The Czech Republic boasts 14 institutes of forensic medicine across the country; Prague alone is home to four. The Institute of Forensic Medicine and Toxicology of the First Faculty of Medicine of Charles University (at the General University Hospital) is the oldest. But with one of the youngest chief physicians: Klára Neureutterová – in her second year heading the facility.
She admires Hercule Poirot’s grey matter, saying the “little Belgian with a moustache”, with his logical thinking knocks all other fictional detectives into a cocked hat. “TV and film nowadays are part of a crowded field and you can't simply get away with just any mumbo-jumbo when it comes to cause of death,” Neureutterová explains. Last year, the Hlava Institute which houses The Institute of Forensic Medicine and Toxicology – turned 100. There, macroscopic and microscopic changes in human tissues are studied as part of medical or forensic autopsies, and med students from the First Faculty of Medicine of Charles University learn what forensic medicine and pathology are all about.
Getting to the truth
“From the first time I turned the handle to the building as a first-year student, I knew that the next six years would be anything but a cakewalk,” Klára Neureutterová recalls. “They were among the most difficult and at the same time the most beautiful! I finished with A's and a great feeling of accomplishment.”
Her experience played a role in her decision to continue as a medical examiner; additionally, she is now familiar with related branches of medicine including histology, surgery, traumatology, internal medicine and toxicology. “The mystery that accompanies my work is probably what attracts me most. We never know what a person - whose body is brought to us from the street, from the woods, from wherever - has been through,” she says. Roughly 1,200 times a year, she delivers a final assessment of cause of death: this person died of natural causes; this person's death was violent, with the latter becoming a case for the criminal justice system. Autopsies that reveal serious infectious diseases, such as tuberculosis or Covid-19 have a positive effect, warning health care facilities to take appropriate measures to prevent their spread.
All is Well
No one in the know calls the Institute of Forensic Medicine and Toxicology anything other than “The Well” from the Czech studna, as taken from the Hlava Institute’s address in Studnička Street. A seven-member team of forensic physicians, together with pathologists, works to shed light on causes of death. Of the seven, five are women!
Why? “I think it's because as women we can endure more. We don't have night shifts, like doctors in hospitals, but we attend many calls at all hours, regardless of the day of the week or how late it is,” the chief medical officer says. An average of 10 bodies a day are received at the Well, 24/7. Suspicious deaths are given priority. Not long ago, the Well was considered the absolute top in its field. The police were said to automatically bring victims of violent deaths there for autopsy. Neureutterová would like to see similar cooperation revived: “I want to get the police back. That is one of my immediate goals. The rivalry in our field is unimaginable. All you have to do is lose trust for a second - someone might question the assessments you made - and you find yourself pushed out, almost in oblivion," says Neureutterová.
Experts on TV
Major Case Squad (2014 to 2016) was a Czech TV series inspired by real cases and is the only domestic TV crime series Neureutter was able to stomach because the show got many things right. When it comes to international series, Agatha Christie's mysteries, she says, are “good”; she also likes the British crime series Midsomer murders. The makers of the others, she says, distort the practice of forensic and toxicology specialists to the point of absurdity: “Experts spout the causes of death almost on the spot. In real life, it takes three days of work to do a first-class toxicology on a victim, for example. I find CSI unwatchable. In addition, in the dubbed version they refer to us as forensic pathologists – a nonsensical and slavish translation of forensic pathologist. We are medical examiners!”
The origin of forensic medicine as a scientific discipline dates back to 1785. Since then, only the methods of death have remained unchanged: a cut wound or death by strangulation remain the same. What has changed substantially are the technological advances that help forensic doctors in their work. “I am enthralled by the possibilities of virtual autopsies using MRI or computed tomography (CT) to scan bodies. Comparing the results obtained from a virtual and real autopsy is a trend in our field today. Hopefully next year the Well will get its own CT scanner,” Neureutterová says.
One advantage, is that colleagues will be able to actively participate in international teleconferences across the world to gain the latest insights and consult with others on ambiguous findings. And in doing so, help to regain the unofficial leadership in Prague forensic medicine. The CT scan, she says, would be used especially on accident victims, and especially in suspected tuberculosis cases. "It is the greatest danger a doctor could contract in the autopsy room. In fact, I'm always afraid of this; tuberculosis can completely shut you off from the outside world for up to six months. And we encounter it quite often," says the medical examiner.
What's next?
Forensic medicine is still evolving and the scientists at the Hlava Institute have already made many important contributions to the development of the field. They are now involved in the study of sudden cardiac death in young people using molecular genetic methods, they are also looking into the possibilities of identifying bodies by dental methods and are increasingly using methods of forensic molecular biology. In toxicology, they are investigating new addictive substances or developing methods for the diagnosis of poisoning and drug abuse.
How interested are students in pursuing a career in the field? “Before my opening lecture on the basics of forensic medicine with fourth years, I always ask them who among them is considering becoming a forensic scientist. I don’t exactly see a forest of hands go up,” the doctor reveals. She says med students - especially men - see themselves more likely to become surgeons. The field of forensic medicine is currently more of a “female” domain.
The institute head is also concerned that forensic doctors are often mistaken for pathologists, as she stated earlier. There’s a difference: “The only thing we have in common with pathologists is the autopsy table; their work is mainly through the microscope. The job of medical examiners is to determine the cause of death. A good sixth sense is needed, often leading us to uncover more. For example, the cause of a brutally executed crime...” Klára Neureutterová explains.
| Dr. Klára Neureutterová |
| Klára Neureutterová has been working at the First Medical Faculty of Charles University since 2020, where she is both an assistant professor and the head of the Department of Forensic Medicine and Toxicology. In addition to Italian (she graduated from an Italian grammar school), she speaks six other languages. After graduating from the Second Faculty of Medicine of Charles University, she went to Sri Lankafor six months. After her return she took up a position as a doctor at the Bulovka University Hospital, where she passed certification in forensic medicine. She takes a break from her mentally demanding work either by total inactivity - staring at the greenery in her garden, she says - or by action - martial arts. “I was particularly interested in kickboxing and krav maga, she says. "The perfect murder exists, but there is no way I’ll provide instructions,” she concludes mysteriously. |
  The 100th anniversary of the Hlava Institute Jaroslav Hlava, born in 1855, was a physician and pathologist who founded the Anatomical Institute. He began designing the site in 1908 in today's Studničkova Street. Before then, after the division of the Charles-Ferdinand University into Czech and German branches, the Institute of Forensic Medicine was located in Kateřinská Street. In 1921, the monumental neo-classical building with elements of functionalism was completed - and last year it celebrated its 100th birthday! As for today's Institute of Forensic Medicine and Toxicology of the First Faculty of Medicine and General University Hospital, it was established in 1999 by merging two departments: the Institute of Forensic Medicine and the Institute of Toxicology and Forensic Chemistry. The Institute is involved in the training of future doctors and other professionals. In addition to students of general and dental medicine, students of some fields of study at the Faculty of Science of the Charles University also take classes there. |
