Alessio Spalla, court surgeon of Christina of Sweden and his unknown Queen's autopsy report.

BACKGROUND: Queen Christina of Sweden, a prominent Early Modern European character, died in Rome on April 19th, 1689. The scarce literature published about her illness and death agrees about the cause of the death in the diagnosis of erysipelas, that did not appear externally with an ulcer, but became manifest in her blood, causing an inflammation of heart and lungs. The article underlines the essential contribution of the learned surgeons to the development of practical anatomy in the late Seventeenth century as illustrated by the specific case of the Queen's autopsy report by the court surgeon Alessio Spalla. METHODS: The study is based on the analysis of the published literature and the comparison of archival sources as the anonymous report of the Queen's autopsy, preserved in Vienna and the unknown autopsy by Spalla, discovered in a private archive. RESULTS: The comparison of Spalla's autopsy with the Viennese report of an anonymous practical doctor -suspected to be Marcello Malpighi-, who also participated in the Queen's dissection highlights how the two perspectives of investigation - the surgical-morphological and the medical-practical ones - are integrated in the theoretical and practical dimension of practical anatomy. CONCLUSIONS: The unpublished report of the surgeon Spalla integrates the knowledge of the queen's illness and death, stands as an example of a private autopsy performed by a court surgeon in the late Seventeenth-century Rome and as a case study on the development of new hybrid areas of knowledge, such as practical anatomy.

The death of the Empress Elisabeth of Austria and Queen of Hungary-retold and reassessed with reconstruction of her autopsy.

In this publication 125 years after the violent death of the famous Empress Elisabeth (1837-1898) of Austria, known as Sisi, a modern evaluation as well as valuation will be presented. The day after her assassination by the young anarchist Luigi Lucheni using a file, a partial autopsy was performed to find out the exact cause of death-a pericardial tamponade. The complete translation of the autopsy report is part of this article, the intention being to avoid unclear wording and translation errors, which have often caused some confusion in the past. A pictorial illustration of the puncture canal will provide clarity through medical facts as to how Empress Elisabeth's death came about by correct pathological and anatomical description and, thus, counteract former interpretations.

Historical Advancements and Evolution in Understanding Human Anatomy and Pathology: The Contribution of the Middle Ages.

Dissections and autopsies are critical for understanding human anatomy, pathology, and uncovering mechanisms of disease. This review presents an historical journey from ancient times until the late Middle Ages. The major steps and developments are summarized with key figures and events presented.

Autopsy or anatomical dissection: evidence of a craniotomy in a 17th-eighteenth century burial site (Ravenna, Italy).

Surgical procedures undergone in life, autopsies and anatomical preparations can all leave clearly identifiable traces on human skeletal remains. Several studies on skeletons from archeological contexts have identified traces of these practices. However, the distinction between medical/forensic autopsy and anatomical dissections for scientific research can be challenging. We report the case of a middle-aged female skeleton from the cemetery of the church of San Biagio (Ravenna, Italy), dating back to the 17th-19th centuries, that shows signs of a complete craniotomy. In an attempt to clarify the reason for this practice, we analyzed all pathological and non-pathological markers on the skeleton. We carried out anthropological analyses and osteometric measurements to determine the biological profile and the cranial capacity of the individual. Paleopathological investigation and analyses of traumatic injury patterns were carried out using both a morphological and a microscopic approach. While we observed that the craniotomy was performed with a rip saw, we identified perimortem blunt force trauma to the frontal bone and an osteolytic lesion on the inner surface of the frontal bone. No other pathology was recognizable on the skeleton. Our differential diagnosis confidently proved that the craniotomy was due to an autoptsy procedure and was not the result of an anatomical dissection. We believe that, among other possible reasons, failed surgery could likely be the motive behind the ordering of the autopsy.

Five autopsy reports of rib fractures in the mental hospital of Reggio Emilia (1874-5): pathogenesis proposal in defence of the 'non-restraint' system.

At the end of the nineteenth century, recurrent cases of rib fractures were recorded in psychiatric asylums, opening a long chapter of discussions about the application of the 'non-restraint' system. Here we present a brief discussion of an article written by Enrico Morselli about five cases of rib fractures in the mental asylum of Reggio Emilia, in 1874-5. Morselli, a supporter of the ideas of 'non-restraint', suggested a common pathological cause. His analysis proposed the osteomalacic condition as the possible cause of fractured ribs, rejecting the accusations of violence by asylum attendants. The discussion also examines similar cases of the same period, making rib fractures the means through which the issue of management of the insane was addressed.

Daniel Smith Lamb (1843-1929): A window into the early histories of the Army Medical Museum and Howard University Medical School.

