Autopsy

“ Where an investigator believes on reasonable grounds that the performance of an autopsy on the body of a deceased, or the carrying out of other medical examinations of human remains, is, or may be, relevant to the conduct of the investigation, the investigator may cause such an autopsy or a medical examination to be performed. ”

“ A physician who performs an autopsy without the consent of the person having the custody of the deceased does so at his own risk, except in those cases in which the autopsy is in accordance with legal statutes. In the majority of the States there are statutes providing that the Coroner or Board of Health shall order an autopsy whenever a person is found dead and the cause of his death is not apparent, and cannot be ascertained from the evidence given, or from a superficial examination of the body. ”

“ If he deems a further examination necessary and is authorized so to do, he must make an autopsy in the presence of two or more discreet persons, whose attendance he may compel by subpœna if necessary, and he must then carefully reduce or cause to be reduced to writing every fact and circumstance tending to show the condition of the body and the cause and manner of death, together with the names and addresses of the witnesses. ”

“ Furthermore, if the cause of death be at all obscure, we should examine not only the wound itself and the parts about the wound, but also, by an autopsy, all the cavities and organs of the body. For death may have been due to natural causes in an organ not examined, if the examination has not included all, and the physician has to disprove it. ”

“ Where it is necessary to ascertain the cause of the death, the official performing the autopsy shall be invested with the power to order the corpse to be dissected and any portion thereof to be analysed, or the whole or part of the corpse to be delivered to a public physician or analyst. ”

“ While it is obviously difficult to give any specific rules as to the method to be pursued in seeking permission for an autopsy, there are certain arguments that can be used to advantage. Natural curiosity, the general good to humanity, the control of diagnostic and therapeutic methods, new knowledge to be gained, the question of inherited or infectious conditions, the strengthening of insurance claims, etc., are some of the lines that may be followed in working for an autopsy. ”

“ In private practice the autopsy is usually made in a private dwelling or, more rarely, in an undertaker’s shop. Under such conditions much depends upon the ability of the operator to make the best of things. In place of a proper table, the cadaver must be examined upon the bed, undertaker’s body-rest or shutter, in or upon the coffin, on the coffin lid, box, door, shutter, table or board. It is always advisable to move the body from the bed when anything else can be found upon which it can be placed. ”

“ In the case of medicolegal autopsies the ends of justice as well as the life, liberty or reputation of some individual may depend upon the results of the postmortem examination. In all cases to which there is any suspicion attached, or in which the cause or manner of death is doubtful an autopsy should be legally required, but unfortunately this is not yet done in this country. Physicians individually should endeavor to create in the public mind a more healthy attitude toward the autopsy and an appreciation of its usefulness. ”

“ The review of anatomic relationships offered by the autopsy is in itself worth while, and in the case of healthy individuals killed by accident the survey of the normal appearances of the organs and tissues offers an opportunity for study too valuable to be neglected. Further, it is justifiable to practice upon the cadaver any surgical operation that does not disfigure it. ”

“ Granting the existence of such a possibility of apparent death before absolute signs of death appear, it follows that in all autopsies made very soon after death has occurred, the prosector must bear such a possibility in mind, and satisfy himself beyond all doubt of the actual occurrence of death before beginning the autopsy. ”

“ We are all aware that there are many cases which come before us where we may entertain suspicions, and strong suspicions, that the patient has been poisoned, and yet we dare not take any steps because, in the first place, we have no clew as to how or by whom he or she has been poisoned, and because, if after death an autopsy should prove that we were mistaken, it would be nothing short of professional ruin. ”

“ But there are other fatal cases, where on autopsy there is revealed no appreciable lesion, death, the penalty of unwarrantably interfering with nature, being occasioned by syncope, by excess of pain, or by moral shock from the thought of the crime. ”

“ By direction of the coroner the body had been exhumed and an autopsy performed. The expert examination had been made by Dr. Clayton Williams of the Johns Hopkins Medical School, and he was the first witness called.
Doctor Williams told the jury that while the wound on the temple might have been sufficient to cause death still he was not prepared to pronounce positively upon the point. In answer to a question from Professor Warriner, [Pg 86] Doctor Williams went on to say that the autopsy had revealed a very peculiar condition of the brain—a lesion of most unusual character. ”

“ In a certain number of cases the matter is hopeless from the beginning, but in the majority the autopsy may be secured by the exercise of proper tact and patience. The laity should be educated to ask for the autopsy; and even at the present time laymen often show a greater willingness in this direction than some members of the profession. That physicians and undertakers who discourage or oppose autopsies should be avoided is a principle that should be instilled into the minds of the public at large. ”

“ Thousands of cases have been handled, and each instance has confirmed the conviction that the principle involved is absolutely sound. It has stood all tests. Where death has occurred, the autopsy showed organic defects, inherent, or acquired through years of continued functional abuse. ”

“ Whenever an autopsy is required, it shall be held without hesitation by an inquirer of the locality where the corpse is, together with a forensic pathologist upon whom a certificate or a Medical Council’s letter of approval has been conferred. Where no such forensic pathologist could be found or where he is unable to perform the duty, a physician affiliated with a public hospital shall act in his place. ”

“ AUTOPSY TECHNIQUE. The object of the autopsy is to examine thoroughly, in as short a time as possible, and in the easiest and most convenient method, all of the organs and tissues of the body, with reference to the occurrence of disease-changes, in such a way that nothing will be overlooked or obscured. The preservation of relationships becomes, therefore, a very important matter; and nothing should be done to disturb these until a complete pathologic picture has been obtained. All unnecessary handling and cutting must be avoided. ”

