Autopsy

The Origins of Performing an Autopsy

Did you know that the first known autopsy was performed in 300 BCE? Or that autopsies officially came of age in 1761?

The autopsy was regarded as ‘coming of age’ with Giovanni Morgagni, due to his extensive research. In 1761 he detailed what could be seen within the body simply using the naked eye.

In the modern-day we rely on an Autopsy report to determine the cause of death, it’s a major process in a criminal case.

iTHINK examines the fascinating origins and history of the autopsy and considers why autopsies are important.

What is an autopsy?

Autopsy

An autopsy, otherwise known as a post-mortem examination, necropsy or obduction, is the examination of a corpse. It is a surgical procedure that is performed by specialised medical professionals, called pathologists.

The body is dissected to determine the cause of the individual’s death. Typically only a small number of deaths require an autopsy to be performed, as they are unnecessary if the individual’s cause of death is clear.

The term ‘autopsy’ derives from the Ancient Greek ‘αὐτοψία autopsia,’ meaning to ‘to see for oneself.’ The term has been in use since the seventeenth century.

Why are autopsies performed?

Here, more detail shall be provided as to why autopsies are performed. They are performed for legal and medical reasons and can be performed if the information is needed for a variety of issues.

For example time of death, to determine the injury and the extent of it, to establish the identity of the deceased, retain organs and to determine whether the death was natural or unnatural.

Forensic autopsies are often carried out when the cause of death is believed to be a criminal matter, for example, a murder. In this case, the autopsy is needed to determine the medical cause of death as this information is required by police to help their investigations.

Autopsies can also be performed for research and training purposes for medical professionals. However, permission from next of kin is required in some cases for an internal autopsy.

How are autopsies performed now?

This section will provide a brief explanation of how autopsies are performed today. Autopsies begin with an external examination of the body. This can help establish the identity of the corpse, or even the cause of death. The body is weighed and measured, and the subject’s physical characteristics are noted.

The next step is to remove the clothes of the subject, in order to examine the body further. Pathologists look for injuries, tattoos, gun residue or other deposits. During this time, hair and nail samples may also be taken.

If an internal examination is required, then the pathologist will remove and dissect the abdominal and pelvic organs, chest and sometimes the brain. It is fairly unusual for pathologists to internally examine body parts such as the arms, hands, legs or face.

If a brain autopsy is required then a cut is made across the crown of the subject’s head. The pathologist will then open the cranium by using a saw that has the ability to cut bone but leaves the soft tissue unharmed.

Once the pathologist has examined the organs within the subject’s body, they are removed for further examination and to be weighed. If organs are removed individually, it is referred to as the Virchow technique.

However, if they are removed as a group, it is called the Rokitansky technique.

Doctor Ed Uthman, a Texas pathologist, states “I like the Rokitansky myself because it frees up the body earlier’ so that people ‘can get to work with the closing and clean-up.”

Pathologists also preserve any parts of the organs that they dissect, especially if they discover an abnormality. Once the autopsy is completed, the organs are either cremated or returned to the body. This decision is made according to laws and regulations and the family of the deceased wishes.

Before the body is sewn shut using the ‘baseball stitch,’ it is lined with cotton wool or a material like it. If the pathologist is returning the organs to the body, they are covered in bags in order to prevent any leakage.

Finally, once the body has been sewn shut, it is washed and prepared for the funeral director.

History of the Autopsy

Are you ready for a history lesson? Here, the key dates concerning the origins of the autopsy are provided and explained to gain a better understanding of its history.

The early Egyptians mummified their dead as they believed that after death the soul leaves the body. Therefore when the soul returned to be reunited with the body after it was buried, it needed to be able to recognise it.

Although they removed the dead’s organs, they did not do this in the hope of learning about disease and death, their process was similar to that of an autopsy.

During this period of history, the Indians and Greeks cremated their dead without any form of autopsy or examination. Muslims, Romans and the Chinese felt that it was wrong and taboo to open the human body.

In 300 BCE the first real dissections for the purpose of studying death and diseases were performed by Alexandrian physicians, Herophilus and Erasistratus.

However, it was in late 2nd century CE, that the Greek physician Galen of Pergamum was able to correlate the patient’s symptoms (or complaints) and signs (what is felt and seen) with what was found upon examining the ‘affected part of the deceased.’

This was an important advance in the field of medicine, and one that broke the barrier of internal examination.

