jiafm, 2010-32(2) april-june. - forensic medicine

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ISSN 0971-0973 J Indian Acad Forensic Med, 32(2)(now the Dominican Republic) a double monster,female twins, joined from the region of the umbilicusto a point in the thorax just below the breast. Ofcourse, the infants were to be baptized, but the priestwas uncertain as to whether one soul or two soulsrequired baptism. The father reported that one wouldcry while the other was quiet, one might sleep whilethe other was awake. Two baptisms were performed,but the priest was still uneasy. When the infants diedat the age of 8 days an autopsy was done in the hopeof settling the question. Since two complete sets ofinternal organs were found, it was decided that thereprobably were two souls. Chavarria and Shipley, wholocated and translated this fascinating story,commented that this was perhaps the only postmortemexamination ever conducted to study the soulof the deceased [13].Respect for the body was an important partof the Jewish tradition, since the Bible taught thatGod created man in his image. Handling a dead bodymade a man unclean for several days, but there wererules for his purification. Nevertheless, it wasemphasized that the body must be treated respectfullyand buried promptly. Even for a criminal put todeath, hanged on a tree, "his body shall not remain allnight upon the tree, but thou shalt in any wise buryhim that day." These laws were interpreted by therabbis to forbid post-mortem dissection which wouldbe a disgrace to the body. However, it is recordedthat about 100 AD the students of the Rabbi Ismaelobtained the body of a young harlot who had beenexecuted and boiled it in order to count the number ofbones. They found 252 [14].There is one passage in the Talmud statingthat if an autopsy would save the life of an accusedmurderer, it would be permitted. Autopsies wereotherwise not approved by Jewish authority until theeighteenth century when Rabbi Landau was asked ifit were permissible to make an incision in the body ofa patient who died of cancer, in order to learn theproper therapy in future cases. Rabbi Landau repliedthat autopsy is a desecration of the dead and is onlypermissible to save the life of another patientimmediately at hand, not some problematic futurepatient [15]. This ruling was apparently maintainedby orthodox Jews until the twentieth century whenthe Knesset, the Israeli parliament, passed a lawpermitting autopsies under strictly limited conditions.[16]Some indications of the popular objectionsto autopsies may be noted. In 1538, GuillaumeRondelet (1507-1566), a scientist in Montpellier,autopsied his own infant son and later requested thatautopsies be performed on his sister-in-law and hisfirst wife. This is told in a biography dated 1578, byhis pupil Joubert, who comments, "a cette époque lepublic avait l'anatomie en horreur”. [17]Vesalius, the noted anatomist, who practicedmedicine and performed many autopsies, died in1564 during the return from a pilgrimage toJerusalem. Many years later a biographer, MelchiorAdam, published a letter allegedly written by HubertLanguet in 1565, stating that Vesalius had beenforced to make this pilgrimage as expiation for thesins of murder and impiety. O'Malley is convincedthat there is no foundation of fact for this story, [18]but points out that it may be based on the same rumorreferred to by Ambroise Pare, who, writing in 1573,warned against opening a body too soon and notedthat "in this century it happened that a great anatomist. . . I say great and famous . . . then a resident inSpain was ordered to open the body of a womanbelieved to be dead of suffocation of the womb. Atthe second cut of the razor the woman began to moveand show other signs that she still lived . . . the goodmaster had to leave the country and being exiled,soon after died of grief which was certainly a greatloss for the Republic” [19].Jarcho has called attention to the problemsof performing autopsies in Germany in 1670. In amedical periodical of that year, there is an autopsyreport with a comment, "the other structures couldnot be examined because a female relative changedher mind. Our people have a great horror of autopsiesand very rarely allow them unless special persuasionhas been used." The editor of the journal added adiscussion of the difficulties of obtaining permissionand some possible answers to the objections ofrelatives [20].Popular reluctance for autopsies at a slightlylater period is also evident by the fact that, when in1699 the Republic of Lucca established rulesdesigned to limit the spread of consumption whichincluded the recommendation of autopsies; the rulinghad to be revoked because of the citizens' objections[21]. Even today these attitudes are still encountered,and further consideration would carry us too farafield.Conclusion:Some Forensic Pathologists argue that moreautopsies are performed than necessary. However,recent studies show that autopsies can detect majorfindings about a person's condition that were notsuspected when the person was alive. And thegrowing awareness of the influence of genetic factorsin disease has also emphasized the importance ofautopsies. It is important to note that autopsies canalso provide peace of mind for the bereaved family incertain situations. Therefore autopsy should beencouraged in all communities regardless of religionupon all unnatural death for the check of justice. Thekey is the renewed understanding by pathologists andclinicians and hospital administrators about the roleof an autopsy in health care. The autopsy room186
J Indian Acad Forensic Med, 32(2) ISSN 0971-0973should not be seen as the place where sorrow and thespectre of death come alive, but rather it should bewhere death rejoices to aid the living.Reference:1. King LS, Meehan Marjorie C. A history of the autopsy,Am J Pathology, 1973; 73: 514-544.2. Reddy KSN, The Essentials of Forensic Medicine andToxicology, Eighteen Edition, 1999, P-82.3. Abdullah Fatteh. In: Handbook of Forensic Pathology,ISBN 0-397-50328-8; P-166-181.4. Martin-de-las-Heras-S et al. Methods for identification of28 burn victims following a 1996 bus accident in Spain; J-Forensic Science,1999 March; 44(20;428-31.5. Gresham GA, Turner AF. The post mortem examination.In: Forensic Medicine. 3 rd edn, 1988. Churchill Livingstone,London.63-79.6. Avrahami R, Watemberg S, Daniels-Philips E, Kahana T,Hiss J. Endoscopic autopsy. Am J Forensic Med Pathol1995; 147-150.7. McBay AJ. Toxicological findings in fatal poisonings. ClinChem 1973; 19: 361-365.8. Bouchardy B, Majno G. Histopathology of early myocardialinfarct: A new approach. Am. J. Pathology 1974; 74:302-330.9. Pillay V.V. Conflicts of opinion in forensic work-Need for arational outlook. J. Indian academy of Forensic Medicine1993; 15: 40-41.10. Wolfe-Heidegger, Cetto9 p 36.11. Proskauer C. The significance to medical history of thenewly discovered fourth century Roman fresco. Bull NYAcad Med 34:672-688, 1938.12. Ullman WH. Obduziert wurde Ignatius von Loyola. MedWelt 35: 1758-1763, 1963.13. Chavarrla AP, Shipley PG. The Siamese twins of Espafiola.Ann Med Hist 6:297-302, 1924.14. Gordon BL. Medicine among the ancient Hebrews. AnnMed Hist (Series 3) 4:219-325, 1942.15. Rosner F: Studies in Torah Judaism, Modern Medicine andJewish Law. New York, Department of Special Publicationsof Yeshiva University, 1972, p 136.16. Kottler A: The Jewish attitude on autopsy. NY State J. Med57:1649- 1650, 1957.17. Pag6s A: Petite histoire de l'autopsie anatomo-pathologique.Monspeliensis Hippocrates 3(10): 16-24, 1960.18. O'Malley 16 pp 304-305.19. Pare A: Oeuvres completes, Vol. 2. Edited by JS Malgaigne,Paris, ailliere, 1840, p 755 (translation by the authors).20. Jarcho S: Problems of the autopsy in 1670. Bull NY AcadMed 47:792 - 796, 1971.21. Castiglioni A: A History of Medicine, Second edition.Translated and edited by EB Krumbhaar. New York, AlfredA. Knopf, Inc, 1947, p 56.187
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