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 A Ripperologist Article 
This article originally appeared in Ripperologist No. 71, September 2006. Ripperologist is the most respected Ripper periodical on the market and has garnered our highest recommendation for serious students of the case. For more information, view our Ripperologist page. Our thanks to the editor of Ripperologist for permission to reprint this article.
The Victorian Medico-Legal Autopsy
Part I: Dissection in Pursuit of the Cause of Death
By KARYO MAGELLAN

Introduction: The Autopsy and Forensic Examination in 1888

It would be wrong to assume that the standards of forensic investigation practiced by medical men during the period of the Whitechapel murders were crude or to suggest that the surgeons were not competent in their conduct of autopsies. An examination of contemporaneous medical texts convincingly reveals an appreciation of the need for thorough and objective investigation of crime scene and bodies, and for the accurate documentation of the findings. These texts give valuable insight into the approach and techniques employed by the surgeons engaged in examining the bodies of the Whitechapel murder victims, and also allows for interpretation of the terminology commonly employed.

During the course of this evaluation I have looked at many pertinent medical books that were published in the United Kingdom toward the end of the nineteenth century. Such texts would undoubtedly reflect the state of knowledge of forensic science during the period of the Whitechapel murders. Indeed, we can hypothesise that some of these texts would almost certainly have been owned by or consulted by Doctors Phillips and Bond and their colleagues.

In 1899, J A P Price defined ‘autopsia’ (autopsy) as ‘a term curiously applied to post-mortem examination or inspection of the body after death’; his definition of ‘Post-mortem’ was, ‘an uncouth expression for the opening and examination of the dead body’. Price also confirmed that ‘Sectio is not satisfactory’, and that autopsia was ‘unintelligible.’ The term Sectio cadaveris meant merely the dissection of a dead body and was clearly inadequate. Price obviously was not too sure what to call the procedure although he passed no judgement either way on ‘necropsia’ (necropsy). Just to confuse the issue further, ‘necroscopy’ was also to be found in the same 1899 edition of the dictionary as another name for a post-mortem examination, but fortunately it never found a way into regular usage.1

The literal meaning of autopsy is ‘self-seen’ or ‘seeing with one’s own eyes’ and the word appears with that definition in the first edition of Samuel Johnson’s 1755 Dictionary of the English Language.2 In another sense, autopsy could even be taken to mean self-examination after death! But the word has since progressed beyond the literal interpretation to establish its own definition and we all know that it means the dissection and examination of a corpse to establish the cause of death, although at best it should only really apply to human corpses and not to those of animals. A Post-mortem literally means ‘after death’ and is taken to mean the same as autopsy, but today it is rather too broad a term. There are many aspects to an ‘after death’ examination that do not just refer to the examination and investigation of the corpse. In any case, its use is not restricted to medical application – there can be post-mortem (or retrospective) analysis on anything. Necropsy, however, is a far better term, referring as it does to examination of the dead and rather more specifically to dissection and investigation of the corpse. All three terms will be encountered here and in the contexts we adopt there is no difference between them. Note also that the term ‘Post-mortem’ is often hyphenated and occasionally one word but that it is never italicised. Here we will use the two-word format and hyphenate the term when we use it adjectivally, ie, as in ‘post-mortem examination’ or ‘post-mortem discolouration’.

US Army post-mortem kit of circa 1860. (Courtesy of Michael Echols, DDS)

Anatomy, Pathology, and the Need for Corpses

What were the standards of investigation that would have governed the work of the surgeons called upon to examine the Whitechapel murder victims? At what point did pathology emerge as a science and how far had it evolved by the time George Bagster Phillips attempted to reassemble Mary Jane Kelly? Before answering these questions, it is necessary to briefly look at the ways in which anatomy and pathology developed over the previous centuries, since progress was shaped as much by society’s attitudes toward death, the body, and the soul as by the quest for scientific advancement.

Public attitudes toward anatomists and surgeons were influential, and the perception of them as ghoulish practitioners prevailed well into the nineteenth century. Aloof arrogance on the part of some in the medical community did little to assist their cause. Inevitably, negative political and religious doctrines slowed progress – although, in England, such conservative influences were rather more entrenched than in Continental Europe.

Contributions of Galen.

Galen

Without a good understanding of normal anatomy, changes in structure could not be appreciated and the morphology of disease could not be recorded. The observation and documentation of normal anatomy was the starting point for understanding disease processes and a great many scientists have contributed to knowledge over many centuries, some more worthy of note than others. The first significant figure in this regard was the Greek physician Galen (129–200 AD). Although Galen adopted Hippocrates’ philosophy on disease processes from five centuries earlier, he advanced knowledge by experimentation. He established that blood was carried in veins and arteries, although he thought the two systems were not connected, and that the brain was responsible for movement and perception. Significantly, he suggested that the mind was in the brain and not in the heart, thus refuting Aristotle’s claim that the mind was in the heart.

Galen influenced European medicine for over a thousand years until the Renaissance, at which time a shift in attitude toward human dissections allowed for significant progress to be made and in particular for more accurate representations of the human body.

Advances in Renaissance Italy.

During the fourteenth century, Italy became the centre of learning with dissections becoming relatively commonplace, and occasionally with public performances – although such events were more a matter of theatre than education. In 1537, the Pope accepted the teaching of anatomy by dissection, a liberal attitude that attracted anatomists from Britain to study in Italy. William Harvey, for example, moved to Padua for five years after graduating from Cambridge in 1597. In the sixteenth century, the Belgian pharmacist Andreas Vesalius progressed the study of anatomy when in 1543 he produced his extensively and accurately illustrated anatomical work De Humani Corporis Fabrica (‘On the Structure of the Human Body’). The Renaissance researchers generally had a better grasp of structure rather than function.

The Companies of Barbers and Surgeons.

In England during the sixteenth and seventeenth centuries, attitudes toward dissection were altogether more conservative. In 1540, Henry VIII granted a Royal Charter to the companies of Barbers and Surgeons that allowed them a total of four bodies per year that they could dissect, the corpses being those of executed felons, and the dissection being a deliberately public affair.3 This practice had the effect of providing the judiciary with an additional punishment given that dissection was literally considered to be a fate worse than death – although given the limited number of corpses given to the companies of Barbers and Surgeons it was obviously little used. Extensions to the Act in 1565 and 1663 added another two corpses to the annual allowance available to the companies of Barbers and Surgeons. In carrying out this additional aspect of the sentence, the Surgeons had become agents of the Crown and their payment was a supply of corpses. While the use of judicial sentencing undoubtedly improved the supply of bodies for dissection, it did not satisfy demand nor did it do anything to make dissection generally acceptable to the public. In fact, the practice further blighted the reputation of the medical profession among a sceptical public.

Needless to say, far more than a paltry six bodies a year were required and indications are that far more than that number were actually used for dissections. Surgeons and anatomists needed to supplement their meagre legal allowance and the law assisted them by not regarding a dead body as property that could be traded or stolen. This effectively circumvented the ‘legal allowance’ and there was money to be made by various arrangements. Not infrequently, condemned prisoners who had not been sentenced to be dissected after death offered their bodies for anatomical research in exchange for some financial reward, usually the settlement of their prison expenses. Unfortunately for the surgeons there was no guarantee that they would actually get their hands on the corpse that they had ‘paid’ for and they had no legal redress to counter any disappointment. Such was the undignified scramble between the victim’s relatives, surgeon’s agents, and anyone else with cupidity in mind to place claim upon the still dangling and barely expired corpse, the result frequently did not go in favour of the surgeons.

Harvey and Malpighi.

William Harvey demonstrating the circulatory system on a deer.

In spite of difficulties with the supply of corpses, advancements in anatomy continued in Britain into the seventeenth century, most notably with the work of William Harvey (1578–1657), who in 1616 discovered the mechanics of the circulatory system. In 1628, Harvey published Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (‘An Anatomical Disquisition Concerning the Motion of the Heart and the Blood in Animals’). Harvey theorised that capillaries must have been present to link the arterial and venous blood. Harvey incidentally found a supply of corpses among his relatives. He dissected both his father and his sister after they died, thus demonstrating an impressive degree of clinical detachment.

The Italian Marcello Malpighi advanced Harvey’s work by carrying out microscopic studies of tissues. In 1661, Malpighi made his most important discovery: he described the network of pulmonary capillaries that connect the small veins to the small arteries, completing the chain of circulation postulated by Harvey.

In 1745, the Surgeons severed their connections with the Barbers, later establishing the Royal College of Surgeons. In 1752, matters improved for the advancement of anatomical study in England with the passing of an Act that allowed judges to substitute dissection instead of a sentence of hanging in a metal cage at the gibbet after execution.4 During this period, the death sentence was also handed out for a variety of paltry offences against property and some restriction upon the addition of dissection to the sentence was warranted. Thus, it was only applied to those criminals executed for the crime of murder.




Harvey explains blood circulation.

The Humoralist Theory.

The humoralist theory, dating back to Hippocrates and adopted by Galen, prevailed for centuries as an explanation for the means by which the body was affected by disease and did not altogether disappear until the end of the nineteenth century. The theory suggested that disease was dependent upon the four basic humours of black bile, yellow bile, phlegm, and blood (corresponding, respectively, to the four elements of earth, fire, water, and air). When these humours were in balance, the body was healthy and when they were out of balance the body was not healthy. The practices of bleeding a sick person or applying hot cups were regarded as cures for the humour imbalance.

