge of internal anatomy to that gleaned from
reason ( science ) as a means of understanding behavior (8). the inspection of wounds and the dissection of animals (9).
Similarly, the purposes for which postmortem examinations Indeed, we might well regard the observations through wounds
were performed have evolved from the prophetic, through a made on battlefields by sabre-slashes as the first autopsies (3,11).
search for an imbalance of the humors, to a scientific approach The use of animal dissection,promoted by Aristotle (384 322
to the evaluation of the nature and extent of disease and the BC), was subsequently used to ground biomedical knowledge
cause of death. Modern medicine has an anatomical and phys- in Alexandrian medicine. Herophilus (c. 335 280 BC), how-
iological attitude underlying most diseases and, even when ever, is reported to have performed vivisections on live humans
such causes cannot be proven we assume that they will some- (probably condemned criminals) and public dissections on
day be elucidated in these terms. human cadavers. His interest was in learning and teaching
What follows is a brief account of the history of the autopsy. anatomy (12). He discovered and named the prostate, duode-
From an exploration of the roots of human dissection in the num (from the Greek for 12 fingers), and the structure that bears
ancient world, I will lead you through the dark ages and his name, the torcular Herophili (the confluence of the intracra-
medieval times to the renaissance. Here we will find the core nial sinuses) (10). That Herophilus described the rete mirabile
that was necessary for the emergence of pathology as a (a network of arteries found at the base of the brain in primates)
medical discipline and the development of the modern autopsy. demonstrates that some of his dissections were also performed
Finally, we consider the contemporary decay of the autopsy in animals; the rete mirabile is not present in humans.
and how the autopsy may evolve from this in the future. The application of human dissection altered little over the
subsequent four centuries. The classical Greeks and their suc-
THE ANCIENT WORLD
cessors were working with an entirely different concept of
The ancient Egyptians, whose civilization rose under the disease; namely a misbalance of humors. This model gives no
Pharaohs around 3000 BC, practiced medicine that had both particular significance to the physical state of the organs and
an empirical and a magico-religious aspect. Human dissec- therefore does not see any particular clinical interest in the
tion was confined to the process of mummification, in which autopsy. The work and views of Galen (129 c. 216 AD) were
embalmers of low social caste attempted to preserve the body to dominate and constrain medicine for the next millen-
intact for its journey through the afterlife (9). The internal nium. Galen practiced his medicine on the gladiators of the
organs were removed through small incisions (although the Roman Empire. However, although he prided himself on being
heart, believed to be the seat of the soul and required by the an expert clinician, he was also a medical scientist and per-
deceased so that it could be weighed against the feather of formed dissections. These were mainly performed on apes,
truth, was left in situ). The brain was removed via the nose sheep, pigs, goats, and even an elephant s heart. Many were
using hooks. Once removed, the organs were stored in special performed in public and, it seems, Galen was something of a
Canopic jars (9). Although it was acceptable to tamper with showman. We can readily imagine the crowd watching with
the body of the deceased in this manner, the procedure was awe as he demonstrated with a flourish that a precise cut here
performed for entirely magico-religious reasons and no attempt with a sharp knife deprived a pig of the use of its hind legs.
was made to understand disease in the living from an exami- Another downward thrust of the blade, here, and the pig s
nation of the dead. forelegs failed. As the animal s pitiful squeals echoed through
Disease was similarly thought to be the result of supernat- the masses, a final triumphant blow, here at the base of the
ural intervention in ancient Mesopotamia ( the kingdoms skull, silenced them forever and ended the creature s life
between two rivers : the Tigris and Euphrates) (9). Rather than (9,13). Human dissection was out of the question (12,14),
looking to the corpse for an understanding of disease, omen- although he told of examining two skeletons observed by
based prognostic practices flourished, including the exami- chance, one washed from a grave by a flood and another of an
nation of the liver (hepatoscopy) and entrails (haruspicy) of unburied thief picked clean by carrion birds (10). (Although
sacrificed animals (9). Hepatoscopy and haruspicy can be traced most sources state that Galen did not dissect humans, some
back to the time of Sargon I of Babylon (c. 3500 BC). Using authors suggest that Galen formally used autopsies in his work
such techniques, Mesopotamian medicine was effectively  sys- [3]. Given his perpetuation of erroneous concepts such as the
tematized sorcery (9). Disease was regarded in an anamistic rete mirabile this seems unlikely). Galen s dominance over the
fashion, that is, controlled by gods or spiritual forces, whose medical establishment and his assertions on human anatomy
intentions could be read in the liver by the haruspex (10). based on comparative anatomy in apes and other mammals
The Greek civilization began to emerge around 1000 BC, but were to remain largely unchallenged for 1400 years (9,15).
