Post-mortem
   HOME

TheInfoList



OR:

An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a
corpse A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stu ...
by
dissection Dissection (from Latin ' "to cut to pieces"; also called anatomization) is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause o ...
to determine the cause, mode, and manner of
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
or to evaluate any
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
or injury that may be present for research or educational purposes. (The term "
necropsy An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
" is generally reserved for non-human animals). Autopsies are usually performed by a specialized medical doctor called a
pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...
. In most cases, a
medical examiner The medical examiner is an appointed official in some American jurisdictions who is trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictio ...
or
coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest into Manner of death, the manner or cause of death, and to investigate or confirm the identity of an unknown person who has been found dead within th ...
can determine the cause of death. However, only a small portion of deaths require an autopsy to be performed, under certain circumstances.


Purposes of performance

Autopsies are performed for either legal or medical purposes. Autopsies can be performed when any of the following information is desired: * Determine if death was natural or unnatural * Injury source and extent on the corpse *
Manner of death In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinc ...
must be determined *
Post mortem interval The post-mortem interval (PMI) is the time that has elapsed since an individual's death. When the time of death is not known, the interval may be estimated, and so an approximate time of death established. Postmortem interval estimations can ra ...
* Determining the deceased's identity * Retain relevant organs * If it is an infant, determine live birth and viability For example, a forensic autopsy is carried out when the
cause of death In law, medicine, and statistics, cause of death is an official determination of conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. The cause of death is ...
may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy is complete, the body is reconstituted by sewing it back together.


Etymology


Autopsy

The term "autopsy" derives from the
Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
αὐτοψία ''autopsia'', "to see for oneself", derived from αὐτός (''autos'', "oneself") and ὄψις (''opsis'', "sight, view"). The word has been in use since around the 17th century.


Post-mortem

The term "post-mortem" derives from the
Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
''post'', 'after', and ''mortem'', 'death'. It was first recorded in 1734.


Purpose

The principal aims of an autopsy are to determine the
cause of death In law, medicine, and statistics, cause of death is an official determination of conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. The cause of death is ...
, mode of death,
manner of death In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinc ...
, the state of health of the person before he or she died, and whether any
medical diagnosis Medical diagnosis (abbreviated Dx, Dx, or Ds) is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information re ...
and treatment before death were appropriate. In most
Western countries The Western world, also known as the West, primarily refers to the various nations and states in the regions of Europe, North America, and Oceania.
the number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologist and former ''
JAMA ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biom ...
'' editor George D. Lundberg, have charged that the reduction in autopsies is negatively affecting the care delivered in hospitals, because when mistakes result in death, they are often not investigated and lessons, therefore, remain unlearned. When a person has permitted an autopsy in advance of their death, autopsies may also be carried out for the purposes of teaching or medical research. An autopsy is frequently performed in cases of sudden death, where a doctor is not able to write a death certificate, or when death is believed to result from an unnatural cause. These examinations are performed under a legal authority (
medical examiner The medical examiner is an appointed official in some American jurisdictions who is trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictio ...
,
coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest into Manner of death, the manner or cause of death, and to investigate or confirm the identity of an unknown person who has been found dead within th ...
, or procurator fiscal) and do not require the consent of relatives of the deceased. The most extreme example is the examination of
murder Murder is the unlawful killing of another human without justification (jurisprudence), justification or valid excuse (legal), excuse, especially the unlawful killing of another human with malice aforethought. ("The killing of another person wit ...
victims, especially when medical examiners are looking for signs of death or the murder method, such as
bullet A bullet is a kinetic projectile, a component of firearm ammunition that is shot from a gun barrel. Bullets are made of a variety of materials, such as copper, lead, steel, polymer, rubber and even wax. Bullets are made in various shapes and co ...
wounds and exit points, signs of
strangulation Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and is one of two main ways that hangin ...
, or traces of
poison Poison is a chemical substance that has a detrimental effect to life. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figuratively, with a broa ...
. Some religions including
Judaism Judaism ( he, ''Yahăḏūṯ'') is an Abrahamic, monotheistic, and ethnic religion comprising the collective religious, cultural, and legal tradition and civilization of the Jewish people. It has its roots as an organized religion in the ...
and
Islam Islam (; ar, ۘالِإسلَام, , ) is an Abrahamic religions, Abrahamic Monotheism#Islam, monotheistic religion centred primarily around the Quran, a religious text considered by Muslims to be the direct word of God in Islam, God (or ...
usually discourage the performing of autopsies on their adherents. Organizations such as
ZAKA ZAKA ( he, זק"א, abbreviation for ''Zihuy Korbanot Ason'', , literally: "Disaster Victim Identification") is a series of voluntary community emergency response teams in Israel, each operating in a police district (two in the Central Distr ...
in Israel and
Misaskim , image = , image_size = , alt = , caption = , logo = , logo_size = , logo_alt = , logo_caption = , map = , map_siz ...
in the United States generally guide families on how to ensure that an unnecessary autopsy is not made. Autopsies are used in clinical medicine to identify a
medical error A medical error is a preventable adverse effect of care (" iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior ...
or a previously unnoticed condition that may endanger the living, such as
infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
s or exposure to hazardous materials. A study that focused on
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...
(heart attack) as a cause of death found significant errors of omission and commission, i.e. a sizable number of cases ascribed to myocardial infarctions (MIs) were not MIs and a significant number of non-MIs were MIs. A
systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...
of studies of the autopsy calculated that in about 25% of autopsies, a major diagnostic error will be revealed. However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors. A large
meta-analysis A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
suggested that approximately one-third of
death certificate A death certificate is either a legal document issued by a medical practitioner which states when a person died, or a document issued by a government civil registration office, that declares the date, location and cause of a person's death, as ...
s are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. Also, it is thought that over one-fifth of unexpected findings can only be diagnosed
histologically Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...
, ''i.e.'', by
biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
or autopsy, and that approximately one-quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue. One study found that (out of 694 diagnoses) "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others". Focusing on intubated patients, one study found "abdominal pathologic conditions – abscesses, bowel perforations, or infarction – were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of an examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued".