Contributions of Magnani, Bichet, and the Hunter Brothers.

Disease theory benefited greatly from advances in pathological anatomy and once again Italy was at the forefront with Giovanni Morgagni, professor of anatomy at Padua, prominent in such research. In 1761, Morgagni published his De Sedibus et Causis Morborum (‘On the Sites and Causes of Disease’), which was based upon his observations from some 700 autopsies. The book was translated into English in 1769 and became an established and authoritative work. Morgagni’s objective was to show that diseases were located in specific organs and that disease symptoms were a consequence of anatomical lesions, thus significantly undermining the humoralist theory. Morgagni gave a useful account of many diseases including syphilis and tuberculosis, and determined the relationship between cerebral haemorrhage and paralysis.

Others built upon and refined Morgagni’s work resulting in a rapid expansion of knowledge, assisted significantly by the work of the French physician Xavier Bichet who postulated that the organs of the body were made up from different tissues. Bichet identified twenty-one tissues that he described as ‘membranes’.

During the second half of the eighteenth century, the brothers William and John Hunter achieved prominence as anatomist surgeons and their work is notable not only for the discoveries they made but also the teaching methods they developed, which placed emphasis on structure and function. Several private anatomy schools appeared around the end of the eighteenth century. Indeed, William Hunter owned his own private school of anatomy. Nonetheless, since the Hunters and other anatomist surgeons had no legal or ready source of bodies, they still had to employ dubious or illegal means to obtain suitable material.

The ‘Resurrectionists’.

Because fresh corpses were much sought after but rare, they correspondingly attracted a premium price. Seven to ten pounds per corpse was the going rate in the 1830s. However, decomposing corpses, if they were not too far advanced in putrefaction, could also be used and provided a useful income for the grave robbers or so-called ‘Resurrectionists’. Grave robbing was a relatively easy way to make money, and the perpetrators, if discovered, were far more likely to suffer retribution at the hands of an outraged public than they were to feel the wrath of the judiciary. Exhumation was not technically a crime of theft and although grave robbers were occasionally punished through the courts the legal basis for such is uncertain. Until the law changed in 1820 legal consequences could only arise from grave robbing if any of the victim’s possessions were stolen from the grave along with the corpse. The robbers were thus careful to strip the corpse naked and throw the clothing back into the grave before making off with the body in a sack. Inevitably, the best sources of material for the Resurrectionists were the mass graves or pits in which paupers were buried. In Britain, hostility toward cutting up the dead prevailed even down through the Anatomy Act of 1832.5 This attitude undoubtedly was not helped by the murderous activities of the notorious Scottish Resurrectionists William Burke and

William Hare, who turned from snatching dead bodies to creating them. Their careers culminated in 1829 with Burke’s execution and Hare’s imprisonment. Paradoxically, the activities of the West Port murderers probably contributed to the beginning of a shift in public attitude and the need to supersede outdated Acts. The 1832 Act regulated the use of bodies and licensed those who practiced anatomy, and the supply was no longer dependent upon executed felons but now included any bodies unclaimed after death, in particular those who died in prison or in the workhouse. Also, bodies could be donated by relatives in exchange for burial at the expense of the recipient, or donated by the individual for the advancement of science, but only with the agreement of relatives. The 1832 Anatomy Act thus effectively ended the activities of Resurrectionists.

Rise of Pathology.

At some point on the long journey of anatomical discovery, investigators turned their attention from the normal to the abnormal, and the science of pathology was born if it was not recognised as a science for some decades to come. Pathology is the study of disease, although included in the discipline is unnatural injury or death by whatever means. Without an understanding of the relationship between form and function there could be no understanding of disease processes. However, that did not mean that progress was not made. Even in the absence of such knowledge it was still possible to make observations and associations although in many cases such theorising led to erroneous conclusions. Prominent among the misconceptions was the miasma theory of disease which broadly suggested that diseases emanated from noxious air from putrefying ground or water. It is easy to see how such a theory came about since the worst centres for disease also happened to be associated with the most densely populated and unsanitary conditions. Such conditions were rife within prisons and workhouses or within the poor areas of major cities – the East End of London being an obvious example. Many relevant observations on disease were made prior to the middle of the nineteenth century, but systematic epidemiological and pathological research, which led significantly to a shift from the miasmic concept of disease to that of spread by contact or vectors, did not become established until the second half of the century. When John Snow dismantled the Broad Street pump in 1854 and interrupted the local spread of cholera his action was based upon observation and not on theory. All the same, it would be nearly another thirty years before the organism responsible for cholera was isolated by the German Robert Koch in 1883.

Development of the Microscope.

Progress in improving the microscope opened up new avenues of discovery and allowed for the accurate determination of the cellular structure of tissues. At last, form and function could be investigated at the cellular level rather than simply in theory. This led to unprecedented progress in pathology research through the work of Karl Rokitansky and Rudolf Virchow, who in 1858 published his Cellularpathologie. The science of bacteriology also progressed rapidly for the same reason, with Koch and Louis Pasteur making important discoveries.

The Need for Medical Evidence and Autopsies

One might think medical testimony in a court of law is a relatively recent contribution. However, such testimony at inquest proceedings has been documented for centuries, although not always with the intention of establishing the cause of death or culpability. As the British coronial system developed over the centuries, the system contributed greatly to the need for medical testimony and ultimately to the manner in which it was presented. Inquests are essentially non-adversarial and thus the opinions of the medical men were usually not tested to any great extent. Even by the late nineteenth century, the medical evidence was largely unquestioned. In some cases, it was difficult to determine whether it was the coroner or the surgeon who was in charge of proceedings. Matters were, however, very different in the criminal courts and medical evidence could be and frequently was challenged by opposing counsel. Surgeons did not only give evidence in murder cases but also in other criminal charges requiring medical evidence such as sexual offences.

It is interesting to see how the demand for expert medical testimony and the quality of such evidence developed prior to the nineteenth century. There are numerous examples of medical evidence given at criminal proceedings. We will look at a few examples to illustrate the early realisation of the value of such testimony and the progressive attention to detail. On 26 August 1685, Thomas Davis and John Buckmaster appeared at the Old Bailey accused of killing Antony Loe.6 The reported summary of the case is as follows:

Thomas Davis and John Buckmaster, in the Parish of St Dunstans in the West, Indicted January 17th for assaulting Anthony Loe with a Sword, and wounding him therewith, on which Wound, August the 10th the said Loe died. It appeared on the Tryal, that a Quarrel arising between Mr. Loe and Mr. Davis about a Guinea, Davis strook Loe with a Whip, challenging him out; upon which going together, and fighting, the said Loe was found on the ground wounded, Davis and Buckmaster being by, and having their Swords drawn; and that Davis being apprehended, he confessed he had fought Loe, and wounded him, and that he was a great Coward. The Physician, in defence of the Prisoner, says, That Loe seem’d to be well of his Wound, but was taken with two Fevers afterwards, in which Fever the said Loe died: the Surgeon likewise says, that the Wound was healed, and perfectly cured, and that his Body was corrupted by other Distempers. The Jury brought them in Not Guilty

By the mid-eighteenth century, knowledge and contributions had progressed and legal counsel knew what was required. In 1745, pipe-maker Thomas Morgan ‘not having the fear of God before his eyes, but being moved and seduced by the instigation of the devil, on the 20th day of August, in the 19th year of his Majesty’s reign, with force and arms’, murdered his wife Elizabeth.7 He was tried at the old Bailey on 11 September and the medical evidence detailed the wounds:

WILLIAM ELLIS, Surgeon: On Wednesday the 21st of August about 4 o’clock in the afternoon I saw the body of the deceased lie prostrate on her back upon the bed.

COUNSEL: As you are a surgeon, I desire you would give an account of the wounds?

ELLIS: I will give you the best account I can, and I don’t doubt but I shall give your Lordship and the Jury satisfaction. I viewed the body and found there had been an attempt to cut her throat, the common teguments and the skin appearing about one inch over the windpipe. There was one wound upon each hand, by which I imagined she had attempted to save herself. Those wounds were on the back of her hands to the bone, as deep as they could be, but about two inches long each. There was a wound under the left ear, and I observed by her defending her throat so well, that the wound by the ear must be given underhanded by a sort of a jab, and by my probe I found it to be four inches and an half in depth; and I judged that wound to be given obliquely, and to have divided the jugular artery, and must have been the cause of her death; for it is a very large vessel; her shift was as bloody, as if it had been dipped in blood.

COUNSEL: What were those wounds given by?

ELLIS: I suppose by some sharp instrument; upon examining the body I found three punctured wounds, one on the left breast, which must have reached the heart, and a portion of the lungs about two inches deep and half an inch broad; I believe it penetrated into the heart, and touched a portion of the lungs; as near as I could judge by my probe it was about two inches deep: there was another wound much in the same angle below that, of the same breadth; which, upon examining with my probe, I judged to be of the same depth, and I believe touched the lower part of the heart, and penetrated into the heart itself: on the side of the belly I saw another wound much of the same breadth, into which I introduced my probe, which is about five inches and an half long, up to the head of it, but that lower wound I do not take to be mortal, though it was so deep, for it went superficially and sideways, but I do not think the intestines were wounded, but the other three wounds I apprehend to be mortal; I am sure they are.