little is known of their medicine before the emergence of
AUTOPSIES IN THE DARK AGES
written texts around 500 BC (9). Hippocrates (c. 460 377 BC)
AND MEDIEVAL TIMES
promoted a naturalistic philosophy that disease resulted from
 natural causes. Early Greek physicians had a sound grasp of Little is known of Western autopsy practices in the early
surface anatomy, but cultural mores against human dissection middle ages. In the early medieval West, dissection of the
Forensic Science, Medicine, and Pathology
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A Bite Into the History of the Autopsy ________________________________________________________________279
human cadaver remained closely bound up with the religious performed) was not included in coronial inquests and is not
beliefs of the time. Dissection for scientific advancement was mentioned in the Eyre records of 198 cases of suicide from
all but unheard of (2) and there was a belief in the sanctity of 1272 to 1300 AD (20). (In England, coronial inquests would
the intact body (16). Indeed, no mention of human dissection not include autopsy findings for another 400 years [21].)
for such purposes is to be found in Paul Binski s 1996 account Disease, death, and decay were considered to be signs of
of medieval death, ritual, and representation (17). sin and the will of God. Furthermore, as the Black Death (and
By contrast, human dissection and autopsies were certainly later, smallpox) ravaged Europe there were fears that cadav-
performed between the 4th and 12th centuries in the Greek ers were sources of contagion (22) and, indeed as Gabriele de
East. As the writings of Pseudo-Eustathius (c. 325 AD) and Mussis recorded, plague was transmitted by infected corpses
Symeon the Theologian (949 1022 AD) illustrate, autopsies lobbed into towns by conquering armies (22). Given this risk
were performed on the dead bodies of criminals (18). Some of plague, coupled with the fact that although the diagnosis
criminals were subjected to a crueller fate. Theophanes of death was often certain, it was not always accurate (giving
(752 818 AD) records that  an apostate from the Christian rise to several  miracles of resurrection), the absence of
faith and leader of the Scamari, was captured. They cut off his autopsy practice was perhaps comforting (23)!
hands and feet on the Mole of St Thomas, brought in physi- Italy is the birthplace of the examination of the dead that
cians, and dissected him from his pubic region to his chest evolved into the autopsy we are familiar with today. The earli-
while he was alive. This they did with a view to understand- est report of such an autopsy dates from 1286 AD when a doc-
ing the structure of man. In this condition they gave him over tor in Cremona undertook an autopsy examination to investigate
to the flames (18). It is apparent that human dissection was an epidemic (19). The chronicles of Fra Salimbene,a Franciscan
not opposed by the Eastern Church. Moreover, the Byzantine friar, tell of a physician who opened a hen and found an abscess
dissections were primarily autopsies seeking to understand at the tip of the heart. He then opened a man who had died of
the nature of disease rather than the anatomical dissections apparently the same disease and found a similar lesion. The
that would emerge in renaissance Italy (18). autopsy was to soon have a place in medicolegal investigations,
In medieval England, Germany, and France human dis- and the report of Azzolino, who died in Bologna in 1302 in sus-
section was limited to the process of  division of the corpse. picious circumstances and was autopsied on the order of the
This practice consisted either of the evisceration of the body court, concludes  We have assured ourselves of the condition
in preparation for a state funeral, or a complete dismember- by the evidence of our own senses and by the anatomisation of
ment ( anatomy ). The latter was undertaken on the bodies the parts (10).
