Forensic Sci Med Pathol
DOI 10.1007/s12024-014-9543-x
LETTER TO THE EDITOR
Is histological examination always necessary to determine a cause
of death? Of course it is!
Fabio De-Giorgio • Giuseppe Vetrugno
Accepted: 10 February 2014
Ó Springer Science+Business Media New York 2014
The reflections of Fronczek et al. [1] on the role of his-
tology in medico-legal investigations aimed at answering
specific questions usually raised with regard to suspicious
deaths, or in any event those of interest to the criminal
police, can at least claim to have attracted the attention of
those who interpret medico-legal matters on an issue that is
obviously still open to debate.
Is histological examination just an ancillary test carried
out at autopsy and one that can justifiably be forgone in
cases in which the cause of death is macroscopically evi-
dent during the ‘‘visual’’ evaluation carried out by the
pathologist, or does it also provide an indispensable and
comprehensive element of a medico-legal investigation
that should be sought in even the simplest of cases because,
in any event, it strengthens the evidence gathered by the
pathologist with his own eyes during the autopsy itself?
The writers are inclined toward the second point of view
for two reasons that they would like to put to the authors of
such an interesting piece [1].
The first deals with the issue from the point of view of
the police investigation in that, if the conclusion of the
autopsy is to be used in evidence, it must meet the usual
standards set by the courts regarding the admissibility of
technical/scientific proof. In a hypothetical court case,
surely the pathologist cannot testify on the basis of evi-
dence that is purely subjective [2], which is what a basic
F. De-Giorgio (&)
Institute of Public Health, School of Medicine, Catholic
University of the Sacred Heart, Largo Francesco Vito 1,
00168 Rome, Italy
e-mail: fabio.degiorgio@rm.unicatt.it
G. Vetrugno
Medical Directorate, School of Medicine, Catholic University of
the Sacred Heart, Rome, Italy
autopsy would provide. Is not additional, objective [3] and
reproducible confirmation of his macroscopic observations
also needed? A histological examination would certainly
provide that [4]. The second deals with the need for uni-
formity in the way forensic investigations are performed on
behalf of the police.
The importance of the guidelines set out in the 1984
Coroner’s Rules regarding the working methods to be used
by forensic pathologists in cases of post-mortems carried
out in England and Wales for medico-legal reasons cannot
be ignored. Mention must also be made, however of,
Recommendation no. R of the Committee of Ministers of
the Council of Europe dated 1999, aimed at reconciling the
manner of carrying out medico-legal autopsies in the EU,
which sets out a ‘‘basic sampling scheme’’ that ‘‘should
include specimens from the main organs for histology in all
autopsies’’ [5].
Even if the data set out by Fronczek et al. [1] seem to
assign histological examination a secondary role in the
identification of the biological cause of death, we do not
think that we can agree with their suggestion that the use of
histology be decided on a case by case basis, as allowing
the forensic pathologist such discretion would not only be
contrary to the position happily adopted by the Council of
Europe, it would also introduce a degree of uncertainty that
would be hard to reconcile with the need for the courts to
be able to fully trust all evidence presented in order to
protect the innocent.
References
1. Fronczek J, Hollingbury F, Biggs M, Rutty G. The role of
histology in forensic autopsies: is histological examination always
necessary to determine a cause of death? Forensic Sci Med Pathol.
2014;10:39–43.
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2. Dulohery K, Papavdi A, Michalodimitrakis M, Kranioti EF.
Evaluation of coronary stenosis with the aid of quantitative image
analysis in histological cross sections. J Forensic Leg Med.
2012;19:485–9.
3. Tagliaro F, Smith FS, Tedeschi L, Castagna F, Dobosz M, Boschi
I, Pascali VL. Criteria for acceptance of new science in court.
J Chromatogr Libr Elsevier Science BV. 1998;60:950–3.
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4. de la Grandmaison GL, Charlier P, Durigon M. Usefulness of
systematic histological examination in routine forensic autopsy.
J Forensic Sci. 2010;55:85–8.
5. Madea B. Histology in forensic practice. Forensic Sci Med Pathol.
2012;8:64–5.