COUNSEL: Did you observe any other wounds?

ELLIS: There were several slighter wounds, but I did not examine them: upon observing the wound at the bottom of the breast, I proposed opening the body several times to the Jury, but they thought it needless, they were so well satisfied. There was a stream of blood that [had] run from the body, which was coagulated: a stream, as if a person had been killing an ox, and must have come from the heart, and was the occasion of her death.

Elizabeth Morgan’s body was not opened because the jury did not require such an examination, so the surgeon determined the depth of the wounds using a probe inserted into each wound to estimate the extent of underlying damage. The defence counsel did not make anything of the fact that an autopsy was not performed. Morgan was found guilty of murder and hanged at Tyburn the following year – not by sharp drop, but by slow strangulation which was the procedure until around the time that executions moved to Newgate Prison in 1783. Morgan’s corpse may well have been used for dissection – unless any of his relatives got to it first!

On 20 February 1782, Jane Sweatman and Mary Humphries were on trial for the murder of John Thatcher by ‘choaking [sic], suffocating and strangling him with a silk handkerchief’ which caused his instant death.8 On this occasion, the surgeon, who did not open the body, was pursued by the defence council:

GEORGE PINCHES: Sworn. I am a surgeon, I was called in to examine the body of the deceased John Thatcher, on Monday night, about eight o’clock; I went, and met the corpse in a shell, in the Eagle and Child alley, I desired them to put it down, they spoke very abruptly to me, and told me I might come into the house, it would be soon enough when he was carried in; I said no time was to be lost, I put my hand down, and felt him, and found he was quite dead; he was taken to the burying ground, I told them it was not a proper place to inspect the body; he was then carried into a room, I then examined him.

COUNSEL: Tell us the cause of his death to the best of your judgment?

PINCHES: I cannot form any idea what was the cause of his death, there was no marks of violence.

COUNSEL: Did you examine the whole of the body?

PINCHES: I examined the whole, I examined the head to see if there was any contusion, there was not; there was another gentleman dropped in belonging to St Thomas’s Hospital; there were no marks of violence at all on the body, that person will confirm the same I believe, if called.

COUNSEL: You cannot say what was the cause of his death?

PINCHES: I cannot form any idea of what was the cause of his death.

COUNSEL: Did you open the head?

PINCHES: No.

COUNSEL: Did you examine his neck?

PINCHES: I examined his neck, and round his chest and side; I examined about his neck very particularly.

COUNSEL: Were there any marks there?

PINCHES: There were no marks at all, as I saw.

COUNSEL: Did you open him?

PINCHES: No, Sir.

COUNSEL: Did you open his head?

PINCHES: No, Sir.

COUNSEL: Did not you hear at that time some ideas how this man came by his death?

PINCHES: No, Sir; I heard nothing of those particulars.

COUNSEL: Did nothing pass, from which you might think it material to open his head?

PINCHES: No, Sir; I had nothing occur to me then to make it necessary to open his head: it was all confusion, one saying one thing, another another thing, and another another thing; some said it was murder, and some said not.

JURY: Was it possible for a man to be strangled, without marks of violence, by a silk handkerchief?

PINCHES: Upon my word I cannot tell that; I cannot take upon me to say that.

COUNSEL: Would it be possible to strangle a man with a silk handkerchief, with or without a mark of violence appearing?

PINCHES: In all cases where I was called in, I always saw marks before.

COUNSEL: Did you ever see a person strangled with a silk handkerchief in your life before?

PINCHES: No.

COURT: If a man dies by being strangled, whether with a silk handkerchief or cord, or any thing else, would it not affect his countenance?

PINCHES: I should think so.

COUNSEL: Was this man’s face at all affected?

PINCHES: Not at all in the least; he had a very pleasing countenance.

COUNSEL: Was it black?

PINCHES: Not in the least.

COUNSEL: In your judgment could a man be strangled with any thing, without having some effect upon his face?

PINCHES: I should think not.

COURT: Would that blackness of the countenance appear immediately after the death of the person, or does it require any space of time before it appears?

PINCHES: I should conceive it would appear instantaneously.

COUNSEL: Where do you live?

PINCHES: In Holborn, sir.

COUNSEL: Do you practice as a surgeon?

PINCHES: Yes.

The accused were both found not guilty of murder. A formal and standardised medico-legal necropsy examination was clearly not a requirement in 1782 and there was appreciable variation in the depth of medical evidence between cases reported in the same year; far more detailed evidence was given in some instances. The consequences for a defendant of such a superficial examination as that conducted by surgeon Pinches are obvious.

On 3 July of that same year, Sarah Russell was tried at the Old Bailey on a charge of infanticide.9 Large sections of later medico-legal texts were devoted of infanticide which was a common charge, even before the Victorian era, and a consequence of the high infant mortality rate. Most of these deaths would have been through natural or accidental causes, but it was often necessary to prove the case in a court of law:

MARY RANGER sworn.

COUNSEL: You are a midwife?

RANGER: Yes. I was fetched on the 26th of May, about a quarter before eleven o’clock, by Mr Wicks, the constable, who said I was wanted to a labour. When I came to White’s-alley, I met the prisoner’s mother coming out at the door. She turned back, and said the child was up three pair of stairs. I went up. There lay the child, dead, wrapped up in a dirty coarse apron. There was a mark under the throat, like two fingers and a thumb, and the thumb-nail had rather scratched it. I took it to the work-house. I did not see the mother till the afternoon. I washed it in the afternoon. I was fetched about five o’clock. There I saw the mother of it.

COUNSEL: How did you know she was the mother of it?

RANGER: I knew she was the mother of a child, that she had been lately delivered.

COURT: How do you know it was that child?

RANGER: She acknowledged it. I asked her whether it was born alive. She said she would not say. I asked her if she had pinched it, in helping herself. She said she did not help herself at all.

COUNSEL: Might this have happened in the delivering herself?

RANGER: It might have happened in that way; that made me ask her that question.

COUNSEL: I suppose she was just brought to the work-house?

RANGER: Yes.

Mr JOHN CLARKE sworn.

COUNSEL: You are a surgeon, and live in Chancery-lane?

CLARKE: I am.

COUNSEL: You saw this child afterwards?

CLARKE: I did.

COUNSEL: You examined it, I suppose?

CLARKE: Yes.

COUNSEL: Were there any marks of violence upon it?

CLARKE: There was the appearance of a bruise on the forehead, and on each side of the windpipe.

COUNSEL: What do you think was the occasion of that child’s death?

CLARKE: The naval string was torn off, at a few inches distance from the belly of the child; it seemed to be torn, and not cut.

COUNSEL: Upon the oath you have taken, do you believe this child got her death by violence?

CLARKE: I am not clear in it. It might happen, if the mother was delivered on the vault, by the child’s falling, the naval string might break. I examined the lungs of the child; it was plain, by the appearance of them, that the child had lived.

COUNSEL: I don’t understand that that is a certain sign of the child’s having been born alive?

CLARKE: If there are no signs of putrefaction.

COUNSEL: You will not take upon you to say that this child received its death by violence from any person?

CLARKE: No.

COURT: I have understood that that experiment upon the lungs has of late been held not to be conclusive: in one way, it has been held to be conclusive, if the lungs sink; but not to be conclusive, if they float: it is a common experiment, and, in that case, gives a degree of probability; if the lungs sink, it is conclusive?

CLARKE: Yes.

COURT: But I understand the floating of the lungs may be occasioned by other circumstances, than that of being inflated. The bruises upon the forehead, you say, might be occasioned by the fall?

CLARKE: Yes.

COUNSEL: And the bruises upon the neck, you think, might be caused by the woman, in the agony of child-birth, endeavouring to free herself from the child?

CLARKE: Yes.

PRISONER’S DEFENCE: I did not know that I was so near my time, or I should not have gone to such a place; but I never intended to do the child any injury.

Sarah Russell was found not guilty of infanticide – but was justice served? Testimony at infanticide trials often involved evidence as to whether or not the foetus was born alive.10

Thomas Wakley and Post-Mortem Evidence

Thomas Wakley

The need for accurate medical testimony at inquests and during criminal proceedings became increasingly obvious. However, it took the campaign by Thomas Wakley (1795–1862), the surgeon, MP, coroner, and founder of The Lancet, to bring about significant changes to a coronial system that did not require post-mortem examinations. Up until Wakley’s intervention, the system neither required a Post-mortem to be conducted and nor could attending surgeons be ordered to give evidence. Wakley’s campaign was as much against the medical establishment as against the inadequate coronial system. In the course of making vociferous attacks on privileged, corrupt, and incompetent surgeons, the reformer made few friends. Making friends was not, however, Wakley’s objective.

In 1828, Wakley engaged in a public spat with Bransby Cooper, a bungling surgeon who attained his position only through, Wakley accused, ‘the influence of a corrupt system’. Cooper sued Wakley for libel and lost. A Post-mortem was conducted on the body of one of Cooper’s patients and the results of his incompetence were published in The Lancet. Wakley used this success, in one of the first medical malpractice litigations, to promote his ideas on the reform of inquests.

