Postmortems on the kitchen table
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7327.1472 (Published 22 December 2001) Cite this as: BMJ 2001;323:1472All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Though domiciliary postmortem examinations seem to have been uncommon
before the 19thC, Dr Robert Peirce, a respected Bath physician, published
detailed accounts of three postmortem examinations carried out during the
17thC. One was performed following the death of Sir Thomas Malevorer who
fell from his horse while hunting and fractured his femur. By the time he
was referred to Peirce, his condition was desperate and he died in his
lodgings a fortnight later.
On the night of the death, Peirce called together two other medical
practitioners and the patient's brother and proceeded to perform a post-
mortem. It says much for the brother's stomach that he witnessed the
opening of "such a suppurative abscess as well nigh filled the cavity of
the left side [of the abdomen] near as high as the spleen." Peirce
described it as being "the colour of an unboyled lobster, and when opened
there spouted out at first some quarts (two or three as we judg’d) of a
wheaty foetid matter which was followed by a cheesy curd...and what
remained of the thigh bone, or at least the upper part of it, was all
carious and eaten into holes."
Peirce, R. “ The History and Memoirs of the Bath” Bath 1713 p32
Competing interests: No competing interests
Dr. Hollman's interesting article brought to mind a couple of other
references to home autopsies. The great American poet (and pediatrician)
William Carlos Williams wrote a number of powerful stories about medical
practice in the early part of the last century. Supposedly based on his
own experiences, some of these stories refer to both kitchen autopsy and
kitchen surgery. There is also a frequently told story about the great
British neurologist SA Kinnier Wilson. This story may be an example of
folklore but Kinnier Wilson was supposedly waiting for a patient with what
we now call Wilson's disease to die so he could confirm the association
between the neurologic phenotype and cirrhosis. One of Kinnier Wilson's
patients is claimed to have been on a holiday trip when he or she died.
Kinnier Wilson is claimed to have taken the first available train (This is
the Edwardian period) and performed the autopsy of the kitchen table of
the vacation cottage. The findings in this case are reputed to have
confirmed Kinnier Wilson's reputation and went a long way towards
establishing his reputation.
Competing interests: No competing interests
It still goes on ...
The author and others may be interested to know that "domicilliary"
autopsies are performed routinely in Romania to this day. Through my
involvement with Medical Support in Romania, working with local forensic
services, I have witnessed autopsies in a bedroom, in the back yard and
on a river bank by a public path. With the help of Rotary International
we have recently delivered the first purpose built mobile autopsy room
(forensic ambulance) in Romania. We hope the idea will catch on and
similar vehicles will be built with the help of other charities in the
country.
I can provide more details, including photographs, if requested.
Competing interests: No competing interests