A Bite Into the History of the Autopsy

FOSSICKINGS

Abstract

The autopsy has had a checkered history, much of which has been surrounded by
controversy. The roots of human dissection are found in the ancient world where
rumors flourished that the prosectors of the day were engaged in vivisection as
well as dissection. Bound up with the prevailing religious and political systems
of the day, the autopsy has alternately been prohibited and encouraged, used to
explore the nature of disease, and conceal questionable political policy. This
review explores the history of the autopsy from its ancient roots in Egypt,
Mesopotamia, Alexandria, and the Far East through the dark ages to medieval
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
decline of this diagnostic tool in the 20th century.

Key Words: Autopsy; history of medicine; necropsy; dissection.

(DOI: 10.1385/Forensic Sci. Med. Pathol.:1:4:277)

277

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:

Julian L. Burton
Academic Unit of Pathology
E-Floor
University of Sheffield Medical
School
Beech Hill Road
Sheffield
S10 2RX UK
E-mail: j.l.burton@sheffield.ac.uk

Accepted for publication:
September 8, 2005

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

INTRODUCTION

To investigate the causes of death, to examine

carefully the condition of organs, after such changes
have gone on in them as to render existence impos-
sible and to apply such knowledge to the preven-
tion and treatment of disease, is one of the highest
objects of the physician.

—Sir William Osler (1849–1919); Extracted from
his Graduation thesis “Pathologic Anatomy” (

)

Autopsy (derived from the Greek autopsia) means “to see

for oneself” (

2,3

) (literally “to look at the dead” [

]) and is

synonymous with the terms postmortem, postmortem exami-
nation, and necropsy. None of these terms have specific mean-
ings that allow the extent or precise nature of the investigation
to be inferred from their use. In current practice, autopsy indi-
cates a detailed examination that includes (but is not limited
to) the external examination of the cadaver, and the eviscera-
tion and subsequent careful dissection of the contents of the
cranial, thoracic, abdominal, and pelvic cavities (although the
examination may be restricted to particular body cavities by
relatives’ wishes or because of some infectious hazard). In
some countries, the postmortem may consist solely of an

external examination, with no effort being made to examine
the internal organs (

2,5

), or indeed to an interview with rela-

tives of the deceased, with no attempt to examine the body
(

6,7

). Although dissection now has a limited meaning confined

to the cutting apart or separating of tissues and organs one
from one another for further study, it once was synonymous
with the examination we designate as an autopsy today. By
contrast, anatomization, a term now rarely used, suggests an
extreme dissection similar to that undertaken by medical stu-
dents learning anatomy, in which the body is slowly reduced
to its component parts.

Humans have always been repulsed and/or fascinated by

the prospect of examination of the internal workings of the
human body. As seen here, this fascination has not always
been confined to a dissection of the deceased. Such attitudes
have been inextricably linked with the prevailing religious and
political climates of the time, and, furthermore, reflect the
epistemological advances in our understanding of medicine
and disease. Auguste Comte (1798–1857) argued that the
human mind has progressed from a theological stage, through
a metaphysical stage, to a final positive stage. In the theolog-
ical stage, primitive attempts were made to explain behavior
in terms of spiritual or supernatural entities. The metaphysical
stage was a modification of this and explained behavior in
terms of abstractions, essences, or forces. The positivistic stage

278 ___________________________________________________________________________________________Burton

dispensed with these concepts and turned to observation and
reason (“science”) as a means of understanding behavior (

Similarly, the purposes for which postmortem examinations
were performed have evolved from the prophetic, through a
search for an imbalance of the humors, to a scientific approach
to the evaluation of the nature and extent of disease and the
cause of death. Modern medicine has an anatomical and phys-
iological attitude underlying most diseases and, even when
such causes cannot be proven we assume that they will some-
day be elucidated in these terms.

What follows is a brief account of the history of the autopsy.

From an exploration of the roots of human dissection in the
ancient world, I will lead you through the dark ages and
medieval times to the renaissance. Here we will find the core
that was necessary for the emergence of pathology as a
medical discipline and the development of the modern autopsy.
Finally, we consider the contemporary decay of the autopsy
and how the autopsy may evolve from this in the future.