Types

There are four main types of autopsy: * ''Medico-legal'' or ''forensic'' or ''coroner's autopsies'' seek to find the cause and manner of death and to identify the decedent. They are generally performed, as prescribed by applicable law, in cases of violent, suspicious or sudden deaths, deaths without medical assistance, or during surgical procedures. * ''Clinical'' or ''pathological autopsies'' are performed to diagnose a particular disease or for research purposes. They aim to determine, clarify, or confirm medical
diagnoses Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems enginee ...
that remained unknown or unclear before the patient's death. * ''Anatomical'' or ''academic autopsies'' are performed by students of anatomy for study purposes only. * ''Virtual'' or ''medical imaging autopsies'' are performed utilizing imaging technology only, primarily magnetic resonance imaging (MRI) and computed tomography (CT).


Forensic autopsy

A forensic autopsy is used to determine the cause, mode, and manner of death.
Forensic science Forensic science, also known as criminalistics, is the application of science to criminal and civil laws, mainly—on the criminal side—during criminal investigation, as governed by the legal standards of admissible evidence and criminal ...
involves the application of the sciences to answer questions of interest to the legal system. Medical examiners attempt to determine the time of death, the exact cause of death, and what, if anything, preceded the death, such as a struggle. A forensic autopsy may include obtaining biological specimens from the deceased for toxicological testing, including stomach contents.
Toxicology Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating expo ...
tests may reveal the presence of one or more chemical "poisons" (all chemicals, in sufficient quantities, can be classified as a poison) and their quantity. Because post-mortem deterioration of the body, together with the gravitational pooling of bodily fluids, will necessarily alter the bodily environment, toxicology tests may overestimate, rather than underestimate, the quantity of the suspected chemical. Following an in-depth examination of all the
evidence Evidence for a proposition is what supports this proposition. It is usually understood as an indication that the supported proposition is true. What role evidence plays and how it is conceived varies from field to field. In epistemology, evidenc ...
, a medical examiner or
coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest into Manner of death, the manner or cause of death, and to investigate or confirm the identity of an unknown person who has been found dead within th ...
will assign a
manner of death In many legal jurisdictions, the manner of death is a determination, typically made by the coroner, medical examiner, police, or similar officials, and recorded as a vital statistic. Within the United States and the United Kingdom, a distinc ...
from the choices proscribed by the fact-finder's jurisdiction and will detail the evidence on the mechanism of the death.


