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An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough
examination Examination may refer to: * Physical examination, a medical procedure * Questioning and more specific forms thereof, for example in law: ** Cross-examination ** Direct examination * Test (assessment), informally "exam", "exams", "evaluation" ** Civ ...

examination
of a
corpse A cadaver or corpse is a dead human body that is used by medical students A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians and surge ...

corpse
by
dissection Dissection (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the Rom ...

dissection
to determine the cause, mode, and manner of
death Death is the permanent, irreversible cessation of all biological functions that sustain a living Living or The Living may refer to: Common meanings *Life, a condition that distinguishes organisms from inorganic objects and dead organi ...

death
or to evaluate any
disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interacting ...
or
injury Injury, also known as physical trauma, is damage Damage is any change in a thing, often a physical object, that degrades it away from its initial state. It can broadly be defined as "changes introduced into a system that adversely affect its ...

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 Examination may refer to: * Physical examination, a medical procedure * Questioning and more speci ...
" 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 causesCauses, or causality, is the relationship between one event and another. It may also refer to: * Causes (band), an indie band based in the Netherlands * Causes (company), an online company See also * Ca ...
. In most cases, a
medical examiner A medical examiner is an official trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. In the US, there are two dea ...
or
coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest An inquest is a judicial inquiry in common law jurisdiction Jurisdiction (from Latin ''Wikt:ius#Latin, juris'' 'law' + ''Wikt:dictio, dictio'' 'd ...

coroner
can determine cause of death and only a small portion of deaths require an autopsy.


Purposes

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 must be determined * Time since death * Establish identity of the deceased * 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 a ...
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 A person's next of kin (NOK) is that person's closest living blood relative. Some countries, such as the United States, have a legal definition of "next of kin". In other countries, such as the United Kingdom, "next of kin" may have no legal defi ...
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 used in and the from around 1500 BC to 300 BC. It is often roughly divided into the following periods: (), Dark Ages (), the period (), and the period (). Ancient Greek was the language of an ...
αὐτοψία ''autopsia'', "to see for oneself", derived from αὐτός (''autos'', "oneself") and ὄψις (''opsis'', "sight, view"). The word “autopsy” has been used since around the 17th century, it refers to the examination of inside the dead human body to discover diseases and cause of death.


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 spoken in the area around Rome, known as Latium. Through the power of the Roman Republic, it became the dominant la ...

Latin
for post, meaning "after" and mortem meaning "death". It was first recorded from 1850.


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 a ...
, mode of death, manner of death, 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 medical sign, signs. It is most often referred to as diagnosis with the medicine, medical context being implici ...
and treatment before death was appropriate. In most
Western countries The Western world, also known as the West, refers to various region In geography Geography (from Greek: , ''geographia'', literally "earth description") is a field of science devoted to the study of the lands, features, inhabita ...

Western countries
the number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologist and former ''
JAMA ''JAMA: The Journal of the American Medical Association'' is a peer-reviewed Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work ( peers). It functions as a form of self-regulat ...
''
editor Editing is the process of selecting and preparing written Writing is a medium of human communication Communication (from Latin ''communicare'', meaning "to share") is the act of developing Semantics, meaning among Subject (philosoph ...

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 given permission 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 A medical examiner is an official trained in pathology that investigates deaths that occur under unusual or suspicious circumstances, to perform post-mortem examinations, and in some jurisdictions to initiate inquests. In the US, there are two dea ...
or
Coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest An inquest is a judicial inquiry in common law jurisdiction Jurisdiction (from Latin ''Wikt:ius#Latin, juris'' 'law' + ''Wikt:dictio, dictio'' 'd ...

Coroner
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 of another without or valid , especially the unlawful killing of another human with . ("The killing of another person without justification or excuse, especially the crime of killing a person with malice aforethought or with ...

murder
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 projectile is any object thrown by the exertion of a force. It can also be defined as an object launched into the space and allowed to move free under the influence of gravity and air resistance. Although an ...

bullet
wounds and exit points, signs of
strangulation Strangling is compression of the neck that may lead to unconsciousness or death (1906) Death is the permanent, Irreversible process, irreversible cessation of all biological process, biological functions that sustain a living organis ...
, or traces of
poison In biology, poisons are Chemical substance, substances that can cause death, injury or harm to organs, Tissue (biology), tissues, Cell (biology), cells, and DNA usually by chemical reactions or other activity (chemistry), activity on the molecul ...

