A Bite Into the History of the Autopsy.pdf

Fo rensic Science, Medicine, and Pathology

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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:

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

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)

Accepted for publication:

September 8, 2005

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.

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

—Sir William Osler (1849–1919); Extracted from

his Graduation thesis “Pathologic Anatomy” ( 1 )

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

for oneself” ( 2,3 ) (literally “to look at the dead” [ 4 ] ) 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

277

278 ___________________________________________________________________________________________Burton

dispensed with these concepts and turned to observation and

reason (“science”) as a means of understanding behavior ( 8 ) .

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.

limited their knowledge of internal anatomy to that gleaned from

the inspection of wounds and the dissection of animals ( 9 ) .

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

BC ), was subsequently used to ground biomedical knowledge

in Alexandrian medicine. Herophilus (c. 335–280 BC ), 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 ( 12 ) . 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) ( 10 ) . 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 AD ) 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 ( 10 ) . (Although

most sources state that Galen did not dissect humans, some

authors suggest that Galen formally used autopsies in his work

[ 3 ] . 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

THE ANCIENT WORLD

The ancient Egyptians, whose civilization rose under the

Pharaohs around 3000 BC ,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 ( 9 ) . 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 ( 9 ) . 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) ( 9 ) . 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 ( 9 ) . Hepatoscopy and haruspicy can be traced

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

such techniques, Mesopotamian medicine was effectively “sys-

tematized sorcery” ( 9 ) . 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 ( 10 ) .

The Greek civilization began to emerge around 1000 BC ,but

little is known of their medicine before the emergence of

written texts around 500 BC ( 9 ) . Hippocrates (c. 460–377 BC )

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

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A Bite Into the History of the Autopsy ________________________________________________________________279

human cadaver remained closely bound up with the religious

beliefs of the time. Dissection for scientific advancement was

all but unheard of ( 2 ) and there was a belief in the sanctity of

the intact body ( 16 ) . 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 ( 17 ) .

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 AD ) and

Symeon the Theologian (949–1022 AD ) illustrate, autopsies

were performed on the dead bodies of criminals ( 18 ) . Some

criminals were subjected to a crueller fate. Theophanes

(752–818 AD ) 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” ( 18 ) . 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 ( 18 ) .

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 ( 17 ) .

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 ( 19 ) account of the

division of Henry I of England in 1135 AD :“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 AD and punishable by excommunication—itself a form

of social death ( 19 ) .

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

mine the cause of death was largely unknown. Seabourne and

Seabourne ( 20 ) 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 AD ( 20 ) . (In England, coronial inquests would

not include autopsy findings for another 400 years [ 21 ] . )

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 ( 22 ) and, indeed as Gabriele de

Mussis recorded, plague was transmitted by infected corpses

lobbed into towns by conquering armies ( 22 ) . 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 ( 23 ) !

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 AD when a doc-

tor in Cremona undertook an autopsy examination to investigate

an epidemic ( 19 ) . 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” ( 10 ) .

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” ( 24 ) . 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”

( 22 ) . 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 Ye rsinia

pestis in 1894 ( 22 ) .

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 ( 2 ) . 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 ( 12 ) , 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” ( 24 ) . 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 ( 24 ) . This work incor-

porated numerous autopsy reports ( 14 ) 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” ( 10 ) .

The performance of forensic autopsies was sanctioned by

Emperor Charles V in 1532 with the introduction of the

Constituto Criminalis Carolina ( 12 ) 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 ( 12 ) . 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”

Ve salius’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

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

ilies requested private autopsies when family members died ( 27 ) .

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” ( 27 ) . Pauw thus provides the first known autopsy report

of diabetes insipidus caused by an arachnoid cyst ( 27 ).

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 ( 27 ) . 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 ( 27 ) . 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” ( 28 ) . 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) ( 29 ) and The Anatomy Lesson of

Dr. Joan Deyman (1656) ( 30 ) .

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 ( 31 ) .

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 ( 14 ) . 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 ( 14 ) . 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” ( 14 ) .

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 ( 32 ) .

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 ( 33 ) . 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 ( 33 ) . 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 ( 33 ) .

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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 ( 14 ) 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 ( 34 ) . 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 ( 14 ) . Baron ( 35 ) 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 ( 35 ) .

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

( 12 ) . 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” ( 10 ) .

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 ( 10 ).

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:

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. ( 37 )

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 ( 36 ) , was translated into English in 1769, 8 years

after its first publication ( 15 ) .

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 ( 21 ) . 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” ( 21 ) . Most likely, Pott referred to chronic

alcoholism and/or a venereal infection, but he did not really

explain the woman’s sudden death ( 21 ) .

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

( 15 ) . 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. ( 10 )

. . . 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

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