When the doctor from Mainz examines the body of a 74-year-old man again before cremation, it is noticeable: A rubber band is stretched around the man's neck, it is wrapped tightly around the neck eight times. The blood is stuck in the head, it comes out of the mouth and ears, there are masses of pin-sized bleeding. However, none of this was noticed by the first doctor at the corpse. Although he was considered experienced, he certified the man a natural death due to cardiac arrhythmia. Probably also because the man was already 74 and was found in his bed at home. Only now, at the re-examination before the cremation, did the second doctor notice the throttling tool and informed the police. The post-mortem revealed that the man had committed suicide.

That this was recognized at all is thanks to the burial laws and ordinances that stipulate in every federal state: Before a dead person is burned and thus all evidence of the cause of death is destroyed, there must be a second physical examination. With one exception: In Bavaria this mandatory second physical examination is missing. There, the 74-year-old's death would have officially had a natural cause. Had the man not committed suicide, he would have been killed - it would never have been noticed.

Cases like these alert legal practitioners. They have known for a long time that doctors make many mistakes at the first physical examination. "There are many mistakes, often the real cause of death is very different from what the doctors say in the death certificate," confirms the legal doctor Klaus-Peter Philipp from the University of Greifswald. Even if it sounds like an extreme case: Even obvious signs of a non-natural death, such as stab wounds, gunshot wounds or cut pulse arteries, were often not recognized at the first physical examination.

Rather suppress quiet doubts

Actually, the first physical examination should bring clarity. It is usually regulated in the state laws as follows: If a person dies, a doctor is called for a physical examination - this is often the responsible family doctor, who also knows the patient's medical history. He determines death by checking the body for certain signs of death such as rigor mortis, death spots or decay. He must note the type of death - natural, not natural or unsettled - and the exact cause of death in the death certificate. To do this, he has to completely undress the dead person, inspect all parts of the body and every opening of the body, as prescribed, for example, by the Bavarian Funeral Ordinance. If the light-sighted doctor finds evidence of murder, suicide or an accident, "non-natural death" must be specified for the type of death. "Natural" is death only when there is an illness, without outside influence. If the doctor is not quite sure, he can enter "unsettled" in the death certificate.

But if the doctor ticks "unclear" or "not natural way of death", he is obliged to alert the police. Often this leads the coroner to prefer to indicate a "natural way of death" and to suppress quiet doubts, legal doctors say. Because who likes to call the police into the house of long-term acquaintances or the family of their own patient? Otherwise, especially in retirement homes, the police would quickly become regular guests and the doctor would be rather unpopular. And then there are the relatives, who often resist a thorough physical examination from the outset. "Even if the relatives may find it impudence to undress the deceased, the doctor should make it clear to them that it has to be, since it is required by law," explains Rostock legal doctor Fred Zack. "The relatives have to leave the room anyway during the corpse."

Nevertheless, some doctors only look at the corpse in a hurry, "corpse avoidance instead of corpse examination" sometimes jokes legal doctors about their colleagues. Forensic physician Philipp, however, it is important not only to blame the doctors for the inadequate body inspections, but rather to blame the legal regulations behind them. Because the medical profession simply lacks experience with the dead and lacks a keen sense of crime. A family doctor only conducts a physical examination a few times a year, if at all. And gynecologists or ophthalmologists, who are known to have little to do with the dead, may also carry out a body examination.