Clinical autopsy

Clinical autopsies serve two major purposes. They are performed to gain more insight into
pathological Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in th ...
processes and determine what factors contributed to a patient's death. For example, material for infectious disease testing can be collected during an autopsy. Autopsies are also performed to ensure the standard of care at hospitals. Autopsies can yield insight into how patient deaths can be prevented in the future. Within the United Kingdom, clinical autopsies can be carried out only with the consent of the family of the deceased person, as opposed to a medico-legal autopsy instructed by a Coroner (England & Wales) or Procurator Fiscal (Scotland), to which the family cannot object. Over time, autopsies have not only been able to determine the cause of death, but also lead to discoveries of various diseases such as fetal alcohol syndrome, Legionnaire's disease, and even viral hepatitis.


Academic autopsy

Academic autopsies are performed by students of anatomy for the purpose of study, giving medical students and residents firsthand experience viewing anatomy and pathology. Postmortem examinations require the skill to connect anatomic and clinical pathology together since they involve organ systems and interruptions from ante mortem and post mortem. These academic autopsies allow for students to practice and develop skills in pathology and become meticulous in later case examinations.


Virtual autopsy

Virtual autopsies are performed using radiographic techniques which can be used in post-mortem examinations for a deceased individual. It is an alternative to medical autopsies, where radiographs are used, for example, Magnetic resonance imaging (MRI) and Computed tomography ( CT scan) which produce radiographic images in order to determine the cause of death, the nature, and the manner of death, without dissecting the deceased. It can also be used in the identification of the deceased. This method is helpful in determining the questions pertaining to an autopsy without putting the examiner at risk of biohazardous materials that can be in an individual's body.


Prevalence

In 2004 in England and Wales, there were 514,000 deaths, of which 225,500 were referred to the coroner. Of those, 115,800 (22.5% of all deaths) resulted in post-mortem examinations and there were 28,300 inquests, 570 with a jury.UK
Department for Constitutional Affairs The Department for Constitutional Affairs (DCA) was a United Kingdom government department. Its creation was announced on 12 June 2003; it took over the functions of the Lord Chancellor's Department. On 28 March 2007 it was announced that the Dep ...
(2006)
Coroners Service Reform Briefing Note
, p. 6
The rate of consented (hospital) autopsy in the UK and worldwide has declined rapidly over the past 50 years. In the UK in 2013 only 0.7% of inpatient adult deaths were followed by consented autopsy. The autopsy rate in
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
is below 5% and thus much lower than in other countries in Europe. The governmental reimbursement is hardly sufficient to cover all the costs, so the medical journal
Deutsches Ärzteblatt The ''Deutsches Ärzteblatt'' is a weekly German-language medical magazine published in Germany. Profile ''Deutsches Ärzteblatt'' is published by the Deutscher Ärzte Verlag, which is co-owned by the German Medical Association (''Bundesärztekam ...
, issued by the
German Medical Association The German Medical Association (GMA) (german: Bundesärztekammer, BÄK), founded in 1947 and based in Berlin, is the co-ordinating body of physicians’ self-regulation in Germany. It co-ordinates the activities of the 17 State Chambers of Physician ...
makes the effort to raise awareness regarding the underfinancing of autopsies. The same sources stated that autopsy rates in
Sweden Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...
and
Finland Finland ( fi, Suomi ; sv, Finland ), officially the Republic of Finland (; ), is a Nordic country in Northern Europe. It shares land borders with Sweden to the northwest, Norway to the north, and Russia to the east, with the Gulf of B ...
reach 20 to 30%. In the United States, autopsy rates fell from 17% in 1980 to 14% in 1985
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(1988)
Current Trends Autopsy Frequency – United States, 1980–1985
''
Morbidity and Mortality Weekly Report The ''Morbidity and Mortality Weekly Report'' (''MMWR'') is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention (CDC). It was originally established as ''Weekly Health Index'' in 1930, ...
'', 37(12);191–94
and 11.5% in 1989, although the figures vary notably from county to county.


