The Evolving Purposes of the Autopsy: Twenty-First-Century Values from an Eighteenth-Century Procedure

THE EVOLVING PURPOSES OF THE AUTOPSY: TWENTY-FIRST-CENTURY VALUES FROM AN EIGHTEENTH-CENTURY PROCEDURE ROLLA B. HILL* and ROBERTE. ANDERSON^ Two hundred and twenty-seven years have elapsed since Giovanni Batista Morgagni published his observations on some 700 autopsies. The appearance of De sedibus et causis morborum per anatomen indagatis was a momentous event in the development of medicine, signaling a significant departure. Although it remained for later scientists to recognize the dynamic nature of the development of disease and to use new technologies such as microscopy as they became available, Morgagni's insistence on systematic correlations between clinical symptoms and anatomic findings paved the way for the later emergence of the era of clinicopathologic correlations. Since then, studies of postmortem findings have contributed seminally to our understanding of medical science. Great and important uses have been made of autopsies, and as medical understanding grew, and societal structures evolved, those uses and purposes have changed. Today, the major purposes of autopsy studies in the nineteenth century are receding in importance, but new purposes have arisen and are arising that may prove equally influential over the next century. In this essay we will briefly review the evolution of the uses of the autopsy. From Morgagni to the Mid-Twentieth Century Prior to Morgagni's vision, dissection of the dead had been undertaken episodically [1], sometimes by scientists such as Vesalius and Portions of this paper are adapted from The Autopsy: Medical Practice and Public Policy, by Rolla B. Hill and Robert E. Anderson (Boston: Butterworth Publishers, 1988), and published here with permission. ?Research professor of pathology, SUNY-Health Science Center, Syracuse, New York. Address (for reprints): 2151 Highway 128, Philo, California 95466. fChairman, Department of Pathology, University of New Mexico, Albuquerque, New Mexico 87131.© 1989 by The University of Chicago. All rights reserved. 003 1-5982/89/3202-06 1 7$01 .00 Perspectives in Biology and Medicine, 32, 2 ¦ Winter 1989 \ 223 Leonardo da Vinci in the study of anatomy; sometimes for ceremonial reasons, as when a group of nobles reverently viewed the remains of their late king; sometimes in a quasi-religious way, as if looking at tea leaves to divine the future; and sometimes as a semipublic event intended to show disrespect for the body of a dead criminal. But the medicine of Galen held sway because of the conviction that Galen had discovered everything of significance. Few thought that anything new of value to the practice of medicine would be gained from again looking at the organs of the dead; fewer yet had any conception that a specific lesion might occur in several people and produce the same disease in each. A few curious physicians, searching for they knew not what, started to dissect the bodies of their dead patients, and some of them even thought enough of this activity to have it memorialized: in the seventeenth century no less a painter than Rembrandt received several commissions to paint the portrait of a physician at the dissecting table. A physician named Bonetus performed several thousand autopsies, but with no pathophysiologic road map to follow, he apparently became lost in the trees and was able to draw no conclusions from what he saw. It was Morgagni who realized that systematic correlation between clinical and anatomical findings would lead to discovery. Working as a clinician and teacher of anatomy in Padua for some 50 years, he eventually proposed a revolutionary purpose: to discover and catalog the anatomic lesions that cause specific diseases. He recognized the power of the autopsy to put medicine on a sound, scientific, clinicopathologic base. Morgagni's contribution was enormous in that he brought to the attention of academic physicians the fact, previously unrealized, that symptoms, signs, syndromes, and so on usually reflect an observable, predictable anatomic lesion or set of lesions. Thus the purposes of autopsy shifted from learning anatomy, and ceremonial purposes, to the cataloging of disease. Morgagni's extraordinary book was published in 1761 [2], and during the next century the textbook of pathology as the basis of medical knowledge was written. Indefatigable academic physicians took up where Morgagni left off. The French school, including Corvisart, Bichat, Laennec, Bayle, and others, performed...