Historical postmortem studies on catatonia: Close reading and analysis of Kahlbaum's cases and scientific texts between 1800 and 1900.

In the 19th century, postmortem brain examination played a central role in the search for the neurobiological origin of psychiatric and neurological disorders. During that time, psychiatrists, neurologists, and neuropathologists examined autopsied brains from catatonic patients and postulated that catatonia is an organic brain disease. In line with this development, human postmortem studies of the 19th century became increasingly important in the conception of catatonia and might be seen as precursors of modern neuroscience. In this report, we closely examined autopsy reports of eleven catatonia patients of Karl Ludwig Kahlbaum. Further, we performed a close reading and analysis of previously (systematically) identified historical German and English texts between 1800 and 1900 for autopsy reports of catatonia patients. Two main findings emerged: (i) Kahlbaum's most important finding in catatonia patients was the opacity of the arachnoid; (ii) historical human postmortem studies of catatonia patients postulated a number of neuroanatomical abnormalities such as cerebral enlargement or atrophy, anemia, inflammation, suppuration, serous effusion, or dropsy as well as alterations of brain blood vessels such as rupture, distension or ossification in the pathogenesis of catatonia. However, the exact localization has often been missing or inaccurate, probably due to the lack of standardized subdivision/nomenclature of the respective brain areas. Nevertheless, Kahlbaum's 11 autopsy reports and the identified neuropathological studies between 1800 and 1900 made important discoveries, which still have the potential to inform and bolster modern neuroscientific research in catatonia.

Chronological transition of necropsy cases of animals in Tokyo, Japan.

There is no nationwide necropsy database of animals in Japan, and most of the records are available from the postwar period. To clarify the chronological transition of animal necropsy cases in Tokyo, Japan, the records accumulated in The University of Tokyo from 1902 were investigated. Of necropsy records on paper or electronic from 1902 to 2021 kept at the Laboratory of Veterinary Pathology, The University of Tokyo, totally 3,137 cases including 572 in 1903-1914 (the Meiji-Taisho period), 1,258 in 1956-1969 (the Showa period) and 1,307 in 2006-2020 (the Heisei-Reiwa period), respectively, were examined for species, breed, age and pathological diagnosis. Dogs (44.6%) and horses (34.8%) in the Meiji-Taisho period, dogs (62.9%) and cats (17.3%) in the Showa period, and dogs (46.0%), cats (26.1%) and exotic animals (20.5%) in the Heisei-Reiwa period were the most necropsied animal species. With the passage of time, the number of animal species increased, and the breeds of dogs and cats came to be more various. The median ages of death were 2 years, 3 years and 10 years old in dogs in the Meiji-Taisho, Showa and Heisei-Reiwa periods, respectively, and 2 years and 10 years old in cats in the Showa and Heisei-Reiwa periods, respectively. Viral, bacterial and parasitic infections were decreased, and inversely tumor cases increased due to the prolonged lifespan.

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.

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.

The gastric disease of Napoleon Bonaparte: brief report for the bicentenary of Napoleon's death on St. Helena in 1821.

After the defeat at the battle of Waterloo on June 18, 1815, Napoleon Bonaparte was sent into exile to the Island of St. Helena where he died 6 years later on May 5, 1821. One day after his death, Napoleon's personal physician, Dr. Francesco Antommarchi, performed the autopsy in the presence of Napoleon's exile companions and the British medical doctors. Two hundred years later, mysteries still surround the cause of his death and different hypotheses have been postulated in the medical and historical literature. The main reasons seem to be the presence of several autopsy reports, their interpretation and perhaps the greed for thrill and mystery. Therefore, for the bicentenary of Napoleon's death, an international consortium of gastrointestinal pathologists assembled to analyse Napoleon's autopsy reports based on the level of medical evidence and to investigate if the autopsy reports really do not allow a final statement.

Forensic Anthropology in Investigations of Crimes Against Humanity: Global Dimensions and the Mid-19th-Century Ajnala (India) Massacre.

Heinous crimes and brutalities have decimated humanity throughout human history. In modern times, forensic anthropologists have helped to reconstruct the nature and mechanism, intent and purpose, manner, and circumstances of various inhumane instances of genocides and violent crimes. Anthropologists endeavor to bring closure and comfort to bereaved families by disseminating information about the location, exhumation, and identification of the remains of victims. The methodological armamentarium and scope of forensic anthropology have developed much beyond the realms of the traditional biological profiling casework to the scenarios of humanitarian concerns. Humanitarian forensics focuses on the excavation and identification of the remains of victims and facilitates the dignified burial of the deceased. This review article highlights and exemplifies the significant contributions of forensic anthropological expertise in revealing various crimes against humanity and human rights violations committed in the recent past as well as in some contemporary cases reported from around the globe. It includes cases such as Guatemalan, Cambodian, and Bosnian genocides, as well as other mass killings that illustrate the efficacy of anthropological evidence in reconstructing the nature, mechanism, and circumstances related to these incidences. Special emphasis is given to the Ajnala (India) skeletal remains excavated from an abandoned well - remains reportedly belonging to 282 Indian soldiers killed in 1857 whose corpses were dumped into the said disused well by sanitary workers - indicating the importance of forensic anthropology in authenticating the occurrence of events as mentioned in historical records. Analysis of different case histories reveals that forensic anthropologists have played a significant role in recovery and identification of the victims of the many war crimes, genocides, racial conflicts, and violent cruelties committed against mankind in modern history.