of Saints (17,19) and allowed several religious communities In 1348, autopsies on plague victims were financed by the
to have local access to a part of such an illustrious person. treasurers of the city of Florence  in order to know more clearly
Relics often consisted of severed body parts and were pre- the illnesses of their bodies (24). Also in the mid-14th cen-
served within the alter or a shrine within the church (17). tury, plague victims were autopsied by the Neapolitan doctor
Division of the corpse was also undertaken to facilitate trans- Johannes della Penna, who noted  some had a multitude of
portation for burial when death occurred far from home. Such ulcers that were internal, in the chest and on the lungs, and
a practice is clearly exemplified in Park s (19) account of the that from these came the spitting of blood and they died
division of Henry I of England in 1135 AD:  Although he had rapidly. Others had them externally, having ulcers, spots and
died in Rouen, the king wished to be buried in Reading. herpes that formed under the skin in the three principle glands
Accordingly, he was decapitated, and his brain, eyes, and vis- (22). Based in part on such autopsy reports, it has been argued
cera were removed and buried in Rouen. The rest of his body that the Black Death of medieval Europe was almost certainly
was cut into pieces, heavily salted, and packed into oxhides not the rat-based bubonic plague found to be caused by Yersinia
against the smell, which, according to the chronicler, had pestis in 1894 (22).
already killed the man responsible for extracting the brain. By
AUTOPSIES AND THE ITALIAN
the time the funeral procession had reached Caen, the corpse
RENAISSANCE (1400 1550)
was exuding a liquid so foul that its attendants could not drain
it without what Henry of Huntington called  horror and faint- Although Pope Boniface VIII had effectively outlawed
ings . In contrast, such practices were only rarely adopted in human dissection within the Roman Catholic Empire, atti-
12th- and 13th-century Italy. Indeed, division in preparation tudes slowly shifted. After his sudden death in 1410, Pope
for burial in Italy was prohibited by Pope Boniface VIII in Alexander was autopsied by Pietro D Argelata (2). Pope Sixtus
1299 AD and punishable by excommunication itself a form IV (1471 1484) passed a bill (later confirmed by Pope Clement
of social death (19). VII (1523 1534)) permitting dissection of the human body
In 13th-century England, dissection of the dead to deter- by students of anatomy in Padua and Bologna (12), although
mine the cause of death was largely unknown. Seabourne and the first human dissection in Bologna had preceded this bill
Seabourne (20) noted that medical records from the late 13th by more than 150 years. By the mid-15th century, autopsies
century are sparse. Evidence from autopsies (if they were were such a common procedure in Florence that Antonio
Forensic Science, Medicine, and Pathology
V1 4
280 ___________________________________________________________________________________________Burton
Benivieni considered the refusal of the relatives of a deceased reaching heaven (27). The practice would continue for more
patient so unusual to be worthy of record,  through I don t than a century and was depicted by William Hogarth in The
know what superstition (24). Benivieni was to write the first Four Stages of Cruelty Plate IV, The Reward of Cruelty in
textbook of autopsy pathology, De abditis nonnullis ac miran- 1751. Hogarth depicted the body of Tom Nero, a condemned
dis morborum et sanationum causis (On Some Remarkable and hanged criminal, being dissected with the noose still around
Hidden Causes of Diseases and of Cures), which was pub- his neck while two accusing skeletons watch over the
lished in 1507, 5 years after his death (24). This work incor-  grotesque dismemberment (28). Public dissection was
porated numerous autopsy reports (14) that by modern reserved for those who had committed the most heinous of
standards would be considered brief. Take for example, the capital crimes. Such individuals were considered beyond sal-
entire report of the findings from a man who died following vation and so the need for an intact body to enter heaven would
protracted vomiting:  It was found that the opening of his not apply. Rembrandt van Rijn (1606 1669) would depict
stomach had closed up and it had hardened down to the low- similar dissections in his paintings The Anatomy Lesson of
est part with the result that nothing could pass through to the Dr. Nicolaas Tulp (1632) (29) and The Anatomy Lesson of
organs beyond, and death inevitably followed (10). Dr. Joan Deyman (1656) (30).