The Medical Witness Act of 1836, enacted largely as a consequence of Wakley’s efforts, gave coroners of the power to compel qualified medical witnesses to testify at inquests and to conduct autopsies when necessary.11 The Births, Deaths, and Marriages Act of 1837 required the registration of all deaths. Any deaths that were suspicious or unexplained were investigated in order that the coroner could authorise a death certificate.

Although Wakley wanted an autopsy to be routine in all such cases of questionable death, but in practice this was not the case. Public acceptance of such an invasion of the body was still influenced by historical prejudices, which remained a major barrier to progress. However, as the value of post-mortem medical evidence became apparent in the pursuit of justice, common sense prevailed.

By 1839, Wakley was himself coroner to the East Middlesex District and from this position he continued to promote the use of autopsies and medical testimony, so that the number of autopsies conducted in England annually steadily increased.12

Rokitansky, Virchow, and Development of the Necropsy Protocol

Pathology and medico-legal investigation did not truly develop into a speciality until the Victorian era, with the advances wrought by Karl Freiherr von Rokitansky (1804–1878) and Rudolf Ludwig Karl Virchow (1821–1902). Rokitansky, founder of the Vienna school of pathological anatomy, reputedly conducted over 30,000 necropsies during a career that extended from his first autopsy in 1827 until his retirement in 1875.

Rokitansky embraced microscopy to advance histopathology. He revealed more clearly than any of his predecessors the natural history of disease and its structural manifestations. His work was not without its shortcomings, which were the subject of criticism from Virchow, then professor of anatomy in Berlin. Virchow vehemently attacked Rokitansky and the Vienna Medical School for their support of outdated theories. Yet, in spite of his criticisms of Rokitansky, Virchow held in high regard much of the older man’s work on pathological anatomy.

Virchow is considered the most prominent German physician of the nineteenth century. He initially worked on anatomy and later founded the discipline of cellular pathology and the modern concept of pathological processes. He envisioned that medical progress could occur from three main sources:

Clinical observations, including the examination of the patient with the aid of physico-chemical methods

Animal experimentation to test specific aetiologies and study certain drug effects

Pathological anatomy, especially at the microscopic level.

Virchow used the cell theory to explain the effects of disease in the organs and tissues of the body. He emphasized that diseases arose, not in organs or tissues in general, but primarily in their individual cells. Virchow insisted that life was merely the sum of physical and chemical actions and that it was essentially the expression of cell activity. He realised that one form of the cell theory, which postulated that every cell originated from a pre-existing cell rather than from amorphous material, could give new insight into pathological processes.

Virchow was sceptical of the new science of bacteriology based on his belief that there was no single cause of disease. He resisted the idea that any germ was the sole aetiological agent causing disease. Thus, he correctly argued that the presence of a certain micro-organism in a patient with a particular disease did not always indicate that the organism was the cause of the disease. Long before toxins were actually discovered, he suggested that some bacteria might produce such substances.

Importantly, in 1874, Virchow introduced a standardised technique for performing autopsies. The whole body was examined in detail, often revealing unsuspected lesions. Even though both Rokitansky and Virchow developed a necropsy protocol it is the one recorded by Virchow that became internationally established. The English translation by T P Smith of Virchow’s Post-Mortem Examination with especial reference to medical-legal practice allowed an understanding of Virchow’s techniques to spread beyond German-speaking countries.13 By the 1880s, necropsies were undertaken in a thorough and professional manner. Microscopic evaluation of tissue samples was routinely employed to assist in diagnoses. The need for accountability and the custody of evidence was appreciated. By this time, toxicology was well established, along with understanding of bacteriology and the mode of infection.

Standard Autopsy Procedures

The need for hospital clinical autopsies developed in the nineteenth century in order to determine the cause of death in cases where it was otherwise not obvious or where death did not follow from a recognised and progressive illness. Victorian surgeons quickly adopted and adapted Virchow’s autopsy techniques and this is evident from works published around the time of the Whitechapel murders. In his book, Virchow gave details of his own methodology together with case histories to illustrate its application. In his preface to the translation of Virchow’s work, T P Smith wrote:

An examination of these cases will show that nothing has been omitted which could throw any possible light on the cause of death. They may be taken as examples of the way in which all post-mortem examinations for medico-legal purposes should be conducted. Lest the length of the notes should seem excessive, Prof Virchow expressly states that three hours are sufficient, even for complicated cases. It will be obvious, on referring to the details, that only by following out a systematic plan could a thoroughly complete examination be performed in that time. Such an examination, however, would be infinitely more satisfactory than one in which important points were overlooked, and only discovered on subsequent investigation. It is much to be wished that a method similar to the one which has received the high sanction of Prof Virchow were adopted in this country.

The autopsy procedure was also described by Sims Woodhead in 1892.14 This is the third edition of Woodhead’s book and because the first edition appeared in 1883, the method is the one that would have been used during the time of the Whitechapel murders. It is likely that this basic method was employed during the post-mortem investigations of the Ripper victims. The section on removal of the kidneys is of particular interest in relation to the commonly supposed anatomical or medical expertise (or lack thereof) of Jack the Ripper. J D Mann’s 1893 suggestions for a medico-legal approach would also have prevailed for surgeon-pathologists during the Whitechapel murders:15

Post-mortem Examinations for Medico-legal Purposes.

There are several important points to be observed when making a medico-legal necropsy over and above the requirements of ordinary pathological investigations.

External Inspection.

The examination should be made in daylight; colour changes are often invisible by artificial light. If the body is seen on the spot where it was first discovered, attention should be paid to the following points:- The exact posture in which it lies, the expression and colour of the face, the position of the hands whether clenched or not; if clenched, they should be examined for any substance possibly grasped by them. The fingers should be examined for cuts or wounds. The condition of the dress: if disordered, indicating a struggle, or if it is soiled or stained with blood. Attention should be directed to the ground on which the body lies and to that immediately around it for signs of struggling and for objects that may have dropped, as fragments of clothing, &c. Any discovery should at once be recorded in writing. The presence or absence of body heat, of cadaveric rigidity, or of putrefactive changes are to be observed. When an exhaustive investigation of the body in situ has been made, it may be removed to some place convenient for further examination.

The clothes are now to be removed and any cuts or injuries sustained by the clothing carefully compared with the underlying surface of the body. Marks resembling bruises should be sponged so as to make sure that they are not due to dirt or other external stain. Indications for identification are to be sought for in surface marks:- naevi, moles, tattoo-marks, cicatrices; external abnormalities or loss of fingers or limbs; absence of natural, or presence of artificial, teeth; colour of the hair; height, weight, sex, age, state of nutrition, and indications of social position, or of occupation. In women and female children, the presence or absence of the hymen, any signs of recent violence to the genital organs, together with the presence of foreign substances in any of the natural apertures of the body should be ascertained.

If there are wounds, examine them carefully as to their length and depth and the structures divided or injured - whether they could have been self inflicted, and the kind of weapon that could have produced them. Examine the neck for marks of strangulation. If there is a gunshot wound, look for blackening or tattooing of the surrounding skin, and also for blackening of the hand.

The internal inspection must be complete; all the cavities of the body should be opened, even though sufficient cause for death is found in the cavity first opened. If this is not done, the counsel for the defence may assume the presence of disease in an important organ which has not been investigated, or it may be necessary to have a second examination made to clear up a doubtful point which ought to have been settled by the first examination. The cavity supposed to be implicated in the cause of death should be opened first. In cases where there is no reason for selecting one cavity before another, the order from above downwards may be followed. If there are any penetrating wounds produced by cutting instruments or by firearms, ascertain their direction, and, in case they are not self-inflicted, try to form an opinion as to the relative position of the deceased and his assailant. When bones, cartilages, or intervertebral substances are injured, it is well to remove the injured parts and preserve them as evidence. Look carefully for any acute or chronic morbid changes in the organs, especially in cases of suspected poisoning, or when there is no gross traumatic lesion which would account for death. When the head has been injured the use of the chisel and hammer to open the cranium is to be avoided for fear of producing a fracture of the skull, or of causing one already existing to spread: the saw only should be used. The vagina and the uterus are to be examined for signs of recent delivery and for mechanical injuries, or for injuries produced by the introduction per vaginam of caustic or irritant substances. The vertebral canal should be opened and the condition of the cord ascertained.

Cases of suspected poisoning.

Several large glass jars, preferably new, but in any case thoroughly cleansed, should be provided. If they are furnished with glass stoppers so much the better, if not, some bladder or gutta-percha tissue should be obtained which may be secured by string over the mouths of the jars. It is convenient to have a large dish - a photographer’s square porcelain dish is the best - for placing the stomach in when opening it.