poison
. Some religions including
Judaism Judaism is an Abrahamic religions, Abrahamic, monotheism, 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 ...
and
Islam Islam (; ar, اَلْإِسْلَامُ, al-’Islām, "submission
o God Oh God may refer to: * An exclamation; similar to "oh no", "oh yes", "oh my", "aw goodness", "ah gosh", "ah gawd"; see interjection An interjection is a word or expression that occurs as an utterance on its own and expresses a spontaneous feeling ...
) is an Abrahamic religions, Abrahamic monotheistic religion teaching that Muhammad is a Muhammad in Islam, messenger of God.Peters, F. E. 2009. "Allāh." In , ed ...
usually discourage the performing of autopsies on their adherents. Organizations such as
ZAKA ZAKA ( he, זק"א, abbreviation An abbreviation (from Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium ...
in Israel and
Misaskim , image = , image_size = , alt = , caption = , logo = , logo_size = , logo_alt = , logo_caption = , map = , map_size ...
in the United States generally guide families how to ensure that an unnecessary autopsy is not made. Autopsies are used in clinical medicine to identify
medical error A medical error is a preventable Adverse effect (medicine), adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete Diagnosis (medical), diagnosis or therapy ...
, or a previously unnoticed condition that may endanger the living, such as
infectious disease An infection is the invasion of an organism's body Tissue (biology), tissues by Pathogen, disease-causing agents, their multiplication, and the reaction of host (biology), host tissues to the infectious agents and the toxins they produce. An inf ...
s or exposure to
hazardous material The pictogram for poisonous substances of the Globally Harmonized System of Classification and Labelling of Chemicals. Dangerous goods, abbreviated DG, are substances that when transported are a risk to health, safety, property or the envir ...
s. A study that focused on
myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow Hemodynamics American and British English spelling differences#ae and oe, or haemodynamics are the Fluid dynamics, dynamics of blood flow. The circulatory sy ...

myocardial infarction
(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 actually MIs. A
systematic review Systematic reviews are a type of review A review is an evaluation of a publication, service, or company such as a film, movie (a Film criticism, movie review), video game (video game review), musical composition (music criticism, music review ...
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 Randomized controlled trial, scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each i ...
suggested that approximately one-third of
death certificate A death certificate is either a legal document issued by a medical practitioner A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply doctor, is a profe ...
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 Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Mol ...

histologically
, ''i.e.'', by
biopsy A biopsy is a medical test A medical test is a medical procedureA medical procedure is a course of action intended to achieve a result in the delivery of healthcare. A medical procedure with the intention of determining, measuring, or diagno ...

biopsy
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 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 Logic (from Ancient Greek, Greek: grc, wikt:λογική, λογική, la ...
that remained unknown or unclear prior to the patient's death. * ''Anatomical'' or ''academic autopsies'' are performed by students of anatomy for study purpose 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 to and , mainly—on the criminal side—during , as governed by the legal standards of and . Forensic scientists collect, preserve, and analyze scientific during the c ...
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 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, evidence ...

evidence
, a medical examiner or
coroner A coroner is a government or judicial official who is empowered to conduct or order an inquest An inquest is a judicial inquiry in common law jurisdiction Jurisdiction (from Latin ''Wikt:ius#Latin, juris'' 'law' + ''Wikt:dictio, dictio'' 'd ...

coroner
will assign a
manner of death In many legal jurisdictions Jurisdiction (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Lat ...
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 causesCauses, or causality, is the relationship between one event and another. It may also refer to: * Causes (band), an indie band based in the Netherlands * Causes (company), an online company See also * Cau ...
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.


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 The departments of the Government of the United Kingdom are the principal units through which it exercises executive authority; a few of them are titled M ...
(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. In the United States, autopsy rates fell from 17% in 1980
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 The United States Department of Heal ...
(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 The United States The United States of America (USA), common ...
'', 37(12);191–94
to 14% in 1985 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 in 2006. It is being folded by some policemen and sailors. 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 The human body is the structure of a Human, h ...

body bag
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, evidence ...

evidence
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), is residue deposited on the hands and clothes of someone who discharges a firearm A firearm is any type of gu ...
or skin under the
fingernails A nail is a claw-like keratinous plate at the tip of the fingers and toes in most primates. Nails correspond to claws found in other animals. Fingernails and toenails are made of a tough protective protein called alpha-keratin which is a polymer a ...
, 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 Discipline is action ACTION is a bus operator in Canberra Canberra ( ) is the capital city of Australia. Founded following the Federation of Australia, federation of the colonies of Austral ...