The performance of forensic autopsies was sanctioned by Those performing dissections did not always understand
Emperor Charles V in 1532 with the introduction of the their findings, as is evidenced by Dr. Edward May. May pub-
Constituto Criminalis Carolina (12) and by 1556 the autopsy lished a pamphlet in 1639 entitled A Most Certain and True
was fully accepted by the Catholic church (10,25). Relation of a Strange Monster or Serpent Found in the Left
Born in Brussels but working principally in Padua, Andreas Ventricle of the Heart of John Pennant, Gentleman, of the Age
Vesalius (1514 1564) rapidly made a name for himself as a of 21 Years. This  strange monster or serpent was composed
skilled dissector and began to seriously challenge Galenic of a whitish substance and probably was clotted plasma (31).
anatomical doctrine, although the latter was so strong that it At the same time as such learned dissections were being under-
would continue to inhibit the use of the autopsy for the under- taken, the practice of division of the corpse continued in
standing of disease for some time (12). In 1539, having acquired England, most notably among the aristocracy (14). Concerns
a large supply of cadavers from executed criminals he produced regarding bodily integrity and resurrection may have been
the De humani corporis fabrica (On the Fabric of the Human mollified because the relatively incorruptible bones were con-
Body),which was finished in 1542 and published in 1543 (12,25). sidered to be the focus of postmortem identity (14). For exam-
ple, in 1605 George Clifford, Earl of Cumberland, died in
1550 1800: THE AUTOPSY MOVES
London having expressed a wish to be buried in Yorkshire.
 UP NORTH
Accordingly  his dead body was opened, and his bowels and
Vesalius expertise became renowned throughout Europe and inward parts was buried in the chappell in the Savoy, but his
human dissections would again become more widespread out- dead body was buried a little after in the vault in Skypton
side Italy. In 1559, King Henry II of France was wounded in a Church in Craven (14).
tournament during which a broken lance entered his right orbit It is not known when autopsies were first undertaken in the
and destroyed his right eye. Vesalius attended the king during New World, but the first documented autopsy report from the
life (and predicted death), and was present at the king s autopsy United States dates to 1661. The report, a lengthy and detailed
(26). Autopsies would not be confined to kings: patrician fam- account, pertains to the autopsy of the 8-year-old daughter of
ilies requested private autopsies when family members died (27). one John Kelley, who developed delirium resulting from
On October 25, 1590, Pieter Pauw (1564 1617) of Leiden bronchial pneumonia and died 5 days later (32).
performed an autopsy on the 18-year-old daughter of Cornelis In the 17th and 18th centuries, the trend toward brief autopsy
Suys, president of the Council of Holland. Pauw s report details descriptions was reversed, and human dissection became more
a clinical history of blindness, thirst, and polydipsia. On open- acceptable. Early evidence of the former is seen in an autopsy
ing the skull, Pauw  found a significant vesicle, that had occu- report composed by Johann Schöner, professor of medicine
pied the optic nerves close to their crossing, and when I cut it at Greifswald in 1636 (33). The subject, Sir George Douglas,
open half a pound of the clearest of watery material flowed Charles I s ambassador to the court of Poland, had died sud-
out (27). Pauw thus provides the first known autopsy report denly following a brief diarrhoeal illness. Schöner s report
of diabetes insipidus caused by an arachnoid cyst (27). describes in detail the processes of the examination and the
Suys autopsy was performed in her home, but Pauw would appearances of the organs so revealed (33). Death was attrib-
go on to build the first anatomy theater in northern Europe, in uted to  apoplexy because of the reddish discolouration of
Leiden, in 1597. A year later he was granted the right to pub- the back of the body (almost certainly postmortem hyposta-
licly dissect executed criminals (27). Echoing the Byzantine sis) and the presence of viscid matter around the torcular
dissections that took place a millennium earlier, dissections Herophili. The findings of an enlarged gallbladder and inflam-
of executed criminals became popular with the 17th century mation of the under surface of the liver (which might more
as an additional penalty that would prevent the offender from realistically account for the death) were discounted (33).