Before opening the body, examine the mouth and lips for injuries caused by a corrosive, and ascertain if there is any peculiar odour given off from the mouth. After making the primary incision through the abdominal parietes, again try [to ascertain] if any special odour can be distinguished, and if so obtain corroboratory evidence from those who are present; the same proceeding should be adopted when the stomach and intestines are opened. When the abdominal cavity is opened, look for signs of inflammation of the peritoneum or of any of the viscera, especially of the peritoneal aspect of the stomach. Then place a ligature round the lower end of the oesophagus, and a double one at the commencement of the duodenum. Divide the oesophagus above its ligature, and the duodenum between the two, and remove the stomach. On a dish, as already described, open the stomach along the lesser curvature, taking care that none of the contents are lost. The contents may be poured into one of the jars, and the inner coat of the stomach examined forthwith, its colour when first opened being noted. Search should be made with the aid of a lens for crystals, fragments of leaves, berries, and other parts of plants, and for particles of pigments (such as indigo) which are mixed with certain poisons - as arsenic when sold in small quantities, and strychnine in the form of vermin-killer. Any suspicious substances found should be carefully collected and examined under the microscope. The intestines, large and small, separately ligatured, are to be removed and treated in the same way. In the case of corrosive and irritant poisons, the oesophagus should also be removed, opened, and its internal appearance noted, the effects of the poison being traced from the mouth down the digestive tract as far as any can be observed. The presence or absence of solid motions in the lower bowel is to be recorded.

Victorian post-mortem saw. (Courtesy of Michael Echols, DDS)

The colour of the blood, its condition as regards fluidity, and the colour of the solid organs generally, should be observed. Indications of fatty degeneration in liver, kidneys, and heart, of injection, especially of the kidneys, and of ecchymoses must be looked for. In addition to the stomach and intestines with their contents, the liver, kidneys, spleen, as much of the blood as can be collected, with the contents of the urinary and gall bladders, should be severally removed and placed separately in appropriate vessels for analysis. It is well to remove the brain with any fluid that is present within the cranium, especially in the case of volatile poisons, and to preserve it as above described. All vessels should be closed so as to be as nearly air-tight as possible, and the mouths finally covered with paper securely tied, the knot of the string being well covered with sealing-wax impressed with the private seal of the medical man who makes the examination. Labels should be attached to the jars and bottles, on each of which a description of the respective contents, with the name of the individual from whom they were derived, and the date of the necropsy, should be clearly written. Two lists of the jars and contents should be made; one being forwarded along with the jars to the analyst, or to the authorities who take charge of them meanwhile, the other being retained by the sender. The jars should pass through as few hands as possible; when feasible, the person who makes the post-mortem should himself deliver them to the analyst. They should be kept in a cool place, but no preservative should be added to their contents.

It is convenient and advisable that two practitioners should conjointly make the post-mortem examination. In case of doubtful or of obscure indications, the advice and countenance of a colleague is advantageous, and the division of labour - one practitioner making the section, and the other recording the results - adds to the completeness of the investigation and to the facility with which it is made. Every step should be accurately recorded at the time, or in event of the examination being made by one medical man only, immediately after its completion. If the notes are made by a colleague they should be read over on the spot by the operator, and then signed by both medical men. No other persons than those concerned in making the necropsy should be present. If a medical man is implicated, he must not be permitted to be present; he may depute another medical practitioner to represent him at the necropsy, but his representative must not take any active part in the proceedings. In all cases in which a legal inquiry is likely to take place, the medical practitioner in charge should refrain from making an examination until he receives an order from the coroner to do so. When an inquest is going to be held, the dead body is technically in the possession of coroner until he has issued his order for the burial, and, consequently, it may not be interfered with without his permission. In other cases the Anatomy Act of 1832 (2 & 3 Wm IV, c 75, sec 7) provides that the executors, or other party having lawful possession of the body, may permit an anatomical examination to be made.

Exhumation.

When suspicion of foul play arises after the body of the supposed victim has been interred, the coroner and the authorities at the Home Office may order the body to be exhumed and a medical inspection made. The medical man deputed to examine the body should be present at the exhumation, and should previously see that adequate provision is made for making a full investigation. A relative or friend of the deceased should be present at the exhumation in order to identify the body. When the interment has been recent an ordinary post-mortem examination can be made, but if the body has lain long underground decomposition will be more or less advanced and the usual post-mortem appearances destroyed. In such cases injuries to the bones, especially those of the skull, and in women the uterus (which resists putrefaction longer than the other soft organs) may afford valuable evidence. Most frequently, exhumations are undertaken in cases of suspected poisoning; in such cases, the stomach and intestines are to be removed - if recent, they should be ligatured as described in the directions for the ordinary examination, and placed in clean glass vessels well secured. The liver, spleen, and kidneys should also be removed. When the presence of a metallic poison is suspected, as mercury or arsenic, some of the bones should also be taken, the shaft of the femur, for example. If the interment was remote, so that the coffin is decayed, it is advisable in cases of mineral poisoning to remove a little of the surrounding earth for chemical examination. However far putrefaction is advanced, neither preservative fluid nor disinfectant must be used when making the post-mortem, nor added to the parts removed. The stage of the putrefactive changes in relation to the length of time the body has been interred should be noted.

There is good reason to be impressed by the careful and detailed approach described by Mann, especially the need to avoid destroying evidence and the requirement for secure custody of toxicology samples. However, it is likely that while all surgeons should have followed such thorough procedures by the end of the nineteenth century, inevitably some would not have done so, at least not as comprehensively as ought to have been the case. And it is also highly likely that evidence was accidentally destroyed or overlooked on a regular basis, especially by some police officers who were not familiar with such a demanding approach in the early days of forensic examination.

Some Practical Considerations

The Whitechapel Murders would have fallen under regulation of The Coroners Act of 188716, which directs that:

...where a coroner is informed that the dead body of a person is lying within his jurisdiction, and there is reasonable cause to suspect that such person has died either a violent or an unnatural death, or has died a sudden death of which the cause is unknown, or that such person has died in prison, or in such place or under such circumstances as to require an inquest in pursuance of any Act, the coroner, whether the cause of death arose within his jurisdiction or not, shall, as soon as practicable, issue a warrant [for an inquest].

As related by as Stevenson17, even as late as the 1890s, it seems that medical men did not take medical contributions to inquests seriously:

The proceedings at coroners’ inquests are treated too lightly by medical men. The ignorant and uneducated class of persons who often constitute the jury, as well as the circumstances under which the inquiry usually takes place, are not calculated to inspire great respect for these initiatory proceedings; but still by law and custom coroners’ inquisitions are, and have been for ages in this country, the primary tribunals for inquiring into and determining the cause of death in cases of suspected violence; and they are therefore deserving of more attention than is usually shown to them by medical witnesses.

And there was also a tendency for surgeons to underestimate the knowledge of the court:18

Some medical men who have treated legal medicine with indifference have occasionally ventured to act as witnesses, thinking that the subjects on which they were likely to be examined were so little known to the judge and counsel that even hazardous or rash statements would escape observation: such witnesses, however, have often found to their cost that they were labouring under a great delusion.

Not all autopsies were conducted in hospital mortuaries; many were performed in makeshift accommodation such as sheds, the workhouse deadhouse, and elsewhere, and the use of such temporary morgues is well demonstrated in the case of the Whitechapel murders. But it was also not unusual for a dead body to be autopsied in a private house – usually the place where the person had died and often still inhabited by the victim’s relatives! Woodhead describes the requirements:19

Where the examination has to be conducted in a private house, the following matters should be attended to beforehand:- A good firm kitchen table is to be placed in the room where the cadaver is lying. (If this cannot be obtained, the coffin lid, or a door removed from its hinges and supported by a couple of chairs, is a good substitute.) The room should be well lighted, and as large and airy as possible; where it is small the windows should be thrown wide-open. A piece of stout Mackintosh should be spread over the table. A couple of wash-hand basins must be procured, two empty pails, a plentiful supply of water, hot and cold, a bottle of 1-20 carbolic acid (watery solution), some turpentine, and some carbolic linseed oil, 1-5. Dr Lindsay Steven recommends a mixture thymol - half a drachm, and Vaseline - one ounce; and Dr Harris of Manchester always uses a mixture of beeswax and vaseline, worked up in a mortar in such proportions that they form a kind of paste.

Clean rags, a number of newspapers, three or four sponges, a piece of soap and several towels, are essential.

Hygiene was not an important consideration in relation to the Victorian autopsy. Although the medical men were undoubtedly aware of the risks, it is unlikely that any of the surgeons performing autopsies at that time wore rubber gloves when dissecting a corpse. Rubber gloves were not much used until around the 1920s. Miller, writing in 1925, stresses the importance of using rubber gloves, and contrasts the improvement using them provided compared to not using them:20

One of the most important parts of the pathologist’s equipment is a good pair of sound rubber gloves. Fifteen or twenty years ago gloves were seldom worn. In consequence, those carrying out post-mortem work suffered periodically from septic wounds, if not from the more serious infections such as tuberculosis. Nowadays [1925] there is no excuse for such accidents, as gloves are cheap, and with care they last a considerable time.

Rubber gloves were available earlier but Mallory gives some insight into why they were not worn:21

Rubber gloves are sometimes worn to protect the hands while making a post-mortem examination; but they greatly dull the sense of touch, and cannot be recommended for routine work except while opening the stomach and intestines. A cut received during an autopsy should immediately be washed thoroughly, and then sucked so that the blood will flow freely.