U.S. Army doctor Daniel Smith Lamb was a significant figure in the history of American pathology during its formative years. For 55 years (1865-1920), Lamb performed hundreds of autopsies in and around Washington, D.C. and personally collected over 1,500 gross pathology specimens for the Army Medical Museum. His work began at the close of the Civil War and continued on through World War I, contributing substantially to gross pathological and histological studies that documented wartime pathology, thus further contributing to the training of Army doctors. Specimens he collected also include material from autopsies he conducted on President James Garfield, his assassin Charles Guiteau, and other historical figures. Under the auspices of the Army Medical Museum, he conducted autopsies across the city of Washington for the museum's collection, many of which survive to this day at the National Museum of Health and Medicine. He served under 12 U.S. Army Surgeons General and 11 Museum Curators and was noted to be a steadying influence during a time of constant leadership changes at that institution. Lamb was known throughout Washington, D.C. as an advocate of medical education for African-Americans and women. While working at the Museum, he simultaneously served for 46 years as professor of anatomy at Howard University (1877-1923). He wrote seminal histories of the institutions with which he was associated and in so doing also contributed significantly to the study of the history of medicine.

Spanish flu in Turin as told by historical autopsy reports.

Spanish flu spread worldwide between 1918 and 1920 causing over 20 million deaths, exceeding even the number of deaths registered during the First World War (WWI). The main symptom of the disease was hemorrhagic tracheobronchitis, the onset of which was typically sudden and fatal. Young, healthy people died quickly. Despite the tragic impact of the disease on populations, already exhausted by the First World War, there is very little documentation. This was likely due to the severe censorship of the time. For this reason, autopsy reports can be a relevant source of information on the disease. Historical catalogues kept in Turin, where all autopsies were detailed, can be consulted. According to the "Regolamento di Polizia Mortuaria" dating back to 1892, autopsies were to be performed on all patients that died at home or in hospital. Therefore, autopsy reports showing the spread of diseases among the population can also help us obtain information about the spread of Spanish flu in Turin. While not documented, almost certainly the "Regolamento" was improperly implemented since just 45 cases of Spanish flu were reported, while deaths were most certainly daily and in their hundreds. According to autopsy reports, the first case occurred on 8th October 1918, although, the first official diagnosis is dated as being 24th November 1918. The records show that 18 people died during the first Italian pandemic wave. The second Italian pandemic wave seems to have been even more aggressive in Turin with 27 people having died between 8th January 1920 and 7th February 1920.

Carl von Rokitansky, the Linné of pathological anatomy.

Carl von Rokitansky was one of the most important figures in pathological anatomy, and was largely responsible for the resurgence of Vienna as the great medical center of the world in the mid-19th century. He was born in current Hradec Králové, studied medicine in Prague and Vienna and was graduated in 1828. He was greatly influenced by the anatomy, embryology and pathology studies of Andral, Lobstein and Meckel. At the Vienna School, he was Johann Wagner pathological anatomy assistant and became a pathology professor, where he remained until four years before his death. Rokitansky emphasized the importance of correlating patient symptoms with postmortem changes. It is possible that he had access to between 1,500 and 1,800 cadavers annually to be able to perform 30,000 necropsies; in addition, he reviewed several thousand more autopsies. In Handbuch der pathologischen Anatomie, published between 1842 and 1846, he made numerous descriptions: lobar and lobular pneumonia, endocarditis, diseases of the arteries, cysts in several viscera, various neoplasms and acute yellow atrophy of the liver. With his brilliant work on gross pathology, Rokitansky established the nosological classification of diseases, for which Virchow named him "the Lineé of pathological anatomy".Carl von Rokitansky fue una de las figuras más importantes en la anatomía patológica y el responsable, en parte, del renacimiento de Viena como centro de la medicina a mediados del siglo XIX. Nació en la actual Hradec Králové, estudió medicina en Praga y Viena y se graduó en 1828. Tuvo gran influencia de los estudios de anatomía, embriología y patología de Andral, Lobstein y Meckel. En la escuela de Viena fue asistente de anatomía patológica de Johann Wagner y se convirtió en profesor de anatomía patológica, donde permaneció hasta cuatro años antes de su muerte. Rokitansky hizo énfasis en correlacionar la sintomatología del enfermo con los cambios post mortem. Es posible que haya tenido acceso a entre 1500 y 1800 cadáveres al año para que pudiera realizar 30 000 necropsias; además, revisó varios miles más de autopsias. En Handbuch der Pathologischen Anatomie, publicado entre 1842 y 1846, realizó numerosas descripciones: de la neumonía lobular y lobular, endocarditis, enfermedades de las arterias, quistes en varias vísceras, diversas neoplasias y de la atrofia aguda amarilla del hígado. Con su brillante labor de patología macroscópica, Rokitansky estableció la clasificación nosológica de las enfermedades, por lo cual Virchow lo llamó "el Linneo de la anatomía patológica".