Forensic Science, Medicine, and Pathology
V1 4
A Bite Into the History of the Autopsy ________________________________________________________________281
That autopsies were undertaken on such notable figures pro- sickness, the advances that the medical profession
foundly raised the acceptability of the dissection of human bod-
would have made in the subsequent ten centuries
ies in England in the 17th and 18th centuries. English morbid
can easily be estimated by considering the advances
anatomists began to take into account autopsy findings from
that have been made since both kinds of examina-
identifiable patients (14) and their work was made easier by a
tion began to be permitted, about the beginning of
number of autopsies that had been conducted in Europe on
the 16th century. (37)
Royalty and other notable figures for political and medico-legal
reasons. These included the autopsies of King Henri IV (1610);
Morgagni gave his inaugural lecture as assistant professor
Prince Henry the Prince of Wales (1612); King James I (1625);
in theoretical medicine at the University of Padua in 1712 at
James, second Marquis of Hamilton (1625); Lord Chichester
the age of 29. Four years later, he held the Chair of Anatomy.
(1625); and Thomas  Old Parr (1635), who claimed to be 152
He would devote much of the next 55 years to his anatomical
years old but whose date of birth remains a mystery (14,34). Old
studies, his students, and his family, rarely leaving Padua. At
Parr s dissector was the famed William Harvey who described
the age of 80, he published De Sedibus et Causis Morborum
the circulation of the blood (34). The autopsy of John Pym (1643)
per Anotomen Indagatis (On the Seats and Causes of Diseases,
the parliamentary leader,rumored by Royalists to have died from
Investigated by Anatomy). The book, which represented the
an infestation of lice, was seen by many, discussed widely in the
summary and synthesis of his life s work, including some 700
press, and significantly increased the acceptability of the pro-
autopsies (36), was translated into English in 1769, 8 years
cedure among the masses (14). Baron (35) drew attention to the
after its first publication (15).
deaths of two women a paintress (Elisabetta Sirani of Bologna
Morgagni s text would have been warmly welcomed in
[1638 1665]) and a princess (Princess Henrietta-Ann of England
England, where autopsies were performed by physicians (the
[1644 1670]) who both died in suspicious circumstances
first pathologists would not emerge for another 30 years). The
following a brief illness characterized by upper abdominal pain
famed physician Sir Percivall Pott (1714 1788) certainly
and vomiting. The autopsy findings in each case included a gas-
undertook postmortem examinations, and on at least one occa-
tric perforation. Public controversies raged at the time (and there
sion was instructed to do so by the coroner (21). In 1767, he
remains some uncertainty) as to whether these women died
was directed to autopsy one Mary Gardiner, a female servant
natural deaths from perforated gastric ulcers or unnatural deaths
who had died following an altercation with her employer and
resulting from poisoning (35).
her friend. Pott s report is somewhat vague, particularly regard-
ing the cause of death, which he attributed to  a very intem-
THE 18TH CENTURY AND THE BIRTH
perate life as evidenced by the  diseased state of the uterus
OF THE MODERN AUTOPSY
and parts adjoining (21). Most likely, Pott referred to chronic
In 1724, Herman Boerhaave highlighted that autopsy prac-
alcoholism and/or a venereal infection, but he did not really
tice was being hampered by partial dissections and a failure
explain the woman s sudden death (21).
to correlate morphological findings with the clinical history
A significant turning point in the history of the autopsy
(12). He emphasized that  Everything pertaining to the case
took place at the end of the 18th century with the work of
must be listed, nor that the least thing neglected which a crit-
Marie-François-Xavier Bichat (1771 1802), who became
ical reader might rightly seek to understand the malady (10).
dubbed  the Father of Histology. Before his untimely death
Boerhaave described the autopsy of a nobleman who died from
from tuberculosis at the age of 30 (possibly acquired at a post-
spontaneous oesophageal rupture following an injudicious
mortem examination), Bichat revolutionized the autopsy exam-
meal (Boerhaave syndrome). The autopsy procedure, narrated
ination, directing attention away from the organs to the tissues
at great length, fills almost six large pages of closely printed
(15). Without the aid of a microscope, he distinguished 21
text, far more than the reports of the previous century. Except
types of tissue, recognizing that it was the tissues that make
for a small incision made in the oesophagus, the organs were
up the organs of the body, rather than the organs themselves,
neither incised nor removed (10).
that held the key to understanding disease. A busy clinician
A special place in the early history of the modern autopsy
working in the Hôtel Dieu, it is said he performed some 600
is reserved for Giovanni Battista Morgagni (1682 1771).