Woodhead took a similar view recommending that if the skin were ‘scratched, or pricked the hands should be at once cleaned, the wound sucked, and pure nitric acid or strong acetic acid applied to it’ and it seems that the only time rubber gloves were advisedly worn was for protection after the prosecutor had already been cut! Not that rubber gloves are much protection from a sharp knife but they do form a first defence and lessen the chances of infection.22 Admittedly the rubber gloves available at the time were rather bulky and there was clearly an acceptable trade-off between the surgeon’s ease of working in the body and the potential of contracting a possibly fatal infection.

With or without rubber gloves, the hands of the surgeon undertaking the dissection would quickly become covered in blood and tissue, to such an extent that he would be quite unable to make notes without wiping if not washing his hands before recording every observation, explaining why surgeons conducting a Post-mortem rarely worked alone. It was better to have an assistant to either dissect or to take notes. On occasions when surgeons conducted a post-mortem examination alone, as may often have been the case with private Post-mortems, they would have no alternative but to make notes at the time or less satisfactorily, as soon after completion of the procedure as possible. Notes contaminated with body fluids would of course have to be re-written in the form of a report anyway. Little reliance should be placed upon associating the handwriting of the report with the surgeon who conducted the necropsy. When an assistant took notes the surgeon responsible for the autopsy and giving evidence might have needed to rewrite them or have them rewritten. Even the signature on a report is no guarantee that the individual conducted the post-mortem examination.

In 1893, Mann stated the importance of accurate record taking at necropsies.23 In 1925, Miller described what had been accepted practice for many years:24

Notes dictated by the operator during the sectio should be taken by a competent person. This is absolutely necessary, as the more minute points in the case cannot be put down unless the organs are actually before the operator. Organs change considerably in colour even during the course of the sectio, so that it is not safe to trust to the description of a case written up afterwards, even when the more important organs are preserved. It is well that a copy of these notes should be gone over and corrected as soon after the sectio as possible.

Divisional police surgeons employed assistants who were almost always present to either take notes or dissect the corpse as appropriate. This would have been in keeping with Mann’s suggested procedure, the presence of more than one surgeon being preferred.

Death and Post-Mortem Changes

It is interesting to see the extent to which the natural processes that occur after death were understood at the time of the Whitechapel murder. Each of these topics comes into consideration for at least one of the Ripper murders so it is useful to understand the nomenclature and appreciate the extent if not the accuracy of knowledge revealed by contemporaneous texts.

Signs of death.

When considering whether or not someone was dead, the Victorian medical men did not have the aid of sophisticated equipment to generate measurements of vital parameters. Thus, they had to use more basic criteria. Reliance was placed initially upon auscultation, ie, listening carefully and repeatedly for sounds of the heartbeat and breathing in conditions of absolute silence. The consequences of making a mistake were dire:25

Error on the part of the practitioner should he wrongly pronounce that death has taken place, is so obviously capable of refutation that his reputation is damaged, and, what is of infinitely greater importance, such an error might lead to that most ghastly of all blunders – the treatment of a living being as though he were dead.

All the more ghastly if the patient were subjected to a necropsy while still alive which was not unheard of or at least cause for doubt.26 There was occasional case of a person who was presumed dead being buried alive, for instance during cholera epidemics. In order to lessen the risk of premature burial, it was recommended that burial should not take place within twenty-four hours after death and that inquests should also not commence within that time.27 It was also considered prudent that ‘No medical man is justified in making an inspection of a body until the signs of death (coldness and rigidity) have been clearly manifested’.28

Cessation of the circulation and respiration, body cooling, rigor mortise, and putrefaction were all regarded as indicators of death, the latter two being especially reliable, but a rather more complex indicator was that of post-mortem discolouration that commenced earlier than, and was not attributable to, putrefaction.

Modes of death.

Three modes of death had been established by 1893. There is a distinction between the mode of death and the cause of death. For example, in the case of Ripper victims, the cause of death would have been the cuts to the throat and consequential haemorrhage from the carotid arteries whereas the mode of death as described by the Victorian medical men was syncope. Such terminology was also used on death certificates but it is non-specific and a requirement to more accurately categorise the information from death records later led to more precise recording of causes of death. Mann listed the three modes of death as asphyxia, syncope, and coma.29 These were generally accepted at the time and are also to be found in other books published during the late nineteenth century. The post-mortem appearance of the internal organs of someone who died from asphyxia was described as:

The right side of the heart, the pulmonary artery, the venae cavae, and the veins in the neck are gorged with dark venous blood. The left side is comparatively empty from post-mortem contraction. The blood nearly black, contains a large amount of CO2, and, therefore, coagulates slowly. The haemoglobin is almost entirely reduced.

Syncope was the mode of death for each of the Whitechapel murder victims with their fatal throat cuts and is reported as being the consequence of a failed circulation. Here Mann draws a distinction between syncope from haemorrhage and that from heart failure:

When death has resulted from insufficient supply of blood to the heart, that organ has been found contracted and empty. When the cause of death has been heart-paralysis both sides have been found to contain blood.

The third mode of death reported by the Victorian surgeon was that of coma ‘from any cause affecting brain insensibility which terminates in death’. The causes are many, from tumours to infection to intracranial haemorrhage but Mann found the post-mortem appearance of the brain rather more difficult to detail:

In some of the conditions which produce coma, examination of the brain reveals the cause. From what has already been said it will be apparent that the condition of the heart and lungs is not constant. As a rule, they resemble more or less the condition found in death from asphyxia.

Post-mortem discolouration.

Post-mortem discolouration occurs as a result of the gravitational movement of fluid blood through capillaries to the lowest parts of the corpse – the lowest parts being relative to the position of the body after death. The internal organs are similarly affected. Mann points out that coagulation of the blood within the body commences later and much more slowly than is the case with blood withdrawn from the living organism.(30) He suggested that four hours is the ‘period allotted’ between death and the commencement of coagulation of blood within the vessels such that it can remain fluid for many hours. Post-mortem staining appears first as dull-red or blue-red patches on the lower aspects extending to large areas with well-defined borders but absent from any areas of the body that are in contact with a surface, the pressure thus produced preventing the seepage of blood through capillaries. Such staining is useful in determining whether or not a body has been moved after death, although permanency of the stains is only achieved when the blood eventually coagulates. The importance of distinguishing post-mortem staining from bruises made during life was well known at the time:31/32

Mistakes in this relation may be, and have been, the cause of doing serious injustice to innocent persons. The difference is very marked and easy of recognition. In post-mortem stains the blood which produces them is still within the blood vessels and capillaries. The surface is uninjured: if examined in an oblique direction, or with oblique light, no trace of disturbance of the epidermis is found. The parts stained are not elevated, they are practically on the same level with the surrounding skin. The margins of the stains are well defined, they do not fade away into the surrounding skin. The depth of colour of the patches of stain is uniform, or nearly so.

In bruises made during life, the discolouration of the skin is caused by extravasation of blood in and under the papillae of the true skin from vessels which have been ruptured by violence. The surface of the skin will generally be found disturbed, the result of impact with the object that produced the bruise. Except in the case of very slight injuries, the bruised part will be more or less elevated. The margin will be ill-defined fading away into the surrounding skin. The colour of a bruise is not uniform; if the bruise has existed for a day or two a zone of yellow or green may be seen around the outer parts.

The colour of bruises also alters with time as blood pigments change colour and are absorbed, and medical witnesses can give an estimate of the probable time at which the injury was inflicted. But more importantly, ‘violence inflicted on a living body may not show itself under the form of ecchymosis [bruising] until after death’.33 The cause producing the ecchymosis may operate during life, but there may be no appearance of it until after death’. This phenomenon was reported earlier than 1861.34 Phillips was well aware of this which explains why he viewed Elizabeth Stride’s body on more than one occasion after his initial post-mortem examination. But bruising can also occur to a body after death according to Stevenson who cautioned that ‘by trusting to external appearance only, contusions made soon after death may be easily confounded with those which have been produced by violence shortly before death’.35 It is doubtful that dead bodies were handled with any great care at that time and injuries to the corpse after death from rough handling may have been common although such damage would be unlikely to cause confusion if inflicted more than a couple of hours after death. Mann suggested that cutting into a stained area will readily reveal the differences between bruising and hypostasis, the effused blood being apparent in areas of bruising.36

Temperature and cooling of the body. It is surprising that the Victorian surgeons in the 1880s and 1890s routinely assessed the temperature of a corpse by whether parts of it felt warm or cool to the touch. This is surprising because thermometers were available by that time and the potential significance of cooling was well appreciated.37 Stevenson suggested that:

In all observations on the temperature of the dead body, a thermometer should, if possible, be employed. This may be applied for the exterior, either to the skin of the abdomen or to the armpits; and for determining the temperature of the interior, the bulb may be introduced into the mouth, throat, or rectum.