Toxicology
, biochemical tests or
genetic testing Genetic testing, also known as DNA testing, is used to identify changes in DNA Deoxyribonucleic acid (; DNA) is a molecule File:Pentacene on Ni(111) STM.jpg, A scanning tunneling microscopy image of pentacene molecules, which consist o ...
/ molecular autopsy often supplement these and frequently assist the
pathologist Pathology is the study of the causesCauses, or causality, is the relationship between one event and another. It may also refer to: * Causes (band), an indie band based in the Netherlands * Causes (company), an online company See also * Ca ...
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 File:13-11-12-rechtsmedizin-berlin-charite-by-RalfR-20.jpg, upright=1.7, A close-up view of a dead body in the morgue in Charité. A morgue or mortuary (in a hospital or elsewhere) is a place used for the storage of human ...
, the
German German(s) may refer to: Common uses * of or related to Germany * Germans, Germanic ethnic group, citizens of Germany or people of German ancestry * For citizens of Germany, see also German nationality law * German language The German la ...

German
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 . The examiner then notes the kind of clothes 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 In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motion and behavior through Spacetime, ...

Ultraviolet
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 In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Ph ...

hair
, nails and the like are taken, and the body may also be . Once the external evidence is collected, the body is removed from the bag, undressed, and any
wound A wound is a type of which happens relatively quickly in which is torn, cut, or punctured (an ''open'' wound), or where blunt force causes a (a ''closed'' wound). In , it specifically refers to a sharp injury which damages the of the skin. ...

wound
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 ethnicity is a grouping of people A people is any plurality of person A person (plural people or persons) is a being that has certain capacities or attributes such as reason, morality, consciousness or self-consciousn ...
,
sex Sex is either of two divisions, typically male Male (♂) is the sex of an organism that produces the gamete known as sperm. A male gamete can fuse with a larger female gamete, or ovum, in the process of fertilization. A male cannot sexual r ...
, age, hair colour and length,
eye colour Eye color is a polygenicA polygene is a member of a group of non-epistatic gene In biology, a gene (from ''genos'' "...Wilhelm Johannsen coined the word gene to describe the Mendelian_inheritance#History, Mendelian units of heredity.. ...
and other distinguishing features (
birthmark A birthmark is a congenital A birth defect, also known as a congenital disorder, is a condition present at birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mam ...

birthmark
s, old
scar A scar is an area of fibrosis, 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 Organ (anatomy), organs, and biological tissue, tissues of the b ...
tissue Tissue may refer to: Biology * Tissue (biology), an ensemble of similar cells that together carry out a specific function * ''Triphosa haesitata'', a species of geometer moth found in North America * ''Triphosa dubitata'', a species of geometer mot ...
, ,
tattoo A tattoo is a form of body modification Body modification (or body alteration) is the deliberate altering of the human anatomy The human body is the structure of a human being. It is composed of many different types of cells that to ...

tattoo
s, etc.) is then made. A
voice recorder A dictation machine is a sound recording device most commonly used to record Speech communication, 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 ...
or a standard examination form is normally used to record this information. In some countries , ''e.g.'', Scotland, France, Germany, 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 deceased, hyperflexing the neck making the spine arch backward while stretching and pushing the
chest The thorax or chest is a part of the anatomy Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology concerned with the study of the structure of organism In biology, an organism (from Ancient Greek, Greek: ὀργανι ...

chest
upward to make it easier to incise. This gives the APT, or pathologist, maximum exposure to the . After this is done, the internal examination begins. The internal examination consists of inspecting the
internal organs An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized as parenchyma, the tissue peculiar to (or ...
of the body by
dissection Dissection (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the Rom ...

dissection
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 injur ...
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, human lung, lungs, and major blood vessels from in ...

sternum
(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 bone ( la, pubis) is the most forward-facing ( ventral and anterior) of the three main bone A bone is a Stiffness, rigid tissue (anatomy), tissue that constitutes part of the vertebrate skeleton in animals. Bones pr ...
(making a deviation to either side of the navel) and avoiding, where possible; transecting any scars that may be present.
Bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally ...