autopsies in the year of his own death (10,15). Without doubt,
Morgagni s work over 60 years at the University of Padua
he was convinced of their value:
thrust the autopsy to the forefront of medical science and
emphasized that medical advancement was firmly dependent
You may take notes for 20 years, from morning
on clinicopathological correlation (15,36). His own words
to night at the bedside of the sick, upon the dis-
serve to illustrate the importance that he placed on the autopsy:
eases of the viscera, and all will be to you only a
. . . if, after hospitals began to exist, it had been confusion of symptoms . . . a train of incoherent
permitted to investigate diseases not only in sick phenomena. Open a few bodies and this obscurity
persons but also in those who had died after every will disappear. (10)
Forensic Science, Medicine, and Pathology
V1 4
282 ___________________________________________________________________________________________Burton
of pathology. He removed the organs one by one and exam-
THE 19TH-CENTURY AUTOPSY
ined each separately (47). His 86-page pocket-sized textbook
The 19th century was a time of transition. The anatomiza-
detailing the method of performing postmortem examinations
tion of condemned criminals continued at least into the third
in the dead-house of the Berlin Charité Hospital (1876) makes
decade, as evidenced by Rowlandson s painting The Lancett
fascinating reading (48).
Club at a Thurtell Feast, which depicts the dissection, in 1824,
In England, renewed interest in anatomy and the autopsy
of John Thurtell, an amateur boxer and well-known criminal
at the start of the 19th century meant that the demand for
who murdered a fellow gambler (38). The 1820s would also
cadavers rapidly outstripped the supply afforded by the courts.
see the autopsy of a number of prominent public figures by
Grave robbing developed as a profitable enterprise, but as rel-
physicians. Included in this group are the autopsies of Napoleon
atives and the authorities began to take preventative measures,
Bonaparte (1821) by Drs. Shortt, Arnott, Mitchell, Burton,
the practice fell into decline. The Anatomy Act in 1832, gave
and Livingstone (39), and of Sir Thomas Stamford Raffles
unclaimed bodies of paupers dying in hospitals and work-
(the founder of Singapore) in 1826 by the English physician
houses a further punishment for their poverty by turning them
Sir Everard Home (40).
over to the anatomists (49). So-called  resurrectionists pro-
The autopsy that is most important in our history of the
vided corpses for dissection by murder. The most famous of
autopsy in the 1820s is that of a middle-aged man with pro-
these were William Burke (1792 1829) and William Hare
found deafness and liver disease of uncertain aetiology. Ludwig
(1792 1870) in Edinburgh. Burke sat on the intoxicated vic-
van Beethoven s death in 1827 is notable for two reasons.
tim s chest, occluding the mouth and nose, whereas Hare
First, the findings, albeit carefully documented, have lead to
dragged the victim round the room by the feet ( Burking ).
prolonged but unresolved speculation as to the cause of
Brought to justice in 1829, Hare turned King s evidence and
Beethoven s deafness and liver disease (41 44). Second, and
Burke was hanged, his body being publicly anatomized and
more importantly, his autopsy was performed at the Allgemein
flayed, and his skin tanned and sold by the strip (50).
Krankenhaus in Vienna 2 days after his death by Johann
In North America, pathology and the autopsy was cham-
Wagner, mentor and tutor to the young Karl von Rokitansky
pioned in the mid-to-late 19th century by Ontario-born
(44). The appearance of Rokitansky in this history approxi-
pathologist-cum-physician William Osler (1849 1919).
mately coincides with the opening of the Autopsy Department
Osler performed approximately 1000 autopsies and wrote
at the Berlin Charité Hospital in 1831, managed by Philipp
five volumes of autopsy protocols, only three of which survive
Phoebus (45).
