Seeing for Oneself: Autopsies in the 19th Century

My topic today is a rather grim one--autopsies, particularly forensic autopsies, in the 19th century.

An autopsy occurs in my latest novel, Something So Divine, set in 1897 rural Pennsylvania. They also occur in several of my other historical mysteries, Fallen From Grace and Sooner Than Gold. So, research on the subject was vital to my stories.

Dr. Hackett, still wearing the same rumpled suit as the day before, scowled at Roth as he entered the small shed attached to the side of the hospital. As always, Roth was surprised to find the room well lit and orderly. Two corpses were laid out on kitchen tables. The windows of the room were thrown wide open, but the movement of a flow of air couldn't disguise the fact one of the subjects awaiting autopsy was fresher than the other. (from Something So Divine)

The term 'autopsy' (derived from Greek: "seeing for oneself") has been used since the 17th century, though the practice may date back to the ancient Egyptians. Great strides had been made prior to the 19th century when Rudolf Virchow, a German now known as the "father of pathology," standardized protocol and procedures.

The late 19th century and early 20th century are considered by some the Golden Age of the autopsy, primarily due to medical advances. In the 19th century, the power of the physician toward a dead body (and relatives) was enormous.

There are now two types of autopsies: clinical, which is a pathological procedure to determine cause of death and generally requires permission of a family, and forensic, which seeks answers to questions of interest to the legal system. This latter is my focus here.

As early as 1897, intent was to conduct an autopsy as soon as possible, from an hour to 10 hours after the death. This was intended, both, to preserve tissue and organs and to return the remains to the family as quickly as possible.

The prestigious New England Journal of Medicine reported in 1897 some pathologists recommended preserving soft body parts in formaldehyde so they could be presented in court where they "...would often convey much more meaning to the average jury than lengthy technical descriptions."

The journal also acknowledges that in the late 19th century autopsies were at the discretion of the medical examiner who made his decision after viewing the body and holding an inquiry. For sanitary reasons, it was recommended cadavers should be held in a location isolated from living medical patients.

Some authorities in Europe (where the greatest strides were being made) were critical of American physicians who they considered careless and indifferent to the deceased, which could lead to no autopsy being conducted or one that was less discerning.

It would be wrong to paint all physicians here with the same brush. Many were competent and thorough in their examinations, basing their work on the latest scientific knowledge. Technical innovations, such as the improvement to the microscope were a significant aid to their findings.

Unfortunately, not all autopsies were conducted in separate hospital facilities where sanitary conditions were more likely to exist. Depending on the location and what was available to the examiner, autopsies could and were performed in deplorable locations, a private house, an old shed or even barn and other places.

Generally, wherever it was to be conducted, there were recommendations for equipping the site. A sturdy kitchen table or a door set upon supports was primary as work station. The room was to be well-lighted, as large as possible and with any windows thrown wide open. Other equipment included wash buckets and pails, a plentiful supply of hot and cold water, a bottle of carbolic acid, turpentine, carbolic linseed oil and other solutions, clean rags, newspapers, sponges, soap and towels. Despite the risk, few surgeons of the time wore rubber gloves, which didn't come into general use until the 1920s.