THE ANCIENT WORLD

The ancient Egyptians, whose civilization rose under the

Pharaohs around 3000

, practiced medicine that had both

an empirical and a magico-religious aspect. Human dissec-
tion was confined to the process of mummification, in which
embalmers of low social caste attempted to preserve the body
intact for its journey through the afterlife (

). The internal

organs were removed through small incisions (although the
heart, believed to be the seat of the soul and required by the
deceased so that it could be weighed against the feather of
truth, was left in situ). The brain was removed via the nose
using hooks. Once removed, the organs were stored in special
Canopic jars (

). Although it was acceptable to tamper with

the body of the deceased in this manner, the procedure was
performed for entirely magico-religious reasons and no attempt
was made to understand disease in the living from an exami-
nation of the dead.

Disease was similarly thought to be the result of supernat-

ural intervention in ancient Mesopotamia (“the kingdoms
between two rivers”: the Tigris and Euphrates) (

). Rather than

looking to the corpse for an understanding of disease, omen-
based prognostic practices flourished, including the exami-
nation of the liver (hepatoscopy) and entrails (haruspicy) of
sacrificed animals (

). Hepatoscopy and haruspicy can be traced

back to the time of Sargon I of Babylon (c. 3500

). Using

such techniques, Mesopotamian medicine was effectively “sys-
tematized sorcery” (

). Disease was regarded in an anamistic

fashion, that is, controlled by gods or spiritual forces, whose
intentions could be read in the liver by the haruspex (

The Greek civilization began to emerge around 1000

, but

little is known of their medicine before the emergence of
written texts around 500

(

). Hippocrates (c. 460–377

)

promoted a naturalistic philosophy that disease resulted from
“natural” causes. Early Greek physicians had a sound grasp of
surface anatomy, but cultural mores against human dissection

limited their knowledge of internal anatomy to that gleaned from
the inspection of wounds and the dissection of animals (

Indeed, we might well regard the observations through wounds
made on battlefields by sabre-slashes as the first autopsies (

3,11

The use of animal dissection, promoted by Aristotle (384–322

), was subsequently used to ground biomedical knowledge

in Alexandrian medicine. Herophilus (c. 335–280

), how-

ever, is reported to have performed vivisections on live humans
(probably condemned criminals) and public dissections on
human cadavers. His interest was in learning and teaching
anatomy (

). He discovered and named the prostate, duode-

num (from the Greek for 12 fingers), and the structure that bears
his name, the torcular Herophili (the confluence of the intracra-
nial sinuses) (

). That Herophilus described the rete mirabile

(a network of arteries found at the base of the brain in primates)
demonstrates that some of his dissections were also performed
in animals; the rete mirabile is not present in humans.

The application of human dissection altered little over the

subsequent four centuries. The classical Greeks and their suc-
cessors were working with an entirely different concept of
disease; namely a misbalance of humors. This model gives no
particular significance to the physical state of the organs and
therefore does not see any particular clinical interest in the
autopsy. The work and views of Galen (129–c. 216

) were

to dominate—and constrain—medicine for the next millen-
nium. Galen practiced his medicine on the gladiators of the
Roman Empire. However, although he prided himself on being
an expert clinician, he was also a medical scientist and per-
formed dissections. These were mainly performed on apes,
sheep, pigs, goats, and even an elephant’s heart. Many were
performed in public and, it seems, Galen was something of a
showman. We can readily imagine the crowd watching with
awe as he demonstrated with a flourish that a precise cut here
with a sharp knife deprived a pig of the use of its hind legs.
Another downward thrust of the blade, here, and the pig’s
forelegs failed. As the animal’s pitiful squeals echoed through
the masses, a final triumphant blow, here at the base of the
skull, silenced them forever and ended the creature’s life
(

9,13

). Human dissection was out of the question (

12,14

although he told of examining two skeletons observed by
chance, one washed from a grave by a flood and another of an
unburied thief picked clean by carrion birds (

). (Although

most sources state that Galen did not dissect humans, some
authors suggest that Galen formally used autopsies in his work
[

]. Given his perpetuation of erroneous concepts such as the

rete mirabile this seems unlikely). Galen’s dominance over the
medical establishment and his assertions on human anatomy
based on comparative anatomy in apes and other mammals
were to remain largely unchallenged for 1400 years (

9,15

AUTOPSIES IN THE DARK AGES
AND MEDIEVAL TIMES

Little is known of Western autopsy practices in the early

middle ages. In the early medieval West, dissection of the

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human cadaver remained closely bound up with the religious
beliefs of the time. Dissection for scientific advancement was
all but unheard of (

) and there was a belief in the sanctity of

the intact body (

). Indeed, no mention of human dissection

for such purposes is to be found in Paul Binski’s 1996 account
of medieval death, ritual, and representation (

