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Autopsy

Autopsy

Overview
An autopsy—also known as a post-mortem examination, necropsy (particularly as to non-human bodies), autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

 and to evaluate any disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 or injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

 that may be present. It is usually performed by a specialized medical doctor called a pathologist
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

.

Autopsies are performed for either legal or medical purposes.
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Encyclopedia
An autopsy—also known as a post-mortem examination, necropsy (particularly as to non-human bodies), autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

 and to evaluate any disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 or injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

 that may be present. It is usually performed by a specialized medical doctor called a pathologist
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

.

Autopsies are performed for either legal or medical purposes. For example, a forensic autopsy is carried out when the cause of death 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
Next of kin
Next of kin is a term with many interpretations depending on the jurisdiction being referred to. In some jurisdictions, such as the United States, it is used to describe a person's closest living blood relative or relatives...

 may be required for internal autopsy in some cases. Once an internal autopsy is complete the body is reconstituted by sewing it back together.

History



The term "autopsy" derives from the Ancient Greek
Ancient Greek
Ancient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...

 autopsia, "to see for oneself", derived from αυτος (autos, "oneself") and όψις (opsis, "eye"). Around 3000 e ancient Egypt
Ancient Egypt
Ancient Egypt was an ancient civilization of Northeastern Africa, concentrated along the lower reaches of the Nile River in what is now the modern country of Egypt. Egyptian civilization coalesced around 3150 BC with the political unification of Upper and Lower Egypt under the first pharaoh...

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
Mummy
A mummy is a body, human or animal, whose skin and organs have been preserved by either intentional or incidental exposure to chemicals, extreme coldness , very low humidity, or lack of air when bodies are submerged in bogs, so that the recovered body will not decay further if kept in cool and dry...

.

Autopsies that opened the body to determine the cause of death are attested at least in the early third millennium BC, 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
Afterlife
The afterlife is the belief that a part of, or essence of, or soul of an individual, which carries with it and confers personal identity, survives the death of the body of this world and this lifetime, by natural or supernatural means, in contrast to the belief in eternal...

 (as with the Egyptians, who removed the organs through tiny slits in the body). Notable Greek autopsists were Erasistratus
Erasistratus
Erasistratus 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 they carried out anatomical research...

 and
Herophilus of Chalcedon, who lived in 3rd century BC Alexandria
Alexandria
Alexandria is the second-largest city of Egypt, with a population of 4.1 million, extending about along the coast of the Mediterranean Sea in the north central part of the country; it is also the largest city lying directly on the Mediterranean coast. It is Egypt's largest seaport, serving...

, but in general, autopsies were rare in ancient Greece. In 44 BC, Julius Caesar
Julius Caesar
Gaius Julius Caesar was a Roman general and statesman and a distinguished writer of Latin prose. He played a critical role in the gradual transformation of the Roman Republic into the Roman Empire....

 was the subject of an official autopsy after his murder
Assassination of Julius Caesar
The assassination of Julius Caesar was the result of a conspiracy by approximately forty Roman senators who called themselves Liberators. Led by Gaius Cassius Longinus and Marcus Junius Brutus, they stabbed Julius Caesar to death in the Theatre of Pompey on the Ides of March 44 BC...

 by rival senators, the physician's report noting that the second stab wound Caesar received was the fatal one. By around 150 BC, ancient Roman legal practice had established clear parameters for autopsies.

The dissection of human remains for medical reasons continued to be practiced irregularly after the Romans, for instance by the Arab physicians Avenzoar
Ibn Zuhr
Abū Merwān ’Abdal-Malik ibn Zuhr was a Muslim physician, surgeon and teacher in Al-Andalus.He was born at Seville...

 and Ibn al-Nafis, but the modern autopsy process derives from the anatomists of the Renaissance
Renaissance
The Renaissance was a cultural movement that spanned roughly the 14th to the 17th century, beginning in Italy in the Late Middle Ages and later spreading to the rest of Europe. The term is also used more loosely to refer to the historical era, but since the changes of the Renaissance were not...