Anatomopathological research in nineteenth-century Gdansk - an outline of the problem.

Between 1793 and 1914, there were many internationally recognised physicians active in Gdansk. Their scientific activities included, among other things, anatomopathological research, constituting a determinant of progress in medical sciences during this period. One of the most important people was Martin Heinrich Rathke (1793-1860). He is recognised as one of the founders of modern embryology. In Gdansk Rathke's successor was Wilhelm Baum (1799-1883). Baum introduced compulsory post-mortem examinations in the city hospital even after the outbreak, and he was mentor to Theodor Billroth (1829-1894). The successor of Baum as the head of the city hospital was Emil Friedrich Götz (1806-1858). He took up an important topic, which was the consent of the family of the deceased to perform an autopsy. Furthermore, it described the gradual broadening of the scope of anatomopathological activities, consistent with the postulates of the first and second Viennese school, performed in Gdansk in the nineteenth century. However, a detailed analysis of the relationship between the discoveries of nineteenth-century medicine, especially in the field of pathological anatomy, and research carried out in Gdansk, remains in the sphere of research to be done.

How the public autopsy of a slave Joice Heth launched P.T. Barnum's career as the Greatest Showman on Earth.

P.T. Barnum's career as the Greatest Showman on Earth began in 1835, when he "leased" and then publically exhibited a frail African American slave Joice Heth, who was reportedly the 161-year-old former nursemaid of George Washington, throughout New England; the contract was a lease, as slave ownership had recently become illegal in northern states. Barnum exhibited Heth 6 days a week for up to 12 hr a day. Under this grueling schedule, Heth became ill and died while under contract. Barnum sold tickets for her autopsy, which was performed by David L. Rogers, an accomplished New York surgeon, in front of an audience of 1,500 paying customers. Roger's autopsy determined that Heth was no more than 80 years old, and the penny newspapers, a new form of public media, called this a "humbug" and then published dozens of fabricated "fake news" stories about Barnum, Rogers, and Heth. Barnum and his business partner generated valuable publicity by telling different penny newspapers different stories. This whole spectacle launched Barnum's career as an entertainer. Five years earlier, Rogers performed a public dissection of Charles Gibbs, an infamous Caribbean pirate who was tried, convicted, and hung in New York City. This article describes the bizarre nature of American politics and culture in the 1830s that made all of these seem normal. I will also distinguish between "public dissection" and "public autopsy," and put these into an historical context. Finally, I will address the macabre concept of autopsy as a form of entertainment. Clin. Anat. 31:956-965, 2018. © 2018 Wiley Periodicals, Inc.

Henry Ware Cattell and Walt Whitman's Brain.

Henry Ware Cattell was a prominent pathologist and medical editor in late 19th and early 20th century America. Strangely, his name is unknown to most medical historians but is more widely known by aficionados of Walt Whitman's poetry. In 1892, Cattell was involved in an incident that abruptly changed his life and decreased his commitment to pathology as a career. Cattell had been serving as the pathologist/prosector for the American Anthropometric Society at the time the poet Walt Whitman died. Cattell, the pathologist for the University of Pennsylvania's Wistar Institute, performed Whitman's autopsy on March 27, 1892; Whitman's brain was removed and was to join those of other prominent American intellectuals who had donated their brains to the Society's "Brain Club," but something went horribly wrong (allegedly, an assistant had dropped the brain and destroyed it) and Cattell kept this a secret. Full of self-doubt, Cattell was anguished about his inadequacies as a pathologist and was extremely worried about how all of this would affect his career when discovered. While still continuing to practice hospital-based pathology, he began to transition into an author and editor. This essay will provide a detailed biographical sketch of Henry Ware Cattell, address his sibling rivalry with his more famous brother James McKeen Cattell, briefly discuss the fad of 19th century intellectuals embracing the pseudo-science of phrenology and their participation in anatomical "brain clubs," and, finally, address the mystery of what happened to Walt Whitman's brain. Clin. Anat. 31:988-996, 2018. © 2018 Wiley Periodicals, Inc.

Back to the Future - Part 1. The medico-legal autopsy from ancient civilization to the post-genomic era.

