Autopsies: Examining the Dead to Understand the Living

An article on MedicineNet states that the first dissections were probably performed in ancient Babylon around 3500 B.C.E., but for oracular, not scientific purposes: people examined animal organs for messages from divine spirits. According to an article in the George Washington University alumni magazine, Herophilus and Erasistratus of Alexandria “used the autopsy to teach anatomy and pathology between 350 and 200 B.C. … reportedly by dissecting live criminals for their studies.” The Greek doctor Galen (131–200 B.C.E.) also dissected both humans and animals in search of the sources of pathology.

It is commonly believed that before 1500 C.E., the Catholic Church condemned the practice of autopsies. However, a paper published by the Renaissance Society of America offers historical evidence that many autopsies were performed in medieval and Renaissance Italy, and the Church did not object. By the mid-14th century, dissections had become part of the medical curriculum in many Italian universities; some private patients also requested their doctors to perform postmortems in the hope that whatever condition had killed them could be prevented or cured in their living family members.

In the 18th century, Giovanni Battista Morgagni’s book, “De sedibus et causis morborum per anatomen indigatis” (“On the Seats and Causes of Disease, Investigated by Anatomy”) laid the groundwork for modern pathology, by establishing a link between pathological changes in organs and specific diseases.

As at Renaissance-era Italian universities, early 19th-century British medical schools included dissecting a cadaver as part of their curriculum. However, British law mandated that only executed criminals could be used for this purpose, and as attendance at anatomy classes swelled, the supply of corpses were not sufficient to the demand. In response, industrious criminals robbed graves and sold their contents to university personnel who were more interested in keeping paying students in class than the provenance of their teaching “supplies.” In 1820s Edinburgh, William Burke and William Hare were too impatient to wait for people to die; instead, they murdered them and sold the corpses to a local anatomy professor. TruTV's Crime Library offers a detailed history of their gruesome exploits.

Approximately 50 years later, German pathologist Rudolf Ludwig Karl Virchow developed a systematic procedure for the autopsy; it included examining the entire body in great detail. The modern autopsy does not actually differ much from Virchow’s process. Read more about this innovative doctor, researcher and reformer at the Who Named It? Web site.

During the first half of the 20th century, postmortem examinations demonstrated that  clinical diagnoses were often wrong. Through autopsies, doctors were better able to understand and correct trends in misdiagnosis and to identify mistakes. In addition, the procedure has been key in identifying sudden infant death syndrome, Legionnaires’ disease, AIDS and the link between smoking and lung cancer.

However, many contemporary pathologists consider autopsies too expensive, labor-intensive and unimportant compared to their duties toward living patients, such as performing biopsies. In addition, many doctors do not want to be notified of misdiagnoses or mistakes in this litigation-hungry society.

According to a 2005 article in The New York Times magazine, American doctors currently do autopsies on fewer than 5 percent of hospital deaths, and doctors trained within the last 30 years are not versed in the topic. In most places, the article’s author reports, “The autopsy is dying.”