Bleeding
from the cuts is minimal, or non-existent, because the pull of
gravity Gravity (), or gravitation, is a by which all things with or —including s, s, , and even —are attracted to (or ''gravitate'' toward) one another. , gravity gives to s, and the causes the s of the oceans. The gravitational attracti ...

gravity
is producing the only
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

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 Asphyxia or asphyxiation is a condition of deficient supply of oxygen Oxygen is the chemical element with the chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen Group ...

drowning
. At this point, shears are used to open the chest cavity. The prosector 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 Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as ...

in situ
and that the heart, in particular the 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 An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized as parenchyma ...

lung
s and the heart are exposed. The sternum is set aside and will be eventually replaced at the end of the autopsy. At this stage the
organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized as parenchyma Parenchyma () is the bulk of functional ...
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 class Upper class in modern societies is the social class composed of people who hold the highest social status, usually are the ...
'' 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 Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible fluid In physics, a fluid is a substance th ...

inferior vena cava
or the pulmonary veins. Before removing the heart, the
pulmonary artery A pulmonary artery is an artery An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are t ...

pulmonary artery
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 An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system The circulatory system, also called the cardiovascular system or the vas ...

aorta
and pulmonary artery, and the
superior vena cava The superior vena cava (SVC) is the anatomical terms of location#Superior and inferior, superior of the two venae cavae, the great vein, venous trunks that return deoxygenated blood from the circulatory system, systemic circulation to the atrium ...
. 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 respiratory system that conducts air into the lung The lungs are the primary organs of the respiratory system in human Humans (''Homo sapiens'') are the most populous and widespread species of ...

bronchus
, 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 The circulatory system, also called the cardiovascular system or the vascular system, is an organ system that permits blood to circulate and transport nutrients (such as amino ...
s are cut open and inspected at this stage. Next the
stomach The stomach is a muscular, in the of humans and many other animals, including several s. The stomach has a dilated structure and functions as a vital organ. In the digestive system the stomach is involved in the second phase of digestion, ...

stomach
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 Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tis ...

brain
, 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 A ceremony (, ) is a unified ritual A ritual is a sequence of activities involving gestures, words, actions, or objects, performed in a sequestered place and according to a set sequence. Rituals may be prescribed by the ...

funeral
. The
scalp The scalp is the anatomical area bordered by the human at the front, and by the at the sides and back. Structure The scalp is usually described as having five layers, which can conveniently be remembered as a : * S: The on the head from w ...
is pulled away from the
skull The skull is a bone A bone is a rigid tissue Tissue may refer to: Biology * Tissue (biology), an ensemble of similar cells that together carry out a specific function * ''Triphosa haesitata'', a species of geometer moth found in North A ...

skull
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 Nervous tissue, also called neural tissue, is the main tissue component of the nervous system In Biology, biology, the nervous system is a Complex system, high ...

spinal cord
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 ( , also ) (systematic nameA systematic name is a name given in a systematic way to one unique group, organism, object or chemical substance A chemical substance is a form of matter In classical physics and general chemist ...
gas in buffered
water Water (chemical formula H2O) is an Inorganic compound, inorganic, transparent, tasteless, odorless, and Color of water, nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known li ...

water
) 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 250px, The picture displays the Mediastinum on sagittal plane, Thoracic diaphragm">sagittal_plane.html" ;"title="Mediastinum on sagittal plane">Mediastinum on sagittal plane, Thoracic diaphragm at the bottom, the heart (Cor), behind Sternum and ...
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 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 Burial, also known as interment or inhumation, is a method of final disposition whereby a ...

shroud
, 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 A funeral home, funeral parlor or mortuary, is a business that provides burial Burial, also known as interment or inhumation, is a method of final disposition wherein a dead person or non-human animal is placed into the ground, sometimes wi ...
after
embalming Embalming is the art and science of preserving human remains by treating them (in its modern form with chemicals) to forestall decomposition Decomposition is the process by which dead organic substance , CH4; is among the simplest organic com ...
.