By contrast, human dissection and autopsies were certainly

performed between the 4th and 12th centuries in the Greek
East. As the writings of Pseudo-Eustathius (c. 325

) and

Symeon the Theologian (949–1022

) illustrate, autopsies

were performed on the dead bodies of criminals (

). Some

criminals were subjected to a crueller fate. Theophanes
(752–818

) records that “an apostate from the Christian

faith and leader of the Scamari, was captured. They cut off his
hands and feet on the Mole of St Thomas, brought in physi-
cians, and dissected him from his pubic region to his chest
while he was alive. This they did with a view to understand-
ing the structure of man. In this condition they gave him over
to the flames” (

). It is apparent that human dissection was

not opposed by the Eastern Church. Moreover, the Byzantine
dissections were primarily autopsies seeking to understand
the nature of disease rather than the anatomical dissections
that would emerge in renaissance Italy (

In medieval England, Germany, and France human dis-

section was limited to the process of “division of the corpse.”
This practice consisted either of the evisceration of the body
in preparation for a state funeral, or a complete dismember-
ment (“anatomy”). The latter was undertaken on the bodies
of Saints (

17,19

) and allowed several religious communities

to have local access to a part of such an illustrious person.
Relics often consisted of severed body parts and were pre-
served within the alter or a shrine within the church (

Division of the corpse was also undertaken to facilitate trans-
portation for burial when death occurred far from home. Such
a practice is clearly exemplified in Park’s (

) account of the

division of Henry I of England in 1135

: “Although he had

died in Rouen, the king wished to be buried in Reading.
Accordingly, he was decapitated, and his brain, eyes, and vis-
cera were removed and buried in Rouen. The rest of his body
was cut into pieces, heavily salted, and packed into oxhides
against the smell, which, according to the chronicler, had
already killed the man responsible for extracting the brain. By
the time the funeral procession had reached Caen, the corpse
was exuding a liquid so foul that its attendants could not drain
it without what Henry of Huntington called ‘horror and faint-
ings’.” In contrast, such practices were only rarely adopted in
12th- and 13th-century Italy. Indeed, division in preparation
for burial in Italy was prohibited by Pope Boniface VIII in
1299

and punishable by excommunication—itself a form

of social death (

In 13th-century England, dissection of the dead to deter-

mine the cause of death was largely unknown. Seabourne and
Seabourne (

) noted that medical records from the late 13th

century are sparse. Evidence from autopsies (if they were

performed) was not included in coronial inquests and is not
mentioned in the Eyre records of 198 cases of suicide from
1272 to 1300

(

). (In England, coronial inquests would

not include autopsy findings for another 400 years [

].)

Disease, death, and decay were considered to be signs of

sin and the will of God. Furthermore, as the Black Death (and
later, smallpox) ravaged Europe there were fears that cadav-
ers were sources of contagion (

) and, indeed as Gabriele de

Mussis recorded, plague was transmitted by infected corpses
lobbed into towns by conquering armies (

). Given this risk

of plague, coupled with the fact that although the diagnosis
of death was often certain, it was not always accurate (giving
rise to several “miracles” of resurrection), the absence of
autopsy practice was perhaps comforting (

Italy is the birthplace of the examination of the dead that

evolved into the autopsy we are familiar with today. The earli-
est report of such an autopsy dates from 1286

when a doc-

tor in Cremona undertook an autopsy examination to investigate
an epidemic (

). The chronicles of Fra Salimbene, a Franciscan

friar, tell of a physician who opened a hen and found an abscess
at the tip of the heart. He then opened a man who had died of
apparently the same disease and found a similar lesion. The
autopsy was to soon have a place in medicolegal investigations,
and the report of Azzolino, who died in Bologna in 1302 in sus-
picious circumstances and was autopsied on the order of the
court, concludes “We have assured ourselves of the condition
by the evidence of our own senses and by the anatomisation of
the parts” (

In 1348, autopsies on plague victims were financed by the

treasurers of the city of Florence “in order to know more clearly
the illnesses of their bodies” (

). Also in the mid-14th cen-

tury, plague victims were autopsied by the Neapolitan doctor
Johannes della Penna, who noted “some had a multitude of
ulcers that were internal, in the chest and on the lungs, and
that from these came the spitting of blood and they died
rapidly. Others had them externally, having ulcers, spots and
herpes that formed under the skin in the three principle glands”
(

). Based in part on such autopsy reports, it has been argued

that the Black Death of medieval Europe was almost certainly
not the rat-based bubonic plague found to be caused by Yersinia
pestis in 1894 (

