by Darcia Helle
“To the living we owe respect, but to the dead we owe only the truth.” ~ Voltaire
If books and TV shows like the Rizzoli and Isles series are to be believed, then medical examiners are crime-fighting heroes who find all the answers hidden within the murder victim’s body, while also pretty much dictating the investigative process. The ladies also wear 5-inch Manolo Blahnik heels while performing autopsies and wandering through crime scenes. Today we’ll take a look at the history of autopsies, and learn whether medical examiners are as vital in solving murders as Maura Isles and her $800 shoes would like us to believe.
The word autopsy comes from the Greek word autopsia, meaning “to see for oneself”. Around the 17th century, autopsy entered our language to describe the examination of the inside of a dead body in order to determine cause of death and/or to learn about various diseases. Before this, the practice was rare. Words like dissection and examination were used, as it was more about scientific experimentation and exploration.
While Egyptians from as far back as 3000 BC removed organs in the religious practice of mummification, they did not examine the organs or the body to find cause of death. In fact, early Egyptians believed outward disfigurement of a dead body prevented that person from entering the afterlife. Organs were removed through small slits, and the body was treated as sacred. Most of our earliest societies, right up through the Middle Ages, forbade dissection of human bodies on religious and/or legal grounds. Fortunately, a few rebels along the way provided a foundation for understanding anatomy, biology, disease and, eventually, how all of this could help solve a murder.
The first dissections of human bodies for the purpose of studying disease were performed by Herophilus, who lived from 335-280 BC. Herophilus was a physician in the newly founded city of Alexandria in Egypt, and lived during a period in early Greek history when human dissection was legally allowed. He is credited with making huge strides in explaining the workings of the human body and is often referred to as the “father of anatomy”.
Erasistratus, an Alexandrian physician practicing around 250 BC, used Herophilus’s work as a starting point for his own studies. He is credited as the first to determine that the heart pumped blood throughout the body. He described the heart valves and the difference between veins and arteries. Erasistratus also gave one of the first in-depth descriptions of the cerebrum and cerebellum. These contributions earned him the title of “father of physiology”.
All of this paved the way for the first autopsy ever to be performed on a murder victim for the purpose of determining cause of death. On March 15, 44 BC, Julius Caesar was murdered by a group of Roman Senators calling themselves the Liberators. The planned assassination took place in Pompey’s Forum after a Senate meeting. Caesar’s servants eventually carried his body home, where the physician Antistius performed an autopsy. Antistius documented 23 stab wounds, perhaps assuming each wound had been inflicted by a different attacker. He determined the second wound, an upward-angled thrust just beneath Caesar’s left shoulder blade, most likely pierced the heart and caused Caesar’s death. Modern studies indicate Caesar would have bled to death regardless of the deciding wound. Historians also agree it would not be possible for 23 people to have attacked Caesar at once, estimating between 5 and 10 people were responsible for the 23 stab wounds. Regardless of any inaccuracies, Antistius’s autopsy report is the first documented autopsy in history.
Various cultures continued performing dissections off and on, though mainly for learning about disease and the inner workings of the human body. Legal prohibition against touching the dead, along with the Christian belief that dissection of humans was a sin, made for extremely slow progress. In 925 AD, England assembled committees naming the ‘Coroner System’ in order to identify causes of death. In 1100, Jerusalem mandated the inspection of all murder cases, to be accompanied by reports stating what had been done to the victims.
The first documented and detailed forensic autopsy report, in which cause of death was investigated for the purposes of laying blame to a killer, was made by Bartolomea de Variagianca in Bolonia (Italy) in the year 1302.
In 1532 in Germany, the “Constitutio Criminalis Carolina” required the dissection of all corpses when imported medical evidence was introduced in court. This legality helped push forensic autopsies forward, eventually leading to the separate branch of forensic medicine.
In 1769, Giovanni Morgagni published the first intensive book on pathology, titled On the Seats and Causes of Diseases as Investigated by Anatomy. By comparing symptoms and observations of roughly 700 patients with the anatomical findings after autopsy, Morgagni moved medicine from the study of books to the study of patients.
By this time, the religion-related fear of cutting open a dead body had, for the most part, been pushed aside and legal restrictions had been lifted. The absence of superstitions gave science room to flourish. First came French anatomist Marie F.X. Bichat, who stressed the role of different generalized body systems and tissues in the study of disease. Karl von Rokitansky of Vienna followed closely behind, introducing pathological anatomy as a diagnostic tool.
German pathologist Rudolf Virchow’s work in the mid-to-late 1800s made perhaps the biggest impact on our modern use of forensic autopsy. Virchow established and published specific protocols for standardized autopsy procedures still used to this day. He introduced the cellular doctrine, stating that changes in cells are the basis of the understanding of disease. He was against the singular dominance of pathologic anatomy in autopsies, which is the study of the structure of diseased tissue. Virchow believed the future of pathology lay in physiologic pathology, or the study of the functioning of the organism in the investigation of disease.
This all laid the foundation for forensic autopsies and crime-fighting medical examiners like Maura Isles.
In the US, any sudden of unexplained death, particularly if murder is even remotely suspected, typically falls under the coroner’s jurisdiction. A coroner is an elected official and not necessarily a medical doctor. Ideally, the police and coroner go to the scene together and decide whether a forensic pathologist is needed before the body is moved.