Process

The body is received at a medical examiner's office, municipal mortuary, or hospital in a
body bag A body bag, also known as a cadaver pouch or human remains pouch (HRP), is a non-porous bag designed to contain a human body, used for the storage and transportation of shrouded corpses. History In the United States, the apparent first docum ...
or evidence sheet. A new body bag is used for each body to ensure that only
evidence Evidence for a proposition is what supports this proposition. It is usually understood as an indication that the supported proposition is true. What role evidence plays and how it is conceived varies from field to field. In epistemology, evidenc ...
from that body is contained within the bag. Evidence sheets are an alternative way to transport the body. An evidence sheet is a sterile sheet that covers the body when it is moved. If it is believed there may be any significant evidence on the hands, for example,
gunshot residue Gunshot residue (GSR), also known as cartridge discharge residue (CDR), gunfire residue (GFR), or firearm discharge residue (FDR), consists of all of the particles that are expelled from the muzzle of a gun following the discharge of a bullet. It ...
or skin under the
fingernails A nail is a claw-like plate found at the tip of the fingers and toes on most primates. Nails correspond to the claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin, which is a polymer ...
, a separate paper sack is put around each hand and taped shut around the wrist. There are two parts to the physical examination of the body: the external and internal examination.
Toxicology Toxicology is a scientific discipline, overlapping with biology, chemistry, pharmacology, and medicine, that involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating expo ...
, biochemical tests or
genetic testing Genetic testing, also known as DNA testing, is used to identify changes in DNA sequence or chromosome structure. Genetic testing can also include measuring the results of genetic changes, such as RNA analysis as an output of gene expression, or ...
/
molecular autopsy Molecular autopsy or postmortem molecular testing is a set of molecular techniques used in forensic medicine to attempt to determine the cause of death in unexplained cases, in particular sudden unexplained deaths (for example sudden cardiac death ...
often supplement these and frequently assist the
pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...
in assigning the cause or causes of death.


External examination

At many institutions, the person responsible for handling, cleaning, and moving the body is called a
diener A diener is a morgue worker responsible for handling, moving, and cleaning the corpse. In the UK, the equivalent job title is 'Mortuary Assistant', whilst the preparation, evisceration and reconstruction of the deceased is performed by an Anatom ...
, the
German German(s) may refer to: * Germany (of or related to) ** Germania (historical use) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizens of Germany, see also German nationality law **Ge ...
word for ''servant''. In the UK this role is performed by an Anatomical Pathology Technician (APT), who will also assist the pathologist in eviscerating the body and reconstruction after the autopsy. After the body is received, it is first photographed. The examiner then notes the kind of clothes - if any - and their position on the body before they are removed. Next, any evidence such as residue, flakes of paint, or other material is collected from the external surfaces of the body.
Ultraviolet Ultraviolet (UV) is a form of electromagnetic radiation with wavelength from 10 nanometer, nm (with a corresponding frequency around 30 Hertz, PHz) to 400 nm (750 Hertz, THz), shorter than that of visible light, but longer than ...
light may also be used to search body surfaces for any evidence not easily visible to the naked eye. Samples of
hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and f ...
, nails , and the like are taken, and the body may also be radiographically imaged. Once the external evidence is collected, the body is removed from the bag, undressed, and any
wound A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...
s present are examined. The body is then cleaned, weighed, and measured in preparation for the internal examination. A general description of the body as regards
ethnic group An ethnic group or an ethnicity is a grouping of people who identify with each other on the basis of shared attributes that distinguish them from other groups. Those attributes can include common sets of traditions, ancestry, language, history, ...
,
sex Sex is the trait that determines whether a sexually reproducing animal or plant produces male or female gametes. Male plants and animals produce smaller mobile gametes (spermatozoa, sperm, pollen), while females produce larger ones ( ova, of ...
, age, hair colour and length,
eye colour Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conv ...
, and other distinguishing features (
birthmark A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth—usually in the first month. They can occur anywhere on the skin. Birthmarks are caused by overgrowth of blood vessels, melanocy ...
s, old
scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...
tissue,
moles Moles can refer to: * Moles de Xert, a mountain range in the Baix Maestrat comarca, Valencian Community, Spain * The Moles (Australian band) *The Moles, alter ego of Scottish band Simon Dupree and the Big Sound People *Abraham Moles, French engin ...
,
tattoo A tattoo is a form of body modification made by inserting tattoo ink, dyes, and/or pigments, either indelible or temporary, into the dermis layer of the skin to form a design. Tattoo artists create these designs using several Process of tatt ...
s, etc.) is then made. A
voice recorder A dictation machine is a sound recording device most commonly used to record speech for playback or to be typed into print. It includes digital voice recorders and tape recorder. The name "Dictaphone" is a trademark of the company of the same ...
or a standard examination form is normally used to record this information. In some countries , ''e.g.'', Scotland, France, Germany, Russia, and Canada, an autopsy may comprise an external examination only. This concept is sometimes termed a "view and grant". The principle behind this is that the medical records, history of the deceased and circumstances of death have all indicated as to the cause and manner of death without the need for an internal examination.