AUTOPSIES AND THE ITALIAN
RENAISSANCE (1400–1550)

Although Pope Boniface VIII had effectively outlawed

human dissection within the Roman Catholic Empire, atti-
tudes slowly shifted. After his sudden death in 1410, Pope
Alexander was autopsied by Pietro D’Argelata (

). Pope Sixtus

IV (1471–1484) passed a bill (later confirmed by Pope Clement
VII (1523–1534)) permitting dissection of the human body
by students of anatomy in Padua and Bologna (

), although

the first human dissection in Bologna had preceded this bill
by more than 150 years. By the mid-15th century, autopsies
were such a common procedure in Florence that Antonio

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280 ___________________________________________________________________________________________Burton

Benivieni considered the refusal of the relatives of a deceased
patient so unusual to be worthy of record, “through I don’t
know what superstition” (

). Benivieni was to write the first

textbook of autopsy pathology, De abditis nonnullis ac miran-
dis morborum et sanationum causis (On Some Remarkable
Hidden Causes of Diseases and of Cures), which was pub-
lished in 1507, 5 years after his death (

). This work incor-

porated numerous autopsy reports (

) that by modern

standards would be considered brief. Take for example, the
entire report of the findings from a man who died following
protracted vomiting: “It was found that the opening of his
stomach had closed up and it had hardened down to the low-
est part with the result that nothing could pass through to the
organs beyond, and death inevitably followed” (

The performance of forensic autopsies was sanctioned by

Emperor Charles V in 1532 with the introduction of the
Constituto Criminalis Carolina (

) and by 1556 the autopsy

was fully accepted by the Catholic church (

10,25

Born in Brussels but working principally in Padua, Andreas

Vesalius (1514–1564) rapidly made a name for himself as a
skilled dissector and began to seriously challenge Galenic
anatomical doctrine, although the latter was so strong that it
would continue to inhibit the use of the autopsy for the under-
standing of disease for some time (

). In 1539, having acquired

a large supply of cadavers from executed criminals he produced
the De humani corporis fabrica (On the Fabric of the Human
Body), which was finished in 1542 and published in 1543 (

12,25

1550–1800: THE AUTOPSY MOVES
“UP NORTH”

Vesalius’expertise became renowned throughout Europe and

human dissections would again become more widespread out-
side Italy. In 1559, King Henry II of France was wounded in a
tournament during which a broken lance entered his right orbit
and destroyed his right eye. Vesalius attended the king during
life (and predicted death), and was present at the king’s autopsy
(

). Autopsies would not be confined to kings: patrician fam-

ilies requested private autopsies when family members died (

On October 25, 1590, Pieter Pauw (1564–1617) of Leiden

performed an autopsy on the 18-year-old daughter of Cornelis
Suys, president of the Council of Holland. Pauw’s report details
a clinical history of blindness, thirst, and polydipsia. On open-
ing the skull, Pauw “found a significant vesicle, that had occu-
pied the optic nerves close to their crossing, and when I cut it
open half a pound of the clearest of watery material flowed
out” (

). Pauw thus provides the first known autopsy report

of diabetes insipidus caused by an arachnoid cyst (

Suys’ autopsy was performed in her home, but Pauw would

go on to build the first anatomy theater in northern Europe, in
Leiden, in 1597. A year later he was granted the right to pub-
licly dissect executed criminals (

). Echoing the Byzantine

dissections that took place a millennium earlier, dissections
of executed criminals became popular with the 17th century
as an additional penalty that would prevent the offender from

reaching heaven (

). The practice would continue for more

than a century and was depicted by William Hogarth in The
Four Stages of Cruelty Plate IV, The Reward of Cruelty in
1751. Hogarth depicted the body of Tom Nero, a condemned
and hanged criminal, being dissected with the noose still around
his neck while two accusing skeletons watch over the
“grotesque dismemberment” (

). Public dissection was

reserved for those who had committed the most heinous of
capital crimes. Such individuals were considered beyond sal-
vation and so the need for an intact body to enter heaven would
not apply. Rembrandt van Rijn (1606–1669) would depict
similar dissections in his paintings The Anatomy Lesson of
Dr. Nicolaas Tulp (1632) (

) and The Anatomy Lesson of

Dr. Joan Deyman (1656) (

Those performing dissections did not always understand

their findings, as is evidenced by Dr. Edward May. May pub-
lished a pamphlet in 1639 entitled A Most Certain and True
Relation of a Strange Monster or Serpent Found in the Left
Ventricle of the Heart of John Pennant, Gentleman, of the Age
of 21 Years. This “strange monster or serpent” was composed
of a whitish substance and probably was clotted plasma (

