To date, a total of 12 cases have been reported in nine publications. The detailed results of our literature review are to be found in Table 1 of the present article.

According to our literature review, Schwarz was the first to use the terminus “Philemon and Baucis death” in the medicolegal literature in 1970. He writes: “Double death from natural causes is a very rare occurrence. We see it, for example, in old married couples who were sickly and die shortly after each other. We may then speak of a Philemon and Baucis death [translated by the authors]” [6].

Subsequently, this designation was used again in 1977 in a retrospective evaluation of autopsies by Bauer [3]. However, it is not clear from the publication whether any cases listed were considered Philemon and Baucis deaths by Bauer.

In another retrospective work, a case was reported under the designation “Baucis death” by Tsokos et al. [1]. In contrast to the example by Schwarz [6] and to the constellation in the eponymous Greek myth, this case involves a brother and sister, and not a married couple. The definition is also expanded here to the extent that multiple deaths are included—in contrast to the limitation to double deaths by Schwarz [6]. Furthermore, the definition of Tsokos et al. [1] seems to make a very strict requirement regarding the temporal connection of the deaths—it presupposes “simultaneous” death. In contrast to this criterion, Tsokos et al. [1] place a sudden death from internal cause, from excitement, upon finding the corpse of a close person. The latter constellation is explicitly assigned to the Philemon and Baucis syndrome by authors of more recent works [7,8,9,10,11,12].

Philemon and Baucis death predominantly affects old people. The mean age of all involved individuals is 73.7 ± 10.6 years. All reported cases are in individuals above 60 years of age.

In the literature, bodies are mostly found in the same room (9 of 12 cases [1, 6,7,8,9,10,11]) or, less frequently, in different rooms of one apartment or house (3 cases [7, 8, 12]). A close local connection of the deaths is therefore a central common feature of the cases.

Only one case with a PMI < 24 h has been published so far [7], and only two further cases with a PMI ≤ 48 days [6, 11], while the vast majority of reports involves corpses with advanced decompositional changes. The isolation in which the deceased often lived together has been reported as a possible explanation for the typically rather late discovery in Philemon and Baucis death [9, 10]. In many cases, this results in limited assessability and complicates the diagnosis of an internal disease as the cause of death [8, 9].

With regard to the results of the autopsy, almost all case reports found cardiac disease in both (8 cases [1, 7, 8, 11, 12]) or at least one of the deceased (3 cases [6, 8, 10]). Only in one case with far advanced putrefaction and thus severely limited assessability, no heart disease was diagnosed [9]. In exceptional cases, however, the triggered psychological stress might also lead to death via a non-cardiac previous illness or at least favor it, as reported in a case by Ciesiolka et al. (acute gastrointestinal bleeding from recurrent gastric mucosal erosion) [7].

Other repeatedly reported pre-existing conditions are diabetes (3 cases/3 individuals [7, 8, 11]), hypertension (3 cases/3 individuals [8, 10, 11]), limited mobility (4 cases/5 individuals, [7, 9, 12]), and various mental illnesses (6 cases/8 individuals [8,9,10,11,12]), including alcoholism (3 cases/4 individuals [8, 9, 12]).

Limited mobility and mental illness are factors that can lead to social isolation and dependence on the close one [10], the latter have been reported in a remarkable proportion of cases in the literature (n = 8 [7, 9,10,11,12]).

In one third of the published cases, the authors established a sequence in which the deaths have occurred in consideration of the condition of the corpses, autopsy findings, and criminal investigations. In most cases, however, no sequence has been established.

In the literature, additional examinations are mostly very limited, partly due to the often encountered advanced putrefactive changes of the bodies. Toxicological examinations were reported in most [1, 7,8,9,10,11,12], but not all publications [6]. Histological examinations are reported in only a few publications [7, 8, 10, 11], while biochemical examinations have been performed in only two publications [8, 10].