Part 1 of the review "Back to the Future" examines the historical evolution of the medico-legal autopsy and microscopy techniques, from Ancient Civilization to the Post-Genomic Era. In the section focusing on "The Past", the study of historical sources concerning the origins and development of the medico-legal autopsy, from the Bronze Age until the Middle Ages, shows how, as early as 2000 BC, the performance of autopsies for medico-legal purposes was a known and widespread practice in some ancient civilizations in Egypt, the Far East and later in Europe. In the section focusing on "The Present", the improvement of autopsy techniques by Friedrich Albert Zenker and Rudolf Virchow and the contemporary development of optical microscopy techniques for forensic purposes during the 19th and 20th centuries are reported, emphasizing, the regulation of medico-legal autopsies in diverse nations around the world and the publication of international guidelines or best practices elaborated by International Scientific Societies. Finally, in "The Future" section, innovative robotized and advanced microscopy systems and techniques, including their possible use in the bio-medicolegal field, are reported, which should lead to the improvement and standardization of the autopsy methodology, thereby achieving a more precise identification of natural and traumatic pathologies.

Post-mortem in the Victorian asylum: practice, purpose and findings at the Littlemore County Lunatic Asylum, 1886-7.

This article examines the purpose of the post-mortem in the late Victorian asylum and discusses what the findings reveal about contemporary understanding of mental health. By examining the practice at the Littlemore Asylum of Oxford, the definition of the asylum post-mortem will be questioned and issues of consent and ownership of the dead body explored. It will be argued that the purpose of the examination was partly to appease the demands of the Commissioners in Lunacy, to protect the asylum against accusations of malpractice, and to appease the resident assistant medical officer's own morbid curiosity. The examinations would therefore be better defined as dissections. This article will challenge understanding of institutional death, the legal processes required for dissection, and mental healthcare.

Description of in-hospital deaths in Vienna during 1850-2000.

The aim of this study was to compare in-hospital deaths in different hospital settings between 1850 and 2000 in Vienna. We reviewed 120 autopsy records for each of the selected years from the Clinical Institute of Pathology of the Medical University Vienna and two community hospitals. In 2000 the autopsy rate was 37.5 % at the community hospitals and 52.5 % at the university hospital. The mean age of those being dissected was significantly lower compared with those not being dissected in the community hospital. Infections were the leading cause of death during the nineteenth and early twentieth century, after 1950 the rate of cardiovascular diseases and cancer increased. In the year 2000 the majority of patients with an underlying malignant disease died because of cardiovascular disease. Causes of death vary between institutions. They should be reported as accurately as possible in order to create a cogent basis for central mortality statistics.

[Medical expert reports in the Valencia of the late Middle Ages: cases of poisoning]. / Los peritajes médicos en la Valencia bajomedieval: los casos de envenenamiento.

During the last decades of the 13th century, in the midst of the shaping and medicalization of the new Kingdom of Valencia, the authorities and citizens envisaged the role that physicians could have in clarifying violent deaths. The first circumstance that compelled judges to resort to physicians was the possible poisoning of an individual, given that they could contribute to elucidating the truth with their expert knowledge. They were even requested to use post-mortem dissection if necessary for this purpose. In reality, physicians were conscious of their limitations in this field and the need for them to act with caution.

[Antike Anatomien]. / Antike Anatomien.

One still wonders today at the anatomical precision with which various ancient authors, like Homer, depict the inner body. How was it possible to get such a precise knowledge, at a period when medicine was not particularly famous for its scientific achievements? The history of the beginnings of western anatomy reveals a surprising variety: its progress, until the tremendous technical fulfilments of contemporary anatomical imaging, has been neither linear, nor spontaneous, nor even necessary. Before becoming one of the epistemological bedrocks of medicine, its history reveals itself filled with accidents, ruptures, contingencies, and actors who contributed to modify its course.

Marks of autopsy and identification of victims of human rights violations exhumed from cemeteries: the case of the Spanish Civil War (1936-1939).

The presence of autopsy marks in human skeletal remains indicates a medicolegal procedure related to ascertaining the cause and manner of death. We present here four cases where signs of autopsy were observed in the remains recovered from mass graves and cemeteries of prisoners from the Spanish Civil War (1936-1939), victims of extrajudicial executions, and of death in prison, respectively. With respect to the former, historical evidence indicate that during the first weeks after the coup, official removal of cadavers and autopsy procedures were carried out to the first victims of extrajudicial killings, whose corpses were found abandoned in the road. Once the civil war was established and systematic extrajudicial killings were systematic, official military orders were issued to stop standard forensic proceedings. Therefore, autopsy marks observed in the remains exhumed from mass graves located in cemeteries may be indicative of an earlier chronology of the killings, and this information proved to be relevant for the identification process in one of the cases presented. In a cemetery of political prisoners, autopsy signs were also observed in two skeletal remains and in the official records of two prisoners, a corroboration of information also relevant for the identification process. These findings indicate that autopsy marks can be found in the remains of victims of human rights violations exhumed from cemeteries. Skeletal and archival information could be useful for the identification process in other cases of large-scale violence, where the first victims of extrajudicial executions were buried unidentified in cemeteries after autopsy procedures.