A forensic pathologist, or medical examiner, is a specialized medical doctor. Unlike a clinical pathologist, who studies and diagnoses disease, a forensic pathologist specifically focuses on cause of death. In doing so, the forensic pathologist must establish and document all anomalies, lethal and nonlethal, in order to present clear and definitive evidence for or against homicide charges.
Autopsy procedures differ in much the same way as pathologists do. A hospital autopsy is performed in order to study the progression of a disease, confirm cause of death, or determine medical malpractice. This type of autopsy is relatively rare, with only about 5% of hospital deaths resulting in autopsy.
A forensic autopsy is performed only on suspected homicide victims and is far more detailed. Here, the medical examiner looks not only for disease, but also for signs of trauma, foreign objects such as bullets and glass fragments, and all other clues that might lead to, confirm, or exclude a suspect. The forensic autopsy report is a legal document and must stand up to scrutiny. These cases are often referred to as medicolegal, because the investigators’ evaluation of the crime scene and circumstances and the forensic pathologist’s findings hold equal weight, and the case is dependent upon both.
In all autopsies, but particularly with forensic autopsies, the medical examiner’s findings must be dictated to a stenographer or into a digital recorder as they are determined throughout the procedure. This is crucial in legal cases, as the transcript or actual recording often becomes evidence. So when you see Medical Examiner Maura Isles talking to Detective Jane Rizzoli during the “ah-ha” moment while performing an autopsy, that is a legal screw-up. Maura needs to be recording her findings, not randomly running in and out of the room sharing information with her cop friend.
A forensic pathologist must approach each autopsy without preconceptions or assumptions, and be open to any and all explanations for cause of death. The pathologist must also determine the chain of causation leading to death. For example, a woman is stabbed on a city street. In her frantic attempt to escape, she runs in front of a car, is struck, and dies. During autopsy, the pathologist will need to figure out whether the stab wound would have been fatal on its own, or whether the victim would have survived had she not run in front of the car.
All autopsy reports contain the following information:
- Circumstances of Death
- Identification of the Decedent
- General Description of Clothing and Personal Effects
- Evidence of Medical Intervention
- External Evidence of Injury
- Internal Examination
- Samples Obtained – Evidence, Histology, Toxicology
- Microscopic Examination
Unlike Maura Isles, who runs down to homicide shouting “Eureka!”, and waving her findings around because she’s solved the murder, a typical medical examiner files his/her report and is finished with the case. The rest is up to the cops, whose actual job it is to catch killers.
Let’s take a look at TV versus reality:
On TV, Maura Isles goes along with Detective Jane Rizzoli to interrogate suspects and make arrests. In reality, that never happens. Medical examiners are not cops, nor do they behave like cops.
On TV, lab results are almost immediate. Maura Isles wants to know if a murder victim was drugged. She runs the toxicology tests herself and in no time the results magically appear right from her own lab. In reality, these results take an average of 3-4 weeks and are not run at the medical examiner’s office. Furthermore, medical examiners do not decide which tests to run but instead only collect DNA. The law enforcement agency then decides whether or not they want to run tests at the crime lab.
Have you ever watched a crime show or read a mystery novel in which the murder was solved based on the stomach contents of the victim? Maura Isles is such a pro at this that all she has to do is sniff the stomach contents, which, by the way, grosses out Jane Rizzoli. The reality is that any tests for stomach contents are completely unreliable and not generally used. Medical examiners test for undigested pills. They do not find out the victim’s last meal was squid that is only served on alternate Thursdays at one restaurant on the lower East Side of New York.
What about murder weapons? Is it possible for a medical examiner to break a murder case open by determining the weapon was a 7-inch serrated blade, 1/4-inch in thickness, which penetrated exactly 6 inches into the chest, thrust upward at a 75-degree angle by a left-handed villain? Sorry, but no. The medical examiner does his/her best to determine whether the blade used was blunt, sharp, single-edged, etc. But the medical examiner simply cannot accurately measure the depth of the stab wound, and would not determine the exact angle of the initial plunge of the blade.
The one major discrepancy that might surprise most people has to do with time of death. This is always the first demand detectives make of the medical examiner. “Give me a time of death.” And, of course, our fictional pathologists always have the answer. The reality is that medical examiners do not determine time of death. Instead, they record the time the victim was declared dead by the professionals on-scene, whether cops or paramedics.
The reality of a medical examiner’s job is not nearly as glamorous as fiction would have us believe. But, then, reality doesn’t make for good TV. The truth is that even “reality” TV shows are scripted.
I have to address one final flaw in our fictional crime-fighting, medical examiner heroine Maura Isles. While I appreciate her fashion sense, I cringe at the way she prances around her office in those 5-inch heels and designer dresses. First, it’s just absurd to consider a professional woman standing on her feet all day in those things. But, beyond that, the reality is that medical examiners wear uniforms and are fully covered, from the cute little paper hat to the little paper booties. And I just don’t think Manolo Blahnik makes those booties.
Please click to below to view Darcia’s Helle’s many excellent posts:
Suspense, random blood splatter and mismatched socks consume Darcia’s days. She writes because the characters trespassing through her mind leave her no alternative. Only then are the voices free to haunt someone else’s mind.
Join Darcia in her fictional world: www.QuietFuryBooks.com
The characters await you.
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