Search

We present the second part of our review concerning the history of autopsy. During the development of medicine the role of autopsy was obviously changing. Concurrently with the progress in the anatomical knowledge, the anatomists observed and noted both single anomalies and repetitive changes which correlated with symptoms in living patients. This is how anatomopathology came into being. We present the most famous people engaged in autopsy comprehension. We discuss main trends and ideas influencing the phenomenon of autopsy in the analyzed period: from sporadic public dissections, through theatra anatomica, introduction of autopsy to the hospital medicine and separation of anatomopathology as a medical speciality. The golden age of autopsy was the 19th century and the first half of the 20th century, with a consecutive decline in frequency. Nevertheless, despite the progress in diagnostics in vivo, it seems that autopsy will keep its important place in medicine according to the old motto "Mortui vivos docent" (the dead teach the living).

Death and corpse were incompatible with god's and family doctor's presence in the Greek-Roman world. This incompatibility between life and the death was surmounted by the admittance of Saints' bodies in the Churches and believers' burial "ad Sanctos". From this, to body's utilization as discloser of the "causae morborum" the way was relatively short, culminating in the stage marked by Morgagni's name.

Between 1912 and 1980, many English language publications analyzed the correlation between clinicians' diagnoses and postmortem examinations. Surprisingly, the percentage of cases with undiagnosed principal underlying diseases or primary causes of death has not diminished during this period. The autopsy's unvarying percentage yield does not indicate a lack of progress, however, since bacterial pneumonia, hepatic cirrhosis, and common tumors were missed routinely in earlier eras but were rarely missed after 1970. Pulmonary embolism remains commonly missed, but the striking recent finding is the emergence of fungal and other systemic infections that were rarely noted in prior eras. Progress in diagnosis and treatment may allow patients to live longer and new or obscure diseases may develop that will often be missed clinically. An appropriately high autopsy rate will be required if medical progress is to continue.

Ileus comes from the Greek word for twisted. The early classical literature suggests that this term was used for what we now call sigmoid volvulus. The Romans translated this word as volvulus. During later classical times, investigators used ileus and volvulus in describing conditions other than sigmoid volvulus. Roman investigators used ileus to describe midgut volvulus, intussusception, and incarcerated hernias because the symptoms of these conditions were similar. During the Renaissance, ileus, volvulus, and intussusception were synonymous and were closely linked to the volgar terms iliac passion and Miserere Mei. The sine qua non of ileus was the clinical triad of abdominal pain, obstipation, and fecal vomiting. Autopsies in the 16th, 17th, and 18th centuries exposed the various causes of these symptoms. Ileus became the clinical diagnosis whereas such terms as intussusception were used to describe autopsy findings. Physicians classified diseases by symptoms not by cause. During the 19th century, emphasis switched to the pathologic basis of disease. The classification of intestinal obstruction became one of cause. Ileus was abandoned because its classical definition did not encompass all forms of intestinal obstruction. In the last 50 years, ileus has been relegated to mean nonmechanical obstruction that does not initially require operative treatment. Thus, ileus which was the twisted intestine of Ascelpiades, the Miserere Mei of Paré and the iliac passion of Barrough, has come in the 20th century to mean nonmechanical intestinal obstruction.