1302 to 1761

Autopsy

It is believed that the first legal autopsy was requested by a magistrate in Bologna in 1302, in order to investigate why the death had occurred, or the ‘fault’ of the death. Antonio Benivieni (a fifteenth-century physician) carried out this autopsy.

It is thought that he completed fifteen autopsy examinations solely for the purpose of determining the cause of death. In addition to this, he was able to connect the deaths to the symptoms the victim was experiencing prior to their death.

Also during this period, Théophile Bonet made significant steps forward in terms of the collection of data concerning autopsies. He considered observations made by physicians from over three thousand autopsies. This contributed to the definitions and explanations of clinical terms, paving the way to more modern medical practice.

The autopsy was regarded as ‘coming of age’ with Giovanni Morgagni, due to his extensive research. In 1761 he detailed what could be seen within the body simply using the naked eye.

In his work entitled On the Seats and Causes of Diseases as Investigated by Anatomy, he compared seven hundred patient’s symptoms with his observations. This meant that the patient was central to his research, as opposed to other doctors’ notes or medical books.

Another significant figure during this time was the German pathologist Rudolf Virchow. He discovered and introduced ‘cellular doctrine,’ where the changes in the cells within the body are the basis of understanding diseases.

He believed that less importance should be placed on pathologic anatomy (the structure of diseased tissue), and stressed the importance of physiologic pathology, as he believed that is where the future of pathology lies.

The 1800s

Xavier Bichat, a French physician, made important advances in the field of medicine and autopsies. He is classed as the father of histology and tissue pathology, due to the fact that he looked deeper into the organs in the human body than had ever been done before.

He not only dissected the organs, but he also analysed the tissues that they were made from. He concluded that the human body possessed twenty-one different types of tissues that made up our organs.

Another important figure during the 1800s was Karl Rokitansky. He enjoyed a long forty-five-year career in the medical industry. He is famous for performing a huge number of autopsies – estimated to be over 30,000! He supervised even more than this throughout his career, believed to be roughly 70,000.

He is also famous for performing the autopsy of Ludwig van Beethoven! Like his predecessors before him, he provided additional findings to the field of medicine and he cataloged all of his findings in incredible detail.

Historians have reported that Napoléon Bonaparte desired an autopsy to be performed on him as his dying wish. He said “After my death I wish you to do an autopsy … make a detailed report to my son. Indicate to him what remedies or mode of life he can pursue which will prevent his suffering … This is very important, for my father died … with symptoms very much like mine.”

He got his wish, as Francesco Antommarchi (his physician) performed an autopsy on him. During this process, he discovered signs of stomach cancer.

During this year, the Anatomy Act was passed by British Parliament. This act was a significant leap forward for the procedure. It provided medical students the right to dissect the bodies donated to universities.

In addition, it also gave doctors and teachers of anatomy the right to dissect donated bodies. This act was passed due to the growing revulsion surrounding the trade of corpses.

Nevertheless, this was an important step in advancing knowledge of autopsies.

The 1900s

Autopsy

During this time, a theory concerning conducting CT scans came to pass. These were appealing, due to the fact that they were a non-invasive way of documenting the surfaces of the body.

From these ideas and inventions, MRI scans and 3D surface scanning began. Also during this time, the term ‘Virtopsy’ was coined by Professor Richard Dirhofer.

In 1995 Jeffrey Dahmer, a prolific serial killer, was bludgeoned to death in prison. Doctors performed an autopsy, and his brain was preserved. The reasoning behind this was the possibility of future study.

2002

During this year, evidence was produced that proved playing contact sports, like football and rugby, could cause permanent brain damage. This was discovered when American football player Mike Webster passed away.

Doctor Bennet Omalu performed the autopsy and concluded that “I saw changes that shouldn’t be in a 50-year-old man’s brains, and also changes that shouldn’t be in a brain that looked normal.” The condition that caused Webster’s death was chronic traumatic encephalopathy (CTE).

Also during this year, the first public autopsy was performed in Britain in over two hundred years. It was performed by Gunter von Hagens, who was the creator of the famous Body Worlds exhibition.

The procedure was done in front of a paying audience, and then made into a documentary. Interestingly, the autopsy occurred in secret due to it being legally ambiguous.

So there you have it – the history behind the vital surgical procedure that is the autopsy. As we have discovered, autopsies are extremely important in helping forensic investigations and have contributed to modern medical knowledge that we have today.

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