Although assessment of time of death from body cooling, even today, is more of an art than a science the relationship between the rate of cooling and the external temperature had been investigated by the end of the nineteenth century and some rather rudimentary observations made. Stevenson concluded that ‘a dead body cools slowly and progressively and that the trunk generally retains a well-marked warmth for ten or twelve hours after death’. And, ‘It may be accepted as a general rule that the body is not cooled to approximately the temperature of the surrounding medium, air, in less than twenty-four hours’. Stevenson also noted that initially a body may lose temperature at the rate of 4 or 5 degrees Fahrenheit per hour but after a lapse of 25 hours this rate had fallen to just one degree per hour thus quashing the generally held assumption at the time that a body cooled at the uniform rate of one degree per hour. The rate of temperature loss according to Stevenson ‘is nearly proportional to the temperature of the surrounding medium’ and the rate of cooling becomes slower as the temperature approximates that of the medium. Stevenson confirmed the prevailing approach of surgeons:38

It is customary to judge of the degree of coldness by the sense of touch; but the dead human skin is a good conductor of heat, and thus the surface may appear cold to a moderately warm hand. The condition of the hand itself may lead to an erroneous impression. If two hands are of different temperatures, a recently dead body may appear cold to one and warm to the other. Another fact should also be borne in mind, that in the chest and abdomen, the viscera may retain a well-marked warmth when the surface of the skin is actually cool or cold.

The contribution made by haemorrhage to the rate of body cooling was also discussed by Stevenson, who concluded that the only difference that excessive haemorrhage ‘would be likely to create, would be by simply reducing the amount of fluids in the body to undergo the cooling process’.39 Mann stated that ‘a body lying naked on the flags will cool quicker than one protected by clothing lying on a bed’.40 Stevenson wrote:41

The dead human body cools first by radiation; secondly by conduction; thirdly, if naked and exposed, by convection; consequently, its own mass, as well as the nature of the materials with which it is in contact, must modify the results. Again, when the dead body is placed on good conducting substances, or is exposed to the open air in a naked state, the cooling process will be hastened. If, on the contrary, it is much covered with badly conducting materials, as cloth, flannel, or cotton, and is allowed to remain on a bed, it will require more than the usual period of time to become cold.

These observations are interesting in relation to the Whitechapel murders since estimates of time of death were reliant upon the touch temperature of the body and measured body temperatures were apparently never taken. A more accurate measurement of the core temperature of the corpse may have been of some value otherwise the approximations merely compounded the vagaries of an already imprecise science. Whether or not a thermometer would have been of any help in estimating the time of death of Mary Kelly is doubtful but had some indication of the temperature of the body been gained as soon as it was discovered and not several hours later there may have been something to have been gained. Phillips stumbled over estimating the time of death of Annie Chapman from the touch temperature of her corpse and in the remaining cases, with the exceptions of Martha Tabram and the Pinchin Street torso, the bodies were discovered shortly after death such that there probably was no significant reduction in body temperature – and certainly none that would be discernable with the touch of a hand. The use of body temperature reduction is of little more value today and can only be used as an estimate and only then in conjunction with other factors.

Rigor mortise.

Another imprecise measure of time after death is the onset of rigor mortise. The process was well known in Victorian times and there were attempts to quantify it. Knowledge on the subject has progressed little since, at least with regard to estimating time of death. The problem with rigor is much the same as that with temperature in that they are both subject to many variables and there is no standard against which to reliably back-calculate the time of death. Stages in the process were well-documented:42/43

The first effect of death from any cause is in most cases a general relaxation of the whole of the musculature system. The lower jaw drops, the eyelids lose their tension, the limbs are soft and flabby and the joints are quite flexible. In from five to six hours after death, and generally while the body is still in the act of cooling the muscles of the limbs are observed to become hard and contracted, the joints stiff, and the body firm and unyielding. This peculiar condition is known under the name of cadaveric rigidity or rigor mortise. The muscular tissue may be considered as passing through three stages in a dead body. 1. It is, as above mentioned, flaccid but contractile, although, as will be seen hereafter, muscles contracted by living force in the act of dying do not necessarily become relaxed in death; 2. It becomes rigid and incapable of contraction; and 3. It is once more relaxed, and does not regain its power of contraction. The body now passes into the incipient stage of putrefaction.

At a variable period after death the muscles of the lower jaw begin to stiffen; this is the first indication of the onset of cadaveric rigidity or, as it is also called, rigor mortise. Under ordinary circumstances, the skeletal muscles begin to stiffen from four to ten hours after death. The stiffening spreads from the muscles of the jaw to those of the face, neck, and trunk, and lastly to the limbs. It is fully developed in from two to three hours, when the entire body is firm and stiff. The limbs cannot be flexed at their joints without considerable force, and the body when moved behaves as though it was devoid of articulations. This condition lasts for a period varying from a few hours to six or eight days. Twenty-four to forty-eight hours may be regarded as the average duration of cadaveric rigidity.

Stevenson stated that rigor generally commenced within five or six hours and lasted from 16 to 24 hours and Mann thought the onset to be after four to ten hours, lasting for 24 hours. Stewart more accurately suggested that ‘In the human body rigor generally appears not earlier than an hour, and not later than four or five hours, after death’.44 Today, it is generally accepted that rigor commences within one to four hours with secondary flaccidity being apparent from 24 to 50 hours after death.

Mann observed that rigor mortise passes off in the same order, thus the muscles that first become rigid are the first to lose their rigidity and rigidity disappears at just about the same time as putrefaction commences.45 The process of putrefaction, or autolysis, commences as soon as the tissues of the body die and after they are no longer in receipt of oxygen and nutrients from the blood. Therefore, Mann’s assertion in this respect probably related more particularly to the outwardly visible signs of putrefaction than to early processes.

Stevenson gave a theory as to the mechanism by which rigor might occur in the muscles, this being essentially a chemical process.46 He highlighted the many circumstances that may influence the timing of the onset and passage of rigor mortise, including violent exercise or exertion which accelerates rigidity as does poisoning with strychnine. Those who die from debilitating disease pass rapidly into rigor which is commonly of short duration. The biological processes involved in rigor mortise depend upon an appreciation of the physiology of skeletal muscle and that was far from well understood in 1895 although the fundamentals were in place. Stewart noted: ‘Rigor mortise is essentially a clotting or coagulation of a substance which yields myosin. What this substance is we cannot tell’.47 In fact, the processes involved in rigor are complex but essentially involve the irreversible combination of two proteins, actin and myosin. Actin was probably the then unknown substance to which Stewart referred. Involuntary muscles are also reportedly affected by rigor and such effects can be observed in the heart:48

Very soon after death, and before the skeletal muscles become rigid, the heart-muscles become rigid. It has long been observed that when the heart is in a condition of cadaveric rigidity, the ventricular walls, especially the left, are firm and contracted, and present an appearance totally different to that which obtains after rigidity has passed off. The heart, like the skeletal muscles, not only stiffens, but undergoes contraction sufficient to entirely alter the relative capacity of its cavities after death. This fact is of great importance to the medical jurist, since a decision as to the mode of death is not infrequently based upon the condition of the heart as found at the necropsy.

However, Mann concluded that the condition of the heart at necropsy affords no reliable proof as to its condition at death. Only when the left and right sides of the heart are both found to be filled with blood is it possible to say that the original condition at death was maintained. And only in cases where haemorrhage has taken place is the heart found to be empty – a commonly reported state among the Whitechapel murder victims.

Putrefaction.

Putrefaction was defined by 1893 as the breakdown of complex organic bodies into simpler forms until ultimately they are split up into inorganic substances, and micro-organisms, moisture, air, and warmth were regarded as being the causative agents.49 In fact, decomposition is brought about largely by enzymatic chemical processes, bacterial and fungal attack, with a contribution from predating organisms from mammals to maggots. Oxygen is required for some micro-organisms, bodies buried soon after death decompose more slowly than those left in air, and moisture and temperature are influential on progress but not causative. Mann was confident of the role played by micro-organisms in decomposition but he appreciated that there were ‘a number of different forms not yet differentiated’. He made no mention of enzymatic processes but stated the importance of ambient temperature, suggesting that 60 to 70 degrees Fahrenheit was optimal to the speed of putrefaction. The drying effect of a current of warm air progressively desiccates the tissues thus slowing down or preventing decomposition, with mummification being the consequence. Even in the 1890s it was appreciated that overweight bodies decompose more quickly that lean bodies and that certain diseases such as enteric infections and those giving rise to septicaemia would accelerate the breakdown of tissues after death. Some poisons retarded autolysis significantly, notably arsenic and antimony. Use of antimony by Ripper suspect George Chapman contributed to his conviction and subsequent execution for murdering his common-law wives.

Contents of post-mortem kit circa 1860. (Courtesy of Michael Echols, DDS)

The first outward signs of putrefaction of a body in air were reported to occur on the second or third day after death – although this would be in temperate conditions because elevated temperatures bring about visible changes more speedily. Such changes are characterised by a greenish discolouration on the middle of the abdomen, which spreads to the genitals. Other centres of discolouration appear on the legs, neck, and back, with general decomposition reported as follows:50

The eyeball yields to pressure, the cornea is more or less corrugated, and has a milky appearance. At or about this period – four to five days after death – blood-stained fluid oozes from the mouth, together with froth and air bubbles. The gases resulting from decomposition collect in the abdomen, under the skin, and distend the whole body, the features being unrecognisable. The tongue may be forced between the lips, and the eyeballs protruded. About eight or ten days after death the cornea falls in and appears concave. Still later, bullae filled with blood-stained serum form on various parts of the surface; the whole body is reddish brown or greenish, and is still further distended with gas. Large areas are devoid of skin, and maggots without number cover the body. The further processes are simply those attending the final dissolution of the soft parts, and are not recognised stages.