Internal examination

If not already in place, a plastic or rubber brick called a "head block" is placed under the shoulders of the corpse; hyperflexion of the neck makes the spine arch backward while stretching and pushing the
chest The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...
upward to make it easier to incise. This gives the APT, or pathologist, maximum exposure to the trunk. After this is done, the internal examination begins. The internal examination consists of inspecting the
internal organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a ...
of the body by
dissection Dissection (from Latin ' "to cut to pieces"; also called anatomization) is the dismembering of the body of a deceased animal or plant to study its anatomical structure. Autopsy is used in pathology and forensic medicine to determine the cause o ...
for evidence of
trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...
or other indications of the cause of death. For the internal examination there are a number of different approaches available: * a large and deep Y-shaped incision can be made starting at the top of each shoulder and running down the front of the chest, meeting at the lower point of the
sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...
(breastbone). * a curved incision made from the tips of each shoulder, in a semi-circular line across the chest/decolletage, to approximately the level of the second rib, curving back up to the opposite shoulder. * a single vertical incision is made from the sternal notch at the base of the neck. * a U-shaped incision is made at the tip of both shoulders, down along the side of the chest to the bottom of the rib cage, following along it. This is typically used on women and during chest-only autopsies. There is no need for any incision to be made, which will be visible after completion of the examination when the deceased is dressed in a shroud. In all of the above cases, the incision then extends all the way down to the
pubic bone In vertebrates, the pubic region ( la, pubis) is the most forward-facing ( ventral and anterior) of the three main regions making up the coxal bone. The left and right pubic regions are each made up of three sections, a superior ramus, inferior ...
(making a deviation to either side of the navel) and avoiding, where possible, transecting any scars that may be present.
Bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
from the cuts is minimal, or non-existent because the pull of
gravity In physics, gravity () is a fundamental interaction which causes mutual attraction between all things with mass or energy. Gravity is, by far, the weakest of the four fundamental interactions, approximately 1038 times weaker than the stro ...
is producing the only blood pressure at this point, related directly to the complete lack of cardiac functionality. However, in certain cases, there is anecdotal evidence that bleeding can be quite profuse, especially in cases of
drowning Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...
. At this point, shears are used to open the chest cavity. The examiner uses the tool to cut through the ribs on the costal cartilage, to allow the sternum to be removed; this is done so that the heart and lungs can be seen
in situ ''In situ'' (; often not italicized in English) is a Latin phrase that translates literally to "on site" or "in position." It can mean "locally", "on site", "on the premises", or "in place" to describe where an event takes place and is used in ...
and that the heartin particular, the
pericardial sac The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made of ...
is not damaged or disturbed from opening. A PM 40 knife is used to remove the sternum from the soft tissue that attaches it to the mediastinum. Now the
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s and the heart are exposed. The sternum is set aside and will eventually be replaced at the end of the autopsy. At this stage, the
organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...
are exposed. Usually, the organs are removed in a systematic fashion. Making a decision as to what order the organs are to be removed will depend highly on the case in question. Organs can be removed in several ways: The first is the ''
en masse Many words in the English vocabulary are of French origin, most coming from the Anglo-Norman spoken by the upper classes in England for several hundred years after the Norman Conquest, before the language settled into what became Modern Engli ...
'' technique of Letulle whereby all the organs are removed as one large mass. The second is the en bloc method of Ghon. The most popular in the UK is a modified version of this method, which is divided into four groups of organs. Although these are the two predominant evisceration techniques, in the UK variations on these are widespread. One method is described here: The pericardial sac is opened to view the heart. Blood for chemical analysis may be removed from the
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...
or the pulmonary veins. Before removing the heart, the
pulmonary artery A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the ''main pulmonary artery'' or ''pulmonary trunk'' from the heart, and ...
is opened in order to search for a blood clot. The heart can then be removed by cutting the inferior vena cava, the pulmonary veins, the
aorta The aorta ( ) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes o ...
and pulmonary artery, and the
superior vena cava The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein th ...
. This method leaves the aortic arch intact, which will make things easier for the embalmer. The left lung is then easily accessible and can be removed by cutting the
bronchus A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronchu ...
, artery, and vein at the hilum. The right lung can then be similarly removed. The abdominal organs can be removed one by one after first examining their relationships and vessels. Most pathologists, however, prefer the organs to be removed all in one "block". Using dissection of the fascia, blunt dissection; using the fingers or hands and traction; the organs are dissected out in one piece for further inspection and sampling. During autopsies of infants, this method is used almost all of the time. The various organs are examined, weighed and tissue samples in the form of slices are taken. Even major
blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...
s are cut open and inspected at this stage. Next the
stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
and intestinal contents are examined and weighed. This could be useful to find the cause and time of death, due to the natural passage of food through the bowel during digestion. The more area empty, the longer the deceased had gone without a meal before death. The body block that was used earlier to elevate the chest cavity is now used to elevate the head. To examine the
brain A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
, an incision is made from behind one ear, over the crown of the head, to a point behind the other ear. When the autopsy is completed, the incision can be neatly sewn up and is not noticed when the head is resting on a pillow in an open casket
funeral A funeral is a ceremony connected with the final disposition of a corpse, such as a burial or cremation, with the attendant observances. Funerary customs comprise the complex of beliefs and practices used by a culture to remember and respect th ...
. The
scalp The scalp is the anatomical area bordered by the human face at the front, and by the neck at the sides and back. Structure The scalp is usually described as having five layers, which can conveniently be remembered as a mnemonic: * S: The ski ...
is pulled away from the
skull The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, th ...
in two flaps with the front flap going over the face and the rear flap over the back of the neck. The skull is then cut with a circular (or semicircular) bladed reciprocating saw to create a "cap" that can be pulled off, exposing the brain. The brain is then observed in situ. Then the brain's connection to the cranial nerves and
spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...
are severed, and the brain is lifted out of the skull for further examination. If the brain needs to be preserved before being inspected, it is contained in a large container of formalin (15 percent solution of
formaldehyde Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section F ...
gas in buffered
water Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as a ...
) for at least two, but preferably four weeks. This not only preserves the brain, but also makes it firmer, allowing easier handling without corrupting the tissue.


