Ted Pysher, MD, Professor of Pathology and Clinical Pediatric Pathologist at Primary Children's Medical Center, discussed autopsy at the January Humanists of Utah meeting. The autopsy is the prime procedure that moved medicine from the view that Galen and the Greeks had on anatomy and the treatment of disease to current practices.

Medical texts survive from many ancient civilizations, including Egypt, Greece, Mesopotamia, India, Chinese, and Old Testament mentions of Hebrews. None of these societies practiced autopsies, and in fact many of them had laws prohibiting postmortem examination. Yet they all had some knowledge of anatomy, perhaps from dissection of animals. The first documented autopsies occurred in Alexandria in the third century. The ruling Ptolemaic Greeks allowed the performance of some autopsies for the study of anatomy and cause of death. There is some evidence of sporadic autopsies being performed during the Middle Ages. One Norwegian king, returning from a Crusade, suffered the loss of many men in a particular town. Thinking that a particular wine caused the deaths, the King had the liver of a pig soaked in the wine and found that it appeared to be damaged. He then had several of the victims dissected and their livers examined to see if they suffered a similar fate. Roger Bacon commended the study of the dead body but did not mention any personal autopsy experience. In 1163, at the Council of Tours, there was an official decree that the Church abhorred blood. It was interpreted to mean that priests could not cut the patient either living or dead.

The earliest record of an autopsy in the New World occurred in 1533 in what is now the Dominican Republic. A set of female Siamese twins died shortly after birth. An autopsy was ordered by the priest to determine if there was one or two souls. The still surviving report indicates that all of the organs were duplicated, resulting in a report of two souls. The father objected because he had to pay for two baptisms.

DaVinci performed at least 30 autopsies and recorded the procedures in great detail. However, because of fear that the Church would ostracize him, he did not publish the results during his lifetime. It was not until the 16th century that routine autopsies were performed. It was found that abnormalities of the organs correlated with diseases the patients had before death. There were several books published documenting autopsies during the 16th and 17th centuries. One of these, published in the 17th century by Bailey, first described diseases as affecting organs instead of the "humors." Napoleon issued specific instructions that an autopsy be performed on his body and that the information gained be used to help his son.

In the 20th century, we have applied what was learned about anatomy in the past 300 years and moved on the causes and cellular effects of disease. Through the 1960's, most medical students were required to view autopsies. Since the 1950's, the autopsy rate has declined dramatically. This is often explained by the argument that advances in technology have eliminated the need for routine autopsies. In fact, unexpected findings occur in as many as 30% of all postmortem examinations. Also, the examination takes a long time, weeks or even months, as compared to minutes to days for other clinical testing.

The main reason for performing an autopsy on children is to try to discover the reason, and therefore clues to future prevention of the cause, of death. Another justification for an autopsy is that it is a final examination that helps to close the book on a person's life. It can also be used as a quality measurement for hospitals. Standards can be set to a certain level of unexpected findings as a benchmark to measure good practice of medicine for the living.

Autopsies always include saving of small pieces of tissue embedded in paraffin wax blocks. Thin sections are cut, stained and examined microscopically. They are kept indefinitely and can provide sections for many years as new information becomes available. The same is true of specimens removed during surgery.

At the great Renaissance medical school in Padua, the examination room wall is lined with the skulls of former professors who have donated their bodies for dissection by students. Since 1950, 150 new diseases have been identified by autopsy. Necessarily the numbers will decline over time but the need for and value of autopsies will continue for a long time to come.

--Wayne Wilson