At the time of the Whitechapel murders – because refrigeration of corpses was not an option until some twenty or thirty years later – there was understandably some urgency to perform post-mortem examinations. Moreover, as noted, there were often no proper holding facilities for bodies apart from a few poorly equipped mortuaries. Bodies were stored wherever possible and autopsied as soon as convenient in order that the inquest could proceed and the body could be released by the coroner for interment.

The effect of putrefaction on the individual organs of the body was also well known:51

About the fifth or sixth day after death the stomach exhibits indications of incipient putrefaction in the form of isolated patches of dirty-red. The spleen may putrify before the stomach. The liver is usually found firm for several weeks. The gall bladder resists putrefaction much longer. The adult brain shrinks, and the hemispheres soften soon after death, but it takes months, under ordinary conditions, for the brain to melt into reddish pulp. The remaining organs putrefy relatively late. The heart is found relatively fresh when the stomach and liver are in an advanced stage of putrefaction; several months are required to produce in the heart an equal degree of decomposition. The lungs usually show putrefactive changes about the same time as the heart. They may be found in good condition when the external signs of putrefaction are well advanced. The first indication consists of pale red spots of varying size on the surface of the lung, the pleura being raised at these points by the gases of decomposition. These small bullae are not unfrequently met with even in relatively fresh corpses, but further changes scarcely ever occur until general putrefaction is well advanced, when the colour of the lungs changes to dark bottle green, and eventually to black, and they subsequently soften and dwindle away. The kidneys resist long; at a considerable interval after death they soften, and become of a blackish-green. The bladder is still more resistant. The oesophagus is much more resistant than the rest of the digestive tract. The pancreas does not decay until the body as a whole is much decomposed. The diaphragm may be seen, and its muscular aponeurotic structures distinguished, four to six months after death. The large arteries last very long; Devergie found the aorta quite recognisable in a body that had been buried fourteen months. The uterus resists the longest of all the soft organs of the body, this enables not only the sex of a cadaver to be ascertained when the external parts are destroyed by putrefaction, but also the occurrence or not of pregnancy or of recent delivery.

Mann also warned that ‘The interval that has elapsed between death and the time that a body undergoing putrefaction is examined cannot be estimated, even approximately, by the stage that the putrefaction has reached.’

Microscopy.

The microscope was not generally employed to any great extent as a routine aid to diagnosing pathological conditions during this period and medico-legal textbooks scarcely mention study of lesions at the microscopic level, although both Woodhead and Mallory at the end of the nineteenth century illustrated the potential benefits in general pathology. Microscopy had certainly been applied to forensic science by that time, especially in confirming the presence of blood as opposed to other substances as well as the identification of hair and fibres deposited on weapons and elsewhere.52

Investigators were able to distinguish between blood from some animal species but not human blood from the blood of other mammals. In 1894, Stevenson admitted that ‘we have at present no certain method of distinguishing human from other mammalian blood, when it has been once dried on an article of clothing or on a weapon’, and at the time any evidence along such lines was inadmissible.53 As early as 1861, it was possible to distinguish microscopically between blood from mammals from the blood of fish, birds, and reptiles but it seems there was little progress over the following thirty years or so.54 On the other hand, at least by 1853, it was possible to detect, by means of microscopy, spermatozoa in fluid samples, and this was of value in supporting circumstantial evidence in cases of rape.55

Conclusion

The objective of this article was not to examine the extent of forensic and medical knowledge of the Victorian medical jurist in comparison with what is know today because such an approach is not of any particular value. It is far more important to appreciate the standard of knowledge and technical skills that were prevalent at the time of the Whitechapel murders in order to accurately interpret the forensic evidence of the surgeon pathologists involved in post-mortem examinations.

A study of contemporaneous texts reveals that the medical scientists during the period of the Whitechapel murders were well-informed on issues relating to post-mortem changes that affect a dead body and while they may not have discovered all of the mechanisms involved they were certainly aware of the problems and the limitations inherent in assessing the time of death from such vague parameters as body cooling and rigor mortis. They knew from observation the processes that occurred after death and the observations used then are still largely valid today.

More significantly, however, the surgeons appreciated the need for thorough examination of a crime scene and corpse and the value of accurate and objective observations in crime detection and criminal prosecution. The last two decades of the nineteenth century would provide a turning point in the development of forensic investigation. Although the battery of forensic techniques available today was naturally not available to investigators in 1888, I believe nonetheless that the publicity given to the Whitechapel murders brought about an elevation of forensic pathology that assisted the evolution of medico-legal investigation into a speciality.

In Part 2, I shall examine how well the autopsies on the Whitechapel murder victims were conducted and what nineteenth century knowledge of forensic pathology can tell us about the injuries. I will attempt to unravel confusion about who actually performed the necropsies, who was present and why, and who wrote what. I’ll look at the mode of death from ‘syncope’ and speculate upon how long it took victims to become unconscious and to die.

Pages from a circa 1878 Tiemann Company catalog showing post-mortem instruments. (Courtesy of Michael Echols, DDS)

Footnotes

1 J A P Price, Hoblyn’s Dictionary of Medical Terms. 13th Ed. London: Whittaker, 1899.

2 Samuel Johnson, Dictionary of the English Language. London: Printed by W Strahan, 1755. Quincy, John Lexicon Physico-Medicum; or, A New Medicinal Dictionary.

3 32 Henry VIII c 42. ‘An Act Concernyng Barbours and Chirurgeons to be on one Companie’ (1540).

4 25 Geo II c 37. ‘An Act for Better Preventing the Horrid Crime of Murder’ (1752).

5 2 & 3 Wm IV c 75. ‘An Act for Regulating Schools of Anatomy’ (1832).

6 The Proceedings of the Old Bailey Case Ref: t16850826-6 (1685).

7 The Proceedings of the Old Bailey Case Ref: t17450911-32 (1745).

8 The Proceedings of the Old Bailey Case Ref: t17820220-5 (1782).

9 The Proceedings of the Old Bailey Case Ref: t17820703-47 (1782)

10 Reference to the lungs floating relates to the belief that if they sink when placed into water then the probability is that they had never inflated thus the child had not drawn breath. However, if they float then they contain air but that this can not exclude the child dying immediately afterwards from natural causes. This assessment of life after birth or a separate existence has been used since mediaeval times, but it has been pointed out that, ‘There are too many recorded instances when control tests have shown that stillborn lungs may float and the lungs of undoubtedly live-born infants have sunk, to allow it to be used in testimony in a criminal trial’. P Saukko and B Knight, Knight’s Forensic Pathology. 3rd Ed. London: Arnold, 2004, 445.

11 6 & 7 Wm IV c 89. ‘An Act to Provide for the Attendance and Remuneration of Medical Witnesses at Coroners Inquests’ (1836).

12 For a review of the British coronial system and the role of Thomas Wakley, see Robert Linford, John Savage, and David O’Flaherty, ‘The Green of the Peak – The Coronial System in Britain.’ Ripperologist 63(2006), 19-43.

13 R Virchow, Post-Mortem Examination with especial reference to medical-legal practice. Translated by T P Smith. Philadelphia: Blakiston & Son, 1887. (This is the second American edition, translated from the fourth German edition of 1875.)

14 G S Woodhead, Practical Pathology. Third US edition of UK Text. Philadelphia: Lippincott, 1892, 1-29.

15 J D Mann, Forensic Medicine and Toxicology. London: Charles Griffin, 1893, 17–21.

16 50 & 51 Vict c 71. ‘The Coroners Act’ (1887).

17 T Stevenson, Taylor’s Principles and Practice of Medical Jurisprudence. Vol I. 4th Ed. London: Churchill, 1894, 10.

18 Ibid, 4.

19 Woodhead, 5.

20 J Miller, Practical Pathology Including Morbid Anatomy and Post-Mortem Technique. London: A&C Black Ltd, 1925, 5.

21 F B Mallory, J H Wright, Pathological Technique. A Practical Manual for the Pathological Laboratory. London: Rebman, 1899, 23.

22 Woodhead, 6.

23 Miller, 10.

24 Mann, 20.

25 Ibid, 36.

26 Stevenson, 50.

27 Ibid, 78.

28 Ibid, 50.

29 Mann, 33.

30 Ibid, 39.

31 Ibid, 41.

32 Ibid, 42.

33 Stevenson, 515.

34 A S Taylor, Medical Jurisprudence. 7th Ed. London: Churchill, 1861, 232.

35 Stevenson, 516.

36 Mann, 42.

37 Stevenson, 47.

38 Ibid.

39 Ibid, 48.

40 Mann, 38.

41 Stevenson, 49.

42 Ibid, 52.

43 Mann, 43.

44 G N Stewart, A Manual of Physiology. London: Balliere, Tindall & Cox, 1895, 516.

45 Mann, 49.

46 Stevenson, 53-60.

47 Stewart, 513.

48 Mann, 45.

49 Ibid, 49.

50 Ibid, 51.

51 Ibid, 54

52 Stevenson, 562.

53 Ibid, 600.

54 Taylor, 305.

55 Ibid, cited on p.709.


Related pages:
  Autopsies
       Dissertations: The Victorian Medico-Legal Autopsy: Part II 
  Karyo Magellan
       Ripper Media: By Ear and Eyes: The Whitechapel Murders, Jack the Ripper...