At the same time as such learned dissections were being under-
taken, the practice of division of the corpse continued in
England, most notably among the aristocracy (

). Concerns

regarding bodily integrity and resurrection may have been
mollified because the relatively incorruptible bones were con-
sidered to be the focus of postmortem identity (

). For exam-

ple, in 1605 George Clifford, Earl of Cumberland, died in
London having expressed a wish to be buried in Yorkshire.
Accordingly “his dead body was opened, and his bowels and
inward parts was buried in the chappell in the Savoy, but his
dead body was buried a little after in the vault in Skypton
Church in Craven” (

It is not known when autopsies were first undertaken in the

New World, but the first documented autopsy report from the
United States dates to 1661. The report, a lengthy and detailed
account, pertains to the autopsy of the 8-year-old daughter of
one John Kelley, who developed delirium resulting from
bronchial pneumonia and died 5 days later (

In the 17th and 18th centuries, the trend toward brief autopsy

descriptions was reversed, and human dissection became more
acceptable. Early evidence of the former is seen in an autopsy
report composed by Johann Schöner, professor of medicine
at Greifswald in 1636 (

). The subject, Sir George Douglas,

Charles I’s ambassador to the court of Poland, had died sud-
denly following a brief diarrhoeal illness. Schöner’s report
describes in detail the processes of the examination and the
appearances of the organs so revealed (

). Death was attrib-

uted to “apoplexy” because of the reddish discolouration of
the back of the body (almost certainly postmortem hyposta-
sis) and the presence of viscid matter around the torcular
Herophili. The findings of an enlarged gallbladder and inflam-
mation of the under surface of the liver (which might more
realistically account for the death) were discounted (

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A Bite Into the History of the Autopsy ________________________________________________________________281

That autopsies were undertaken on such notable figures pro-

foundly raised the acceptability of the dissection of human bod-
ies in England in the 17th and 18th centuries. English morbid
anatomists began to take into account autopsy findings from
identifiable patients (

) and their work was made easier by a

number of autopsies that had been conducted in Europe on
Royalty and other notable figures for political and medico-legal
reasons. These included the autopsies of King Henri IV (1610);
Prince Henry–the Prince of Wales (1612); King James I (1625);
James, second Marquis of Hamilton (1625); Lord Chichester
(1625); and Thomas “Old” Parr (1635), who claimed to be 152
years old but whose date of birth remains a mystery (

14,34

). Old

Parr’s dissector was the famed William Harvey who described
the circulation of the blood (

). The autopsy of John Pym (1643)

the parliamentary leader, rumored by Royalists to have died from
an infestation of lice, was seen by many, discussed widely in the
press, and significantly increased the acceptability of the pro-
cedure among the masses (

). Baron (

) drew attention to the

deaths of two women—a paintress (Elisabetta Sirani of Bologna
[1638–1665]) and a princess (Princess Henrietta-Ann of England
[1644–1670])—who both died in suspicious circumstances
following a brief illness characterized by upper abdominal pain
and vomiting. The autopsy findings in each case included a gas-
tric perforation. Public controversies raged at the time (and there
remains some uncertainty) as to whether these women died
natural deaths from perforated gastric ulcers or unnatural deaths
resulting from poisoning (

THE 18TH CENTURY AND THE BIRTH
OF THE MODERN AUTOPSY

In 1724, Herman Boerhaave highlighted that autopsy prac-

tice was being hampered by partial dissections and a failure
to correlate morphological findings with the clinical history
(

). He emphasized that “Everything pertaining to the case

must be listed, nor that the least thing neglected which a crit-
ical reader might rightly seek to understand the malady” (

Boerhaave described the autopsy of a nobleman who died from
spontaneous oesophageal rupture following an injudicious
meal (Boerhaave syndrome). The autopsy procedure, narrated
at great length, fills almost six large pages of closely printed
text, far more than the reports of the previous century. Except
for a small incision made in the oesophagus, the organs were
neither incised nor removed (

A special place in the early history of the modern autopsy

is reserved for Giovanni Battista Morgagni (1682–1771).
Morgagni’s work over 60 years at the University of Padua
thrust the autopsy to the forefront of medical science and
emphasized that medical advancement was firmly dependent
on clinicopathological correlation (

15,36

). His own words

serve to illustrate the importance that he placed on the autopsy:

