Received: November 12, 2006
Accepted: December 20, 2006
Ref:Verhoff MA, Ulm K, Kreutz K, Müller KM, Stachetzki U. Exhumation as a matter of fact. Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology [serial online], 2007; Vol. 8, No. 1 (January - June 2007): [about 10 p]. Available from: . Published : January 2, 2007, (Accessed:
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Marcel A Verhoff
The results of 371 autopsies, following exhumation, were evaluated. On average, the time elapsed after burial was 74 days, varying from 9 to 478 days. All exhumations were carried out for medical insurance reasons. In all cases these were exclusively male bodies, ranging in age from 27 to 87 years, with a mean age of 66 years. In 99.2% of the cases, the issues in question could be clarified. The morphological findings (both macroscopic and microscopic) were gathered and the maximum post-mortem period after which these could still be demonstrated was established and compared with those described in literature. The existing, so called, catalogues of expectation, could be expanded and augmented. An Exhumation Database, compiling all previously published exhumation results, was constructed.
Autopsy, Exhumation, Morphological findings, Post-mortem period, Catalogues of expectation
An exhumation is carried out when issues, which can only be clarified by an autopsy and possible supplementary examinations, arise after burial.
Forensic indication, as in the case when a belated suspicion of an unnatural cause of death arises, makes an exhumation mandatory.1 In such cases, an autopsy, ordered by the public prosecutor, is performed. This may also be a second autopsy.2
Exhumations are frequently requested when medical insurance problems arise.3 Most cases are initiated by health insurances rather than by next-of-kin. Either the question whether an occupational disease was present and relevant to death has to be clarified, or the consequences of an accident need to be assessed. As a matter of principle, family members have the right to refuse a medical insurance autopsy, but often risk losing all financial claims they have on the insurance in consequence. This autopsy process and the role of the insurance company is specific to Germany.
When an exhumation is being considered, the ordering party would like to know how good the chances of clarifying the issues in question will be.4 Particularly for an insurer, there is the question of profitability. Compared to an autopsy performed immediately after death, an exhumation brings additional costs for the excavation of the grave, transport, cleaning, medical examiner's fee and reburial.5 Whereas important toxicological6,7,8 and osteological evidence9,10,11 can still be recovered after decades, the recovery of morphological evidence depends on the state of preservation of the corpse. Apart from the time elapsed post-mortem, there are different variables influencing decomposition, i.e. seasonal environmental factors12,13, soil conditions6, and coffin material.14
These influencing factors cannot be standardized and are difficult to represent statistically. For this reason, different work groups have collected morphological findings, together with the maximum post-mortem period in which they could still be demonstrated, in a so called "catalogue of expectation"2,4,15,16 to supplement published case collections12,14,17,18,19,20,21,22,. The most recent study dealing with previously undiscovered homicides in 155 forensic exhumations was conducted in Münster (Germany) in 2004.23,
In the years 1967 to 1998 the Department of Pathology, Occupational Associations Hospital, Bergmannsheil-Bochum performed 400 exhumations - all for medical insurance reasons. The collected morphological results from this study, including the maximum post-mortem period in which they could still be found, were gathered to elaborate the hitherto published insights. In addition, the success of autopsies following exhumation as a means for answering the issues in question was evaluated. Two aspects of this study, the pertinence to medical-insurance issues24 and the microscopical findings25, have already been published. This paper presents the bulk of the findings from the study and compares them to those documented in literature.
The basis for this evaluation were the documented files (autopsy reports and written evaluations) which were archived for all the autopsies performed by the Department of Pathology, Occupational Associations Hospital, Bergmannsheil-Bochum for the years 1967-1998. In addition, histological slides were available up to 1976. Criteria for inclusion in the study were the presence of complete autopsy protocols and evaluation reports.
371 cases could be included in the study. In three quarters of the cases, the deceased had lived and worked in the Ruhrgebiet, the biggest congested German urban area, and were also buried there. Since the Department of Pathology in Bochum is specialized at a national level in the performance of medical insurance autopsies, the other cases came from different regions of the Federal Republic of Germany. The corpses were all buried according to German burial laws. The cemeteries had variable soil conditions. Preparation of the corpses prior to burial, i.e. embalmment, did not take place. In most cases, the post-mortem examiner was not present during exhumation. Specifications about the soil conditions were not given for any of the cases. The autopsy was performed on site, at the graveyard, if this was possible. Otherwise, the body was transferred to the Department of Pathology or another graveyard. In all cases, complete autopsy was performed with removal of organ packages.26 After formalin fixation, representative parts of the organs were processed histologically. All slides were stained for EvG and HE, and histochemical stains were performed.
The average number of days after burial for the 371 exhumations was 74. The shortest period was 9, the longest 478 days. All bodies were male, aged between 27 and 87 years at death (average 66).
The majority of the issues in question concerned occupational diseases (93%). 12% of the issues were concerned with the consequences of accidents, either alone or in combination with an occupational disease. In 99.2% of the cases, a definite recommendation for the medical insurance questions concerning the right to compensation was achieved.
In all, 300 different diagnoses were established. For a better understanding, 181 diagnoses are presented in seven subdivisions (Tables 1-7). The results are listed in tables, together with their maximum post-mortem intervals. The longest post-mortem intervals listed for results previously described in literature, are included in the tables as a means of comparison.
In the present study, the, as yet, largest case collection of exhumations was available. The largest previously described collection contained 200 cases, but was, however, not evaluated systematically.22 The most extensive study with a catalogue of expectations contained 131 cases.16 Apart from the extensive number of cases, the presented case collection is unique, compared to cases in literature, in that all exhumations were performed exclusively to clear medical insurance issues. The second distinction is that only male bodies were investigated. Surprisingly, 99.2% of the medical insurance issues could be resolved. Even after a period of 478 days after burial, usable macroscopic and pathological anatomical diagnoses could be obtained. The existing catalogue of expectations could be expanded and augmented with the obtained results.
Of course, even the aid of a catalogue of expectations does not permit a definite prognosis for the success or failure of a planned exhumation. However, the documented maximum post mortem intervals do show whether an expected diagnosis is still feasible, and with which expected frequency it can be found for the post mortem intervals (PMI). Corresponding soil conditions for findings and PMI were neither noted in this study nor in literature. In principle, therefore, it can be assumed that the best possible conditions existed for each constellation of finding and PMI in the catalogue of expectations. For a given case, an estimate is made possible, which can be corrected upwards or downwards, according to the available details on the resting conditions.
Since it is an arduous task to consult all the previously published catalogues of expectation, case collections and reports for a given case, an Exhumation Database containing all published results has been online since 2003 (Please click here for visiting the link).
In spite of an apparently optimistic prognosis, within the limits of the presented post-mortal periods, for autopsies after exhumation one should not forget that macroscopic, and particularly, microscopic, evidence25,27 deteriorates with each post-mortem day. Thus, exhumation should and can only be a second best solution, even if it can bring light into many cases by supplying essential information for the resolution of forensic and insurance medical issues.
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