(1,51). He suffered for his art, acquiring many prosectors warts
Karl Rokitansky (1804 1878) was to become the father of
(tuberculosis verrucosa cutis, verruca necrogenicum) (52).
the modern-day autopsy. Working at the Allgemein
Nonetheless, he so firmly believed in the autopsy that he
Krankenhaus in Vienna, he performed more than 30,000 autop-
dreamed of one being performed on his own person.  Archie,
sies during his career and is thought to have supervised about
you lunatic, he said to his friend Dr. T. Archibald Mallock
70,000 autopsies (46). In addition, he amassed a collection of
3 weeks before he died,  I ve been watching this case for
tens of thousands of anatomical specimens, collections of
2 months and I m sorry I shall not see the postmortem (1,15).
skulls and pelvic bones, and treasures including the report on
Osler collected approximately 200 museum specimens, of
the autopsy of Ludwig van Beethoven. Rokitansky and his
which 55 are on display at the McGill Pathology Institute (53).
colleagues Johann Wagner and Lorenz Biermayer were per-
Osler eventually moved to the Johns Hopkins Hospital as
haps the first professors of pathology anywhere. Rokitansky
professor of medicine, where he continued to depend heavily
initiated the concept of a thorough and systematic autopsy
on autopsy findings (54).
examination that ensured that every part of the body would
be examined in identical fashion, regardless of the clinical
THE 20TH-CENTURY AUTOPSY:
history. In doing so he echoed Morgagni, saying:
CONTROVERSY AND DECAY
Pathological anatomy is the essential basis for
Thanks to the work of pioneers such as Rokitansky,Virchow,
pathological physiology, to be supplemented fur- and Osler, the autopsy saw its heyday in the 19th century. By
contrast, the next 100 years would see pathology flourish,
ther by pathological histology, chemical pathol-
while the autopsy declined from clinical use amid spectacular
ogy, and experimental pathology. (46)
controversies.
Ironically, he also set the precedent of the pathologist Pathology as a discipline took time to become established
divorced from clinical practice. In so doing, he may have fore- (55) but as it did so, autopsies moved out of anatomy theaters
shadowed the decline of the appreciation of the autopsy (15). and private homes and into hospital and public mortuaries.
Rudolf Virchow (1821 1902), working in Berlin, advanced Autopsies had certainly been performed in the homes of the
the autopsy yet further beyond the work of Rokitansky, extend- deceased or in physicians consulting rooms in the 19th cen-
ing the understanding of disease to the cellular level a piv- tury (56 58) a firm kitchen table in a well-lit room was rec-
otal point in the development of the modern understanding ommended for the purpose (58). The practice was continued,
Forensic Science, Medicine, and Pathology
V1 4
A Bite Into the History of the Autopsy ________________________________________________________________283
3. Hanzlick R, Hutchins GM, Autopsy Committee of the College
to a diminishing extent and usually by general practitioners,
of American Pathologists. Case of the month: History repeats
until the 1960s (58). By an interesting quirk of fate, Sir John
itself (sometimes). Arch Intern Med 1999;159:1837 1838.
Mackenzie was autopsied by John Parkinson (of Wolff
4. Wood MJ, Guha AK. Declining clinical autopsy rates versus
Parkinson White fame) in 1925 using a set of autopsy instru-
increasing medicolegal autopsy rates in Halifax, Nova Scotia.
ments that the former had advised the latter to purchase for
Arch Pathol Lab Med 2001;125:924 930.
home autopsies some 12 years prior to his death (56).
5. Rutty GN, Duerden RM, Carter N, et al. Are coroners necrop-
The 20th century saw the autopsy associated with scandal,
sies necessary? A prospective study examining whether a  view
controversy, and political intrigue. First the findings of autop- and grant system of death certification could be introduced
into England and Wales. J Clin Pathol 2001;54:279 284.
sies would be hotly contested, then the process of autopsy itself
6. Gajalakshmi V, Peto R, Kanaka S, et al. Verbal autopsy of 48,000
would come under fire. Considering the former first,two autop-
adult deaths attributable to medical causes in Chennai (formerly
sies are notable for the controversies they sparked those of
Madras), India. BMC Public Health 2002;2:7 16.
Vladimir Lenin (V.I. Ul yanov) in 1924 and of John F.