. . . if, after hospitals began to exist, it had been

permitted to investigate diseases not only in sick
persons but also in those who had died after every

sickness, the advances that the medical profession
would have made in the subsequent ten centuries
can easily be estimated by considering the advances
that have been made since both kinds of examina-
tion began to be permitted, about the beginning of
the 16th century. (

)

Morgagni gave his inaugural lecture as assistant professor

in theoretical medicine at the University of Padua in 1712 at
the age of 29. Four years later, he held the Chair of Anatomy.
He would devote much of the next 55 years to his anatomical
studies, his students, and his family, rarely leaving Padua. At
the age of 80, he published De Sedibus et Causis Morborum
per Anotomen Indagatis (On the Seats and Causes of Diseases,
Investigated by Anatomy). The book, which represented the
summary and synthesis of his life’s work, including some 700
autopsies (

), was translated into English in 1769, 8 years

after its first publication (

Morgagni’s text would have been warmly welcomed in

England, where autopsies were performed by physicians (the
first pathologists would not emerge for another 30 years). The
famed physician Sir Percivall Pott (1714–1788) certainly
undertook postmortem examinations, and on at least one occa-
sion was instructed to do so by the coroner (

). In 1767, he

was directed to autopsy one Mary Gardiner, a female servant
who had died following an altercation with her employer and
her friend. Pott’s report is somewhat vague, particularly regard-
ing the cause of death, which he attributed to “a very intem-
perate life” as evidenced by the “diseased state of the uterus
and parts adjoining” (

). Most likely, Pott referred to chronic

alcoholism and/or a venereal infection, but he did not really
explain the woman’s sudden death (

A significant turning point in the history of the autopsy

took place at the end of the 18th century with the work of
Marie-François-Xavier Bichat (1771–1802), who became
dubbed “the Father of Histology.” Before his untimely death
from tuberculosis at the age of 30 (possibly acquired at a post-
mortem examination), Bichat revolutionized the autopsy exam-
ination, directing attention away from the organs to the tissues
(

). Without the aid of a microscope, he distinguished 21

types of tissue, recognizing that it was the tissues that make
up the organs of the body, rather than the organs themselves,
that held the key to understanding disease. A busy clinician
working in the Hôtel Dieu, it is said he performed some 600
autopsies in the year of his own death (

10,15

). Without doubt,

he was convinced of their value:

You may take notes for 20 years, from morning

to night at the bedside of the sick, upon the dis-
eases of the viscera, and all will be to you only a
confusion of symptoms . . . a train of incoherent
phenomena. Open a few bodies and this obscurity
will disappear. (

)

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282 ___________________________________________________________________________________________Burton

THE 19TH-CENTURY AUTOPSY

The 19th century was a time of transition. The anatomiza-

tion of condemned criminals continued at least into the third
decade, as evidenced by Rowlandson’s painting The Lancett
Club at a Thurtell Feast, which depicts the dissection, in 1824,
of John Thurtell, an amateur boxer and well-known criminal
who murdered a fellow gambler (

). The 1820s would also

see the autopsy of a number of prominent public figures by
physicians. Included in this group are the autopsies of Napoleon
Bonaparte (1821) by Drs. Shortt, Arnott, Mitchell, Burton,
and Livingstone (

), and of Sir Thomas Stamford Raffles

(the founder of Singapore) in 1826 by the English physician
Sir Everard Home (

The autopsy that is most important in our history of the

autopsy in the 1820s is that of a middle-aged man with pro-
found deafness and liver disease of uncertain aetiology. Ludwig
van Beethoven’s death in 1827 is notable for two reasons.
First, the findings, albeit carefully documented, have lead to
prolonged but unresolved speculation as to the cause of
Beethoven’s deafness and liver disease (

41–44

). Second, and

more importantly, his autopsy was performed at the Allgemein
Krankenhaus in Vienna 2 days after his death by Johann
Wagner, mentor and tutor to the young Karl von Rokitansky
(

). The appearance of Rokitansky in this history approxi-

mately coincides with the opening of the Autopsy Department
at the Berlin Charité Hospital in 1831, managed by Philipp
Phoebus (

Karl Rokitansky (1804–1878) was to become the father of

the modern-day autopsy. Working at the Allgemein
Krankenhaus in Vienna, he performed more than 30,000 autop-
sies during his career and is thought to have supervised about
70,000 autopsies (