Dusseldorf autopsies 1914-1918.

This article presents an evaluation of 4255 autopsy cases recorded at the Dusseldorf Pathology Institute in the years 1914 to 1918. Diagnoses were coded according to the International Classification of Diseases, 10th edition (ICD-10), and the contemporaneous history of the Pathology Institute was reviewed. We found a proportion of 54.1% adults and 45.5% children in our cohort, with a male predominance of 63.9%. Infectious diseases account for the majority of all cases (35.5%), among which tuberculosis is the most frequent, reported in 22.7% of all cases. The second largest diagnosis group is the one of respiratory diseases (16.9%), including pneumonia and influenza. Cases of perinatal conditions account for 10.5% of the collective, followed by neoplasms, injuries, intoxications, or external causes, each representing 6.6%. Cardiovascular diseases account for 5.3% of the cases. In 4.4% of the pediatric and 0.8% of adult cases, a diagnosis of the ICD-10 group "nutritional and endocrine diseases" was made. No diagnosis of hunger edema is reported. Parts of the cohort are 272 war pathology cases (6.4%), made up by soldiers who mainly had died of shotgun injuries. The whole cohort represents the disease spectrum of a German big city population at times of World War I. The data exemplify the epidemiological shift that has occurred in industrialized countries over the last 100 years, from infectious to neoplastic and cardiovascular diseases.

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.

Carl von Rokitansky, el Linneo de la anatomía patológica / Carl von Rokitansky, the Linné of pathological anatomy

Resumen 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”.

Abstract 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 Linné of pathological anatomy”.

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.

The 1918/19 Spanish Flu in Pisa (Tuscany, Italy): Clinical, Epidemiological and Autoptic Considerations

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemor agic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.

Reform of the death investigation system in Japan.

The autopsy rate in Japan is lower than that in other countries, and most death investigations have historically been conducted by police officers through external inspection. Although medicolegal autopsy was not performed during the samurai administration, the European death investigation system was adopted in the second half of the 19th century and judicial autopsy began in universities' forensic medicine departments. After World War II, the medical examiner system was introduced under US influence, but it was only adopted in certain areas. Further reforms were introduced in the 21st century-in 2012, two laws relating to death investigation were enacted: The Act on Promotion of Death Investigation (Promotion Act), which provided foundational principles and included measures for investigating the causes of death and identification of bodies, and the Act on the Investigation of Cause of Death and on Identification of Bodies Handled by the Police, which recommended a procedure for death investigation, including a new autopsy system.The Death Investigation Promotion Program was to meant to be decided by the government in 2014. However, the relevant Act expired after it ran out of time. Later, in 2019, the Basic Act for Promotion of Death Investigation, the successor to the Promotion Act, was passed. This Act is significant because it sets the basic foundational principle and imposes plans created by the government. However, it remains unclear how these measures can be implemented, so further discussion and financial investment are now required.

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".

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.

Pope Leo XII's death: the twist to a longstanding dispute by novel historical documents and paleopathographic analysis.

Although the practice of autopsy on the Pope's corpse was performed from the 16th century, autopsy reports are only rarely analysed, and never with the aim of investigating the real causes of the death from a concomitant medical and historical point of view. Here, for the first time, we report on the discovery of new unpublished documents from the Vatican Secret Archives and their investigation by a scientific and inter-disciplinary approach. This analysis allows us to draw new conclusions on the true cause of Leo XII's mysterious death. His sudden death, that occurred on February 10th, 1829 after a short illness, particularly struck the public. Suspicions of poisoning or surgeon's guilt or inexperience and even the shadow of a venereal disease, contributed to create a "black legend" on his pontificate and death. On the contrary, the present paleopathographic analysis points toward a new conclusion. The regular use of catheterization with a silver syringe provided an easy access for bacterial superinfection, confirmed by the observed early emphysematous stage of the corpse. So, the most substantiated hypothesis concerning the cause of Leo XII's death indicates a severe form of sepsis, exacerbated by a weakened state due to chronic hemorrhoids.

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.