Reconstitution of the body

An important component of the autopsy is the reconstitution of the body such that it can be viewed, if desired, by relatives of the deceased following the procedure. After the examination, the body has an open and empty
thoracic cavity The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia). The central compartment of the thoracic cavity is the mediastinum. There ...
with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck. It is unusual to examine the face, arms, hands or legs internally. In the UK, following the
Human Tissue Act 2004 The Human Tissue Act 2004 is an Act of the Parliament of the United Kingdom, that applied to England, Northern Ireland and Wales, which consolidated previous legislation and created the Human Tissue Authority to "regulate the removal, storage, u ...
all organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation. Normally the internal body cavity is lined with cotton, wool, or a similar material, and the organs are then placed into a plastic bag to prevent leakage and are returned to the body cavity. The chest flaps are then closed and sewn back together and the skull cap is sewed back in place. Then the body may be wrapped in a
shroud Shroud usually refers to an item, such as a cloth, that covers or protects some other object. The term is most often used in reference to '' burial sheets'', mound shroud, grave clothes, winding-cloths or winding-sheets, such as the famous S ...
, and it is common for relatives to not be able to tell the procedure has been done when the body is viewed in a funeral parlor after
embalming Embalming is the art and science of preserving human remains by treating them (in its modern form with chemicals) to forestall decomposition. This is usually done to make the deceased suitable for public or private viewing as part of the funeral ...
.