7. Gajalakshmi V, Peto R. Verbal autopsy of 80,000 adult deaths
Kennedy (1963). Both deaths have been shrouded in political
in Tamilnadu, South India. BMC Public Health 2004;4:47 54.
and pathological speculation despite thorough and careful auto- 8. Cohen L, Manion L. Introduction:The nature of Inquiry. Research
Methods in Education, 4th ed. London: Routledge, 1998:1 43.
psies. In the case of Lenin, speculation has raged around which
9. Porter R. Antiquity. The greatest benefit to mankind: a medical
of two natural diseases (atherosclerosis and neurosyphillis)
history of humanity from antiquity to the present. London:
were the cause of death (59). The autopsying pathologist
Fontana Press, 1999:44 82.
Professor Alexei Abrikosov formulated the diagnosis of
10. King LS, Meehan MC. A history of the autopsy: a review. Am
atherosclerosis, which was clearly more politically acceptable
J Pathol 1973;73:514 544.
than neurosyphillis to Dr. Nikolai Semashko, Commissar for
11. Parkinson D. Autopsies. Surg Neurol 1999;52:103 105.
Health (59). In the case of Kennedy, much speculation has
12. Dada MA, Ansari NA. The postmortem examination in diag-
nosis. J Clin Pathol 1996;49:965 966.
persisted as to the precise nature of the injuries sustained and
13. Burton JL. Anatomy for beginners: from in a box to on the box.
whether or not these were the result of one bullet or two (60 69).
acpNews 2005;Spring:9 10.
(In fact it was probably two bullets, from the rear [62]).
14. Harley D. Political post-mortems and morbid anatomy in sev-
The history of the autopsy in the latter part of the 20th cen-
enteenth-century England. Soc Hist Med 1994;7:1 28.
tury is beyond the scope of this article, and is not dealt with
15. Hill RB, Anderson RE. The recent history of the autopsy. Arch
here. As we have seen, the autopsy began from humble roots,
Pathol Lab Med 1996;120:702 712.
became heavily entwined in religious dogma, and is the sub- 16. Daniell C, Thompson V. Pagans and Christians. In: Jupp PC,
Gittings C, eds. Death in England: An Illustrated History.
ject of political machination. The recent history of the autopsy
Manchester: Manchester University Press, 1999, pp. 65 89.
is one of decline and decay. If history teaches us anything,
17. Binski P. Medieval Death, Ritual and Representation. London:
however, it is that all things change. One can only wonder
British Museum Press, 1996.
what a history of the autopsy will include in 40 years time.
18. Bliquez LJ, Kazhdan A. Four testimonia to human dissection
in Byzantine times. Bull Hist Med 1984;58:554 557.
19. Park K. The life of the corpse: division and dissection in late
Educational Message
medieval Europe. J Hist Med Allied Sci 1995;50:111 132.
1. The modern autopsy has its earliest roots in the magico- 20. Seabourne A, Seabourne G. Suicide or accident self-killing
in medieval England. Series of 198 cases from the Eyre records.
religious dissections of Mesopotamia and Ancient Egypt.
Br J Psychiatry 2001;178:42 47.
2. Human dissection is historically associated with pre-
21. Forbes TR. Percival Pott performs a postmortem. Bull N Y Acad
vailing religious and political attitudes.
Med 1975;51:272 276.
3. In the West, the earliest autopsies to determine cause of
22. Cohn SK. The Black Death Transformed. Disease and Culture
death stem from the 12th and 13th centuries.
in Early Renaissance Europe. London: Arnold, 2003.
4. The scientific revolution prompted the development of
23. Horrox R. Purgatory, prayer and plaque. In: Jupp PC, Gittings
the modern autopsy in the 19th century. C, eds. Death in England: An Illustrated History. Manchester:
Manchester University Press, 1999, pp. 90 118.
5. The medicalization of the autopsy moved it into the hos-
24. Rosai J. Pathology: a historical opportunity. Am J Pathol
pital arena but heralded its eventual decline.
1997;151:3 6.
25. Porter R. Renaissance. The Greatest Benefit to Mankind: A
Medical History of Humanity From Antiquity to the Present.
The author has stated that he does not have a significant finan-
London: Fontana Press, 1999, pp. 163 200.
cial interest or other relationship with any product manufac-
26. Martin G. The death of Henry II of France: a sporting death and
turer or provider of services discussed in this article.
post-mortem. ANZ J Surg 2001;71:318 20.
27. Kivela T, Pelkonen R, Oja M, et al. Diabetes insipidus and blind-
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