). In addition, he amassed a collection of

tens of thousands of anatomical specimens, collections of
skulls and pelvic bones, and treasures including the report on
the autopsy of Ludwig van Beethoven. Rokitansky and his
colleagues Johann Wagner and Lorenz Biermayer were per-
haps the first professors of pathology anywhere. Rokitansky
initiated the concept of a thorough and systematic autopsy
examination that ensured that every part of the body would
be examined in identical fashion, regardless of the clinical
history. In doing so he echoed Morgagni, saying:

Pathological anatomy is the essential basis for

pathological physiology, to be supplemented fur-
ther by pathological histology, chemical pathol-
ogy, and experimental pathology. (

)

Ironically, he also set the precedent of the pathologist

divorced from clinical practice. In so doing, he may have fore-
shadowed the decline of the appreciation of the autopsy (

Rudolf Virchow (1821–1902), working in Berlin, advanced

the autopsy yet further beyond the work of Rokitansky, extend-
ing the understanding of disease to the cellular level—a piv-
otal point in the development of the modern understanding

of pathology. He removed the organs one by one and exam-
ined each separately (

). His 86-page pocket-sized textbook

detailing the method of performing postmortem examinations
in the dead-house of the Berlin Charité Hospital (1876) makes
fascinating reading (

In England, renewed interest in anatomy and the autopsy

at the start of the 19th century meant that the demand for
cadavers rapidly outstripped the supply afforded by the courts.
Grave robbing developed as a profitable enterprise, but as rel-
atives and the authorities began to take preventative measures,
the practice fell into decline. The Anatomy Act in 1832, gave
unclaimed bodies of paupers dying in hospitals and work-
houses a further punishment for their poverty by turning them
over to the anatomists (

). So-called “resurrectionists” pro-

vided corpses for dissection by murder. The most famous of
these were William Burke (1792–1829) and William Hare
(1792–1870) in Edinburgh. Burke sat on the intoxicated vic-
tim’s chest, occluding the mouth and nose, whereas Hare
dragged the victim round the room by the feet (“Burking”).
Brought to justice in 1829, Hare turned King’s evidence and
Burke was hanged, his body being publicly anatomized and
flayed, and his skin tanned and sold by the strip (

In North America, pathology and the autopsy was cham-

pioned in the mid-to-late 19th century by Ontario-born
pathologist-cum-physician William Osler (1849–1919).
Osler performed approximately 1000 autopsies and wrote
five volumes of autopsy protocols, only three of which survive
(

1,51

). He suffered for his art, acquiring many prosectors warts

(tuberculosis verrucosa cutis, verruca necrogenicum) (

Nonetheless, he so firmly believed in the autopsy that he
dreamed of one being performed on his own person. “Archie,
you lunatic,” he said to his friend Dr. T. Archibald Mallock
3 weeks before he died, “I’ve been watching this case for
2 months and I’m sorry I shall not see the postmortem” (

1,15

Osler collected approximately 200 museum specimens, of
which 55 are on display at the McGill Pathology Institute (

Osler eventually moved to the Johns Hopkins Hospital as
professor of medicine, where he continued to depend heavily
on autopsy findings (

THE 20TH-CENTURY AUTOPSY:
CONTROVERSY AND DECAY

Thanks to the work of pioneers such as Rokitansky,Virchow,

and Osler, the autopsy saw its heyday in the 19th century. By
contrast, the next 100 years would see pathology flourish,
while the autopsy declined from clinical use amid spectacular
controversies.

Pathology as a discipline took time to become established

(

) but as it did so, autopsies moved out of anatomy theaters

and private homes and into hospital and public mortuaries.
Autopsies had certainly been performed in the homes of the
deceased or in physicians’ consulting rooms in the 19th cen-
tury (

56–58

)—a firm kitchen table in a well-lit room was rec-

ommended for the purpose (

). The practice was continued,

Forensic Science, Medicine, and Pathology

V1–4

A Bite Into the History of the Autopsy ________________________________________________________________283

to a diminishing extent and usually by general practitioners,
until the 1960s (

). By an interesting quirk of fate, Sir John

Mackenzie was autopsied by John Parkinson (of Wolff–
Parkinson–White fame) in 1925 using a set of autopsy instru-
ments that the former had advised the latter to purchase for
home autopsies some 12 years prior to his death (

