Postmortems on the kitchen table

My interest in home postmortem examinations began when the cardiologist Sir John Parkinson¹ gave me his portable postmortem set. Parkinson bought the set in 1914, when he worked as first assistant to Sir James Mackenzie at the London Hospital,² because Mackenzie said that it would be useful for doing postmortem examinations in patients' homes. Shortly before his death from angina pectoris, Mackenzie told Parkinson that he wanted his heart removed for study. Parkinson did the postmortem examination in the bathroom of Mackenzie's flat.³

As there is little published on home postmortem examinations, I wrote a letter to the Journal of the Royal College of General Practitioners asking for more information. This article is based on the replies I received and the recollections of Professor Bruce Perry, a physician from Bristol.

Summary points

• Postmortem examinations in the home were uncommon

• General practitioners recall home postmortem examinations occurring up until the middle of the last century

• Home postmortem examinations have been recorded as early as 1802

Experiences of general practitioners

The letters I received from general practitioners show that home postmortem examinations were done until at least the 1960s, although they were not that common. Dr Colin Mann wrote with details of how his father, Dr Alan Mann, had assisted his senior partner to do a postmortem examination in a patient's house in 1921. The place was very poor, the bedroom being upstairs and accessible only by a ladder. The man had died from acute pancreatitis, which was hardly recognised at that time. After the examination the senior partner said to the widow, “Your husband died of a rare disease . . . You're very fortunate, it could have been something quite common you know.”

Dr John Fleetwood from Dublin also used to do home postmortem examinations, although most patients who had died suddenly were examined in the mortuary. “Around 1960 I removed several brains for a pathologist who was doing work on cerebral arteriosclerosis, and all of these were done in the patient's home. At a terminal care hospice we had patients with cardiac pacemakers and I salvaged these for the veterinary college where they were put into animals.”

Dr Gwyn Thomas remembered helping his father do a postmortem examination on a patient in a shed behind the Denbighshire Infirmary in about 1945. His father was dressed in a rubber macintosh, with thick domestic gloves, spats, and a trilby hat. “I held a candle as he opened the chest, took out the heart, cut it across, and said thrombosis to me.” At around the same time, Dr J M S Whiting was doing home postmortem examinations in east Yorkshire. The local coroner insisted that general practitioners should do coroner's postmortem examinations in patients' houses, presumably because it was cheaper than doing them in a mortuary.

Published evidence of home postmortem examinations comes from the obituary of Dr Rudolph Friedlander, a German pathologist who became a general practitioner in Manchester in 1937. His obituary states: “He retained his interest in pathology and often himself carried out post-mortem examinations (sometimes in the home) when some clinical feature had puzzled him.”⁴

Professor Bruce Perry

Dr Carey Coombs was the Bristol physician who made the first clinical diagnosis of coronary thrombosis in Britain in 1910. In 1928, one of his patients died at home and his registrar, Bruce Perry, went to the house with the general practitioner. “I took knives, etc, and lots of old newspapers.” He lifted the body from the bed on to the floor and took out the heart, which showed a typical infarct.

Dr Coombs died in 1932 after two syncopal attacks, and the day before the funeral his widow asked Dr Perry to follow her husband's wishes and place his heart in the hospital museum. The body was in a coffin in Dr Coombs' consulting room with the lid already screwed down. With help, Dr Perry removed the heart and, after taking many sections, found a microscopical lesion in the bundle of His. He wrote: “I'm afraid there was nothing to put in the museum.”⁵

Coroner's postmortem examinations

The pathologist Dr Denis Hocking did 35 000 examinations for the Cornish coroner starting in the 1930s. Before that all postmortem examinations were done by general practitioners in primitive mortuaries. Dr Hocking examined only one body in the home. “The widow refused permission to remove the body and also refused to let me do it on the kitchen table. One can sympathise with this! So I had to do it on the edge of a large double bed. To my credit I did not spill a drop of blood on the bedclothes.”⁸

Early examinations

It is not clear when the first home postmortem examination was done. However, I have found evidence of home examinations from the beginning of the 19th century.⁶ In 1802, a man who was refused admission to three London hospitals because he was thought to have a syphilitic ulcer in his throat was so upset by this diagnosis that his dying wish was that “he might be opened.” The family doctor recorded that “it was at ye top of a house. . .we began makg an incision from his chin to his umbilicus. . .cutting thro ye cartilages (this is ye modern way and by far ye neatest).”⁶ The man had a perilaryngeal abscess.

Home postmortem examinations were sufficiently common at the end of the 19th century for Professor Sims Woodhead to include a section on them in his book Practical Pathology, published in 1883.⁷ He said that “where the examination has to be conducted in a private house,” a firm kitchen table should be placed in a well lighted room covered with a piece of stout macintosh. The operator's hands were to be washed with water and turpentine and then anointed with carbolic oil. Rubber gloves came slowly into use after 1890.

Tools of the trade

Professor Woodhead lists 19 instruments for home postmortem examinations but emphasises that an examination can be done without many of them. The portable postmortem set belonging to Sir John Parkinson contains a saw, a spine wrench, bowel scissors, a large knife and scalpels, a hammer, scissors, hooks, and a needle and twine for sewing up (figure). However, despite doing a huge number of examinations, Dr Hocking related: “I have never spent a penny on postmortem instruments. I collected most of them from throw outs from the operating theatres.”⁸

Comment

Most postmortem examinations have always been done in hospitals or in a coroner's mortuary. Those done at home would mostly have been performed by general practitioners who wanted to confirm the cause of death or to examine a particular organ. As far as I can tell from the largely anecdotal evidence, home postmortem examinations were very uncommon.

Figure.

Sir James Mackenzie (1853-1925)

Figure.

Sir John Parkinson (1885-1976)

Figure.

Sir John Parkinson's postmortem set, which is now in the museum of the Royal London Hospital. The case measures 310×160×60 mm