In stroke

An autopsy of stroke may be able to establish the time taken from the onset of cerebral infarction to the time of death. Various microscopic findings are present at times from infarction as follows: File:Cortical pseudolaminar necrosis - lfb - very low mag.jpg,
Micrograph A micrograph or photomicrograph is a photograph or digital image taken through a microscope or similar device to show a magnified image of an object. This is opposed to a macrograph or photomacrograph, an image which is also taken on a mic ...
showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. File:Reactive astrocytes - lfb - high mag.jpg,
Micrograph A micrograph or photomicrograph is a photograph or digital image taken through a microscope or similar device to show a magnified image of an object. This is opposed to a macrograph or photomacrograph, an image which is also taken on a mic ...
of the superficial
cerebral cortex The cerebral cortex, also known as the cerebral mantle, is the outer layer of neural tissue of the cerebrum of the brain in humans and other mammals. The cerebral cortex mostly consists of the six-layered neocortex, with just 10% consistin ...
showing neuron loss and reactive astrocytes in a person that has had a stroke. H&E-LFB stain.


History

Around 3000 BCE, ancient Egyptians were one of the first civilizations to practice the removal and examination of the internal organs of humans in the religious practice of
mummification A mummy is a dead human or an animal whose soft tissues and organs have been preserved by either intentional or accidental exposure to chemicals, extreme cold, very low humidity, or lack of air, so that the recovered body does not decay furt ...
. Autopsies that opened the body to determine the cause of death were attested at least in the early third millennium BCE, although they were opposed in many ancient societies where it was believed that the outward disfigurement of dead persons prevented them from entering the
afterlife The afterlife (also referred to as life after death) is a purported existence in which the essential part of an individual's identity or their stream of consciousness continues to live after the death of their physical body. The surviving ess ...
(as with the Egyptians, who removed the organs through tiny slits in the body). Notable Greek autopsists were
Erasistratus Erasistratus (; grc-gre, Ἐρασίστρατος; c. 304 – c. 250 BC) was a Greek anatomist and royal physician under Seleucus I Nicator of Syria. Along with fellow physician Herophilus, he founded a school of anatomy in Alexandria, where th ...
and Herophilus of Chalcedon, who lived in 3rd century BCE
Alexandria Alexandria ( or ; ar, ٱلْإِسْكَنْدَرِيَّةُ ; grc-gre, Αλεξάνδρεια, Alexándria) is the second largest city in Egypt, and the largest city on the Mediterranean coast. Founded in by Alexander the Great, Alexandria ...
, but in general, autopsies were rare in ancient Greece. In 44 BCE,
Julius Caesar Gaius Julius Caesar (; ; 12 July 100 BC – 15 March 44 BC), was a Roman general and statesman. A member of the First Triumvirate, Caesar led the Roman armies in the Gallic Wars before defeating his political rival Pompey in a civil war, and ...
was the subject of an official autopsy after his murder by rival senators, the physician's report noting that the second stab wound Caesar received was the fatal one. Julius Caesar had been stabbed a total of 23 times. Bryant, Clifton. Handbook of Death and Dying. California: Sage Publications, Inc, 2003. Print. By around 150 BCE, ancient Roman legal practice had established clear parameters for autopsies. The greatest ancient anatomist was
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
(CE 129– ), whose findings would not be challenged until the
Renaissance The Renaissance ( , ) , from , with the same meanings. is a period in European history marking the transition from the Middle Ages to modernity and covering the 15th and 16th centuries, characterized by an effort to revive and surpass ideas ...
over a thousand years later. The dissection of human remains for medical or scientific reasons continued to be practiced irregularly after the Romans, for instance by the Arab physicians Avenzoar and Ibn al-Nafis. In Europe they were done with enough regularity to become skilled, as early as 1200, and successful efforts to preserve the body, by filling the veins with wax and metals. Until the 20th century, it was thought that the modern autopsy process derived from the
anatomist Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...
s of the
Renaissance The Renaissance ( , ) , from , with the same meanings. is a period in European history marking the transition from the Middle Ages to modernity and covering the 15th and 16th centuries, characterized by an effort to revive and surpass ideas ...
.
Giovanni Battista Morgagni Giovanni Battista Morgagni (25 February 1682 – 6 December 1771) was an Italian anatomist, generally regarded as the father of modern anatomical pathology, who taught thousands of medical students from many countries during his 56 years as Pro ...
(1682–1771), celebrated as the father of
anatomical pathology Anatomical pathology (''Commonwealth'') or Anatomic pathology (''U.S.'') is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination ...
, wrote the first exhaustive work on pathology, ''De Sedibus et Causis Morborum per Anatomen Indagatis'' (The Seats and Causes of Diseases Investigated by Anatomy, 1769). In 1543,
Andreas Vesalius Andreas Vesalius (Latinized from Andries van Wezel) () was a 16th-century anatomist, physician, and author of one of the most influential books on human anatomy, ''De Humani Corporis Fabrica Libri Septem'' (''On the fabric of the human body'' ' ...
conducted a public dissection of the body of a former criminal. He asserted and articulated the bones, this became the world's oldest surviving anatomical preparation. It is still displayed at the Anatomical Museum at the University of Basel. In the mid-1800s,
Carl von Rokitansky Baron Carl von Rokitansky (german: Carl Freiherr von Rokitansky, cs, Karel Rokytanský; 19 February 1804 – 23 July 1878) was a Bohemian physician, pathologist, humanist philosopher and liberal politician, founder of the Viennese School of Medi ...
and colleagues at the Second Vienna Medical School began to undertake dissections as a means to improve diagnostic medicine. The 19th-century medical researcher
Rudolf Virchow Rudolf Ludwig Carl Virchow (; or ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder ...
, in response to a lack of standardization of autopsy procedures, established and published specific autopsy protocols (one such protocol still bears his name). He also developed the concept of pathological processes. During the turn of the 20th century, the
Scotland Yard Scotland Yard (officially New Scotland Yard) is the headquarters of the Metropolitan Police, the territorial police force responsible for policing Greater London's 32 boroughs, but not the City of London, the square mile that forms London's ...
created the Office of the Forensic Pathologist, a medical examiner trained in medicine, charged with investigating the cause of all unnatural deaths, including accidents, homicides, suicides, etc.