The 20th century saw the autopsy associated with scandal,

controversy, and political intrigue. First the findings of autop-
sies would be hotly contested, then the process of autopsy itself
would come under fire. Considering the former first, two autop-
sies are notable for the controversies they sparked—those of
Vladimir Lenin (V.I. Ul’yanov) in 1924 and of John F.
Kennedy (1963). Both deaths have been shrouded in political
and pathological speculation despite thorough and careful auto-
psies. In the case of Lenin, speculation has raged around which
of two natural diseases (atherosclerosis and neurosyphillis)
were the cause of death (

). The autopsying pathologist—

Professor Alexei Abrikosov—formulated the diagnosis of
atherosclerosis, which was clearly more politically acceptable
than neurosyphillis to Dr. Nikolai Semashko, Commissar for
Health (

). In the case of Kennedy, much speculation has

persisted as to the precise nature of the injuries sustained and
whether or not these were the result of one bullet or two (

60–69

(In fact it was probably two bullets, from the rear [

]).

The history of the autopsy in the latter part of the 20th cen-

tury is beyond the scope of this article, and is not dealt with
here. As we have seen, the autopsy began from humble roots,
became heavily entwined in religious dogma, and is the sub-
ject of political machination. The recent history of the autopsy
is one of decline and decay. If history teaches us anything,
however, it is that all things change. One can only wonder
what a history of the autopsy will include in 40 years time.

3. Hanzlick R, Hutchins GM, Autopsy Committee of the College

of American Pathologists. Case of the month: History repeats
itself (sometimes). Arch Intern Med 1999;159:1837–1838.

4. Wood MJ, Guha AK. Declining clinical autopsy rates versus

increasing medicolegal autopsy rates in Halifax, Nova Scotia.
Arch Pathol Lab Med 2001;125:924–930.

5. Rutty GN, Duerden RM, Carter N, et al. Are coroners’ necrop-

sies necessary? A prospective study examining whether a “view
and grant” system of death certification could be introduced
into England and Wales. J Clin Pathol 2001;54:279–284.

6. Gajalakshmi V, Peto R, Kanaka S, et al. Verbal autopsy of 48,000

adult deaths attributable to medical causes in Chennai (formerly
Madras), India. BMC Public Health 2002;2:7–16.

7. Gajalakshmi V, Peto R. Verbal autopsy of 80,000 adult deaths

in Tamilnadu, South India. BMC Public Health 2004;4:47–54.

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history of humanity from antiquity to the present. London:
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11. Parkinson D. Autopsies. Surg Neurol 1999;52:103–105.
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nosis. J Clin Pathol 1996;49:965–966.

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enteenth-century England. Soc Hist Med 1994;7:1–28.

15. Hill RB, Anderson RE. The recent history of the autopsy. Arch

Pathol Lab Med 1996;120:702–712.

16. Daniell C, Thompson V. Pagans and Christians. In: Jupp PC,

Gittings C, eds. Death in England: An Illustrated History.
Manchester: Manchester University Press, 1999, pp. 65–89.

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British Museum Press, 1996.

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

medieval Europe. J Hist Med Allied Sci 1995;50:111–132.

20. Seabourne A, Seabourne G. Suicide or accident—self-killing

in medieval England. Series of 198 cases from the Eyre records.
Br J Psychiatry 2001;178:42–47.

21. Forbes TR. Percival Pott performs a postmortem. Bull N Y Acad

Med 1975;51:272–276.

22. Cohn SK. The Black Death Transformed. Disease and Culture

in Early Renaissance Europe. London: Arnold, 2003.

23. Horrox R. Purgatory, prayer and plaque. In: Jupp PC, Gittings

C, eds. Death in England: An Illustrated History. Manchester:
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24. Rosai J. Pathology: a historical opportunity. Am J Pathol

1997;151:3–6.

25. Porter R. Renaissance. The Greatest Benefit to Mankind: A

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27. Kivela T, Pelkonen R, Oja M, et al. Diabetes insipidus and blind-

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28. The topography of decay. http://www.library.northwestern.edu/

spec/hogarth/Decay9.html. 15–7–2005.

Forensic Science, Medicine, and Pathology

V1–4

1. The modern autopsy has its earliest roots in the magico-

religious dissections of Mesopotamia and Ancient Egypt.

2. Human dissection is historically associated with pre-

vailing religious and political attitudes.

3. In the West, the earliest autopsies to determine cause of

death stem from the 12th and 13th centuries.

4. The scientific revolution prompted the development of

the modern autopsy in the 19th century.

5. The medicalization of the autopsy moved it into the hos-

pital arena but heralded its eventual decline.

Educational Message

The author has stated that he does not have a significant finan-
cial interest or other relationship with any product manufac-
turer or provider of services discussed in this article.

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