History

Around 3000 BCE,
ancient Egypt Ancient Egypt was a civilization  A civilization (or civilisation) is a that is characterized by , , a form of government, and systems of communication (such as ). Civilizations are intimately associated with additional char ...

ancient Egypt
ians 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 Humans (''Homo sapiens'') are the most abundant and widespread species In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, B ...

mummification
. 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 or the world to come) is an existence in which the essential part of an individual's identity Identity may refer to: Social sciences * Identity (social science), personhood or group ...

afterlife
(as with the Egyptians, who removed the organs through tiny slits in the body). Notable Greek autopsists were
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized Linguistic anglicisation (or anglicization, occasionally anglification, anglifying, or Englishing) is the practice of modi ...
(BCE 129– c. 200/ 216),
Erasistratus Erasistratus (; grc-gre, Ἐρασίστρατος; c. 304 – c. 250 BC) was a Greek anatomist and royal physician under Seleucus I Nicator Seleucus I Nicator (; ; grc-gre, Σέλευκος Νικάτωρ, Séleukos Nikátōr, Seleucus the Vi ...
and Herophilus of Chalcedon, who lived in 3rd century BCE
Alexandria Alexandria ( or ; ar, الإسكندرية ; arz, اسكندرية ; Coptic language, Coptic: Rakodī; el, Αλεξάνδρεια ''Alexandria'') is the List of cities and towns in Egypt, third-largest city in Egypt after Cairo and Giza, ...

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 Roman or Romans most often refers to: *, the capital city of Italy *, Roman civilization from 8th century BC to 5th century AD *, the people of ancient Rome *', shortened ...

Julius Caesar
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 In historiography, ancient Rome is Roman people, Roman civilization from the founding of the Italian city of Rome in the 8th century BC to the collapse of the Western Roman Empire in the 5th century AD, encompassing the Roman Kingdom (753 BC ...
legal practice had established clear parameters for autopsies.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 Ala-al-Din abu al-Hasan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi (Arabic Arabic (, ' or , ' or ) is a Semitic language that first emerged in the 1st to 4th centuries CE.Semitic languages: an international handbook / edited by Stefan Weninger ...

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 (Greek ''anatomē'', 'dissection') is the branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, mo ...

anatomist
s of the
Renaissance The Renaissance ( , ) , from , with the same meanings. is a period Period may refer to: Common uses * Era, a length or span of time * Full stop (or period), a punctuation mark Arts, entertainment, and media * Period (music), a concept in ...

Renaissance
.
Giovanni Battista Morgagni Giovanni Battista Morgagni (25 February 1682 – 6 December 1771) was an Italian anatomist Anatomy (Greek ''anatomē'', 'dissection') is the branch of biology Biology is the natural science that studies life and living organisms, includi ...

Giovanni Battista Morgagni
(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 , , biochemical, immunologic and examination of and . Over the last century, ...

anatomical pathology
, 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 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. Medical career Carl von Rokitansk ...
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 Germans, German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as th ...

Rudolf Virchow
, 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 a metonym Metonymy () is a figure of speech in which a thing or concept is referred to by the name of something closely associated with that thing or concept. Etymology The words ''metonymy'' ...

Scotland Yard
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)

Post-mortem examination, or necropsy, is far more common in
veterinary medicine Veterinary medicine is the branch of medicine Medicine is the science Science (from the Latin word ''scientia'', meaning "knowledge") is a systematic enterprise that Scientific method, builds and Taxonomy (general), organizes knowledge i ...
than in
human medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment or Palliative care , palliation of their injury or dise ...

human medicine
. For many species that exhibit few external symptoms (sheep), or that are not suited to detailed 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 professional who practices veterinary medicine Veterinary medicine is the branch of medicine Medicine is the Art (skill), art, science, and Praxis (pro ...
s to come to a diagnosis. A necropsy is mostly used like an autopsy to determine cause of death. The entire body is examined at the gross visual level, and samples are collected for additional analyses.


See also

*
Body identification Body identification is a subfield of forensic science that uses a variety of scientific and non-scientific methods to identify a body. Forensic purposes are served by rigorous scientific forensic identification techniques, but these are generally ...
* Forensic anthropology * Forensic facial reconstruction * Forensic identification * Murder book * Virtopsy * Vivisection


References


External links

*
Autopsy
nbsp;– a detailed description by a pathologist complete with cartoon figures.
The Virtual Autopsy
nbsp;– a site from the University of Leicester 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