“ Another effort was not out of place, however; and the Coroner, summoning up some of the pompous severity he found useful at times, asked the witness if his attention had been drawn to the dead woman's hands.
He acknowledged that it had. "The physician who made the autopsy urged me to look at them, and I did; they were certainly very like my wife's."
"Only like."
"I cannot say that they were my wife's. Do you wish me to perjure myself?"
"A man should know his wife's hands as well as he knows her face." ”

“ Perry’s autopsy received a confirmation which ended, after a mass of testimony tending rather to confuse than enlighten, the jury, in the non-committal verdict:
Death by strangulation at the hands of some person unknown. ”

“ Suppose that some person, some one who had the opportunity, had committed a murder. By removing the body of your husband, and replacing it with that of his victim, the evidences of his own crime would be concealed. The discovery of your husband's body, even if identified, as it has been, could lead to little else than mystification, for the criminal well knew that the autopsy would show natural causes of death. ”

“ When carried out primarily with the view of obtaining evidence of legal importance, as in the case of a suspected crime, accidental death, the identification of a body, in damage suits for injuries received, malpractice, insurance, etc., the autopsy is usually styled medicolegal, or the German term obduction is not infrequently applied. ”

“ In several States legal authority is given to the Board of Health to order an autopsy whenever the health interests of the people demand such an investigation. Autopsies performed under such orders against the desire of the relatives should always be carried out with extreme care and in the presence of proper witnesses. ”

“ An autopsy has revealed traces of the disease of which I died, and this after a hundred years! If they were as expert in diagnosing the living as they are in cutting up the dead, fewer of the mistakes of the doctors would have to be buried from sight and mind. ”

“ Ogilvie has to thank McGrath for another of his marvelous medical discoveries, namely an instrument which, used during an autopsy, registers almost automatically to what cause death has been due. If death apparently has been due to more than one cause, it decides between them and points at the right one. ”

“ He worked late at night on the murder cases, referring constantly to autopsy protocols and police memoranda, and more than once I saw him reading his Bible. On several occasions he visited the county morgue and examined the remains of the Head-hunter's victims, and following each such visit he lapsed into a state of mental and physical agitation that exhausted him within a few hours. ”

“ Drops of blood or other fluids upon the surface of the cadaver should be removed before they become dry. All respect should be paid to the dead body. The face and hair should be covered after they have been examined; and great care should be taken to prevent any accidental cuts on the surface; and the entire field of operation as well as the autopsy-table must be kept clean. ”

“ In medicolegal examinations a definite autopsy order should be prescribed by law. For the average case, in fact for nearly every autopsy, I believe the following order, as given in my protocol book, to be the best one. It is based upon topographic and anatomic relationships, preservation of blood-content, ease and convenience of method, etc. As the protocol should follow this order, it is given here in full.
Autopsy-Protocol No.
1. Name: 2. Sex: 3. Age:
4. Nationality: 5. Status: 6. Occupation:
7. ”

“ Imperfect and subjective conclusions will be avoided if the regular order is followed and each organ examined objectively. In all cases a complete autopsy should be made if permission can be obtained, and the permit for an autopsy should be regarded as one for a complete examination unless definite exceptions have been made. The examination of any organ or part should never be neglected. ”

“ That would be a solution. But there are only a few sentences...
THE PRESIDENT: You can read it. Take the book back.
DR. STAHMER: Mr. President, I propose to read only a few short sentences.
[Turning to the witness.] Yesterday you testified, Witness, that the experts restricted or limited themselves to making an autopsy on one corpse only. In this report the following is set down—I quote:
“The members of the commission personally performed an autopsy on nine corpses and numerous selected cases were submitted for post-mortem examination.” ”

“ Each autopsy is a law unto itself in this regard. New complications constantly arise and must be studied before the right way of revealing the solution of the pathologic problem is found. Above all things nothing should be destroyed until its relationships have been fully [Pg 21] determined. False steps taken in an autopsy cannot be retraced, and the complete investigation and the successful attainment of a diagnosis may be made impossible by improper methods of technique. As in all other technical matters there is a best way of carrying out the different steps of the autopsy ”

“ It is not to be supposed that, even when the cadaver is opened within a very short time after death, the color is that of the living body. Certain color-changes always take place as soon as death occurs, but it is necessary to create a color-standard for the different organs as seen under the conditions of the ordinary autopsy. Injections of formalin and other undertaker’s fluids destroy all color, and should not be permitted before the autopsy. Freezing likewise changes the color of many of the organs. ”

“ Even to the prosector with an experience of several thousand autopsies to his credit, each new examination of a dead body becomes a new revelation and extends still farther his intellectual horizon. To the student and physician in practice each autopsy may, if performed in the proper spirit, become in itself an educational factor of the greatest value. In no other scientific procedure is there such a demand made upon the faculties of observation, judgment and interpretation, and in no other is there such intimate correlation between methods of technique and the higher intellectual processes. ”

“ Whenever it is manifested or reasonably suspected that any person has died an unnatural death or died while being restrained by an official, an autopsy shall be held, save where the person has been put to death lawfully. ”

“ Besides if I had not been present, that would today be considered as an incomprehensible lack of interest in the death—if I had not accepted Rascher’s invitation. If such a death happened during a centrifugal experiment in our institute, if such an accident had happened which was not in my field of work, I certainly would have gone to watch the autopsy. One must learn from the findings; that is one’s duty as a doctor. One has to look at such things so that one can draw one’s own conclusions and be able to avoid subsequent accidents. ”