Other animals (necropsy)

A post-mortem examination, or necropsy, is far more common in
veterinary medicine Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...
than in
human medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...
. For many species that exhibit few external symptoms (sheep), or that are not suited to detail clinical examination (poultry, cage birds, zoo animals), it is a common method used by
veterinary physician A veterinarian (vet), also known as a veterinary surgeon or veterinary physician, is a medical professional who practices veterinary medicine. They manage a wide range of health conditions and injuries in non-human animals. Along with this, vet ...
s to come to a diagnosis. A necropsy is mostly used like an autopsy to determine the cause of death. The entire body is examined at the gross visual level, and samples are collected for additional analyses.


See also

* Body identification *
Forensic anthropology Forensic anthropology is the application of the anatomical science of anthropology and its various subfields, including forensic archaeology and forensic taphonomy, in a legal setting. A forensic anthropologist can assist in the identification o ...
*
Forensic facial reconstruction Forensic facial reconstruction (or forensic facial approximation) is the process of recreating the face of an individual (whose identity is often not known) from their skeletal remains through an amalgamation of artistry, anthropology, osteol ...
* Forensic identification *
Murder book In law enforcement parlance, the term murder book refers to the case file of a murder investigation. Typically, murder books include crime scene photographs and sketches, autopsy and forensic reports, transcripts of investigators' notes, and witne ...
*
Virtopsy Virtopsy is a virtual alternative to a traditional autopsy, conducted with scanning and imaging technology. The name is a portmanteau of "virtual" and "autopsy" and is a trademark registered to Richard Dirnhofer (de), the former head of the Insti ...
*
Vivisection Vivisection () is surgery conducted for experimental purposes on a living organism, typically animals with a central nervous system, to view living internal structure. The word is, more broadly, used as a pejorative catch-all term for Animal testi ...


References


External links

*
Autopsy
nbsp;– a detailed description by a
pathologist Pathology is the study of the causal, causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when us ...
complete with cartoon figures.
The Virtual Autopsy
nbsp;– a site from the
University of Leicester , mottoeng = So that they may have life , established = , type = public research university , endowment = £20.0 million , budget = £326 million , chancellor = David Willetts , vice_chancellor = Nishan Canagarajah , head_lab ...
where one examines the patient, looks at the (medical) history and gets a try at the diagnosis.
''Autopsy of a Murder''
nbsp;– An interactive exploration of a murder scene and the science involved in a criminalistic investigation: autopsy and laboratory expertise. Produced by the Montreal Science Centre for its namesake exhibition.
Autopsy checklist and reporting template at Patholines
{{Authority control Medical aspects of death Anatomical pathology Forensic techniques Forensic pathology