. Giovanni Morgagni (1682–1771), celebrated as the father of anatomical pathology
Anatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...

, 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).

The great 19th-century medical researcher Rudolf Virchow
Rudolf Virchow
Rudolph Carl Virchow was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health...

, in response to a lack of standardization of autopsy procedures, established and published specific autopsy protocols (one such protocol still bears his name).

Purpose


The principal aim of an autopsy is to determine the cause of death
Cause of Death
Cause of Death is a 1990 album by American death metal band Obituary. Cause of Death is considered a classic album in the history of death metal. The artwork was done by artist Michael Whelan...

, the state of health of the person before he or she died, and whether any medical diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

 and treatment before death was appropriate.

In most Western countries the number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologist and former JAMA
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...

editor
Editing
Editing is the process of selecting and preparing written, visual, audible, and film media used to convey information through the processes of correction, condensation, organization, and other modifications performed with an intention of producing a correct, consistent, accurate, and complete...

 George 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
Unnatural death
Unnatural death is a category used by coroners and vital statistics specialists for classifying all human deaths not properly describable as death by natural causes...

. These examinations are performed under a legal authority (Medical Examiner or Coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...

 or Procurator Fiscal) and do not require the consent of relatives of the deceased. The most extreme example is the examination of murder
Murder
Murder is the unlawful killing, with malice aforethought, of another human being, and generally this state of mind distinguishes murder from other forms of unlawful homicide...

 victims, especially when medical examiners are looking for signs of death or the murder method, such as bullet
Bullet
A bullet is a projectile propelled by a firearm, sling, or air gun. Bullets do not normally contain explosives, but damage the intended target by impact and penetration...

 wounds and exit points, signs of strangulation, or traces of poison
Poison
In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....

.
Many religions such as Judaism
Judaism
Judaism ) is the "religion, philosophy, and way of life" of the Jewish people...

 and Islam
Islam
Islam . The most common are and .   : Arabic pronunciation varies regionally. The first vowel ranges from ~~. The second vowel ranges from ~~~...

 usually discourage the performing of autopsies on their adherents. Organizations such as Zaka
ZAKA
ZAKA , is a series of voluntary community emergency response teams in Israel, each operating in a police district . These organizations are officially recognized by the government...

 in Israel
Israel
The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...

 and Misaskim in the USA generally guide families how to ensure that an unnecessary autopsy is not made.

In medicine


Autopsies are important in clinical medicine as they can identify medical error
Medical error
A medical error may be defined as a preventable adverse effect of care, 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, infection, or other ailment.-Definitions:As a general...

 and assist continuous improvement.

A study that focused on myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

 (heart attack) as a cause of death found significant errors of omission and commission, i.e. a sizable number cases ascribed to myocardial infarctions (MIs) were not MIs and a significant number of non-MIs were actually MIs.

A systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

 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
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...

 suggested that approximately one-third of death certificates 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
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

, i.e. by biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 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 "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others".

Focusing 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".

In veterinary medicine



Post-mortem examination is far more common in veterinary medicine
Veterinary medicine
Veterinary Medicine is the branch of science that deals with the prevention, diagnosis and treatment of disease, disorder and injury in non-human animals...

 than in 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 veterinarians to come to a diagnosis.

Types


There are three main types of autopsies:
  • Medico-Legal Autopsy 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 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.

Forensic autopsy



A forensic autopsy is used to determine the cause of death. Forensic science involves the application of the sciences to answer questions of interest to the legal system. In United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 law, deaths are placed in one of five manners:
  • Natural
    Death by natural causes
    A death by natural causes, as recorded by coroners and on death certificates and associated documents, is one that is primarily attributed to natural agents: usually an illness or an internal malfunction of the body. For example, a person dying from complications from influenza or a heart attack ...

  • Accident
  • Homicide
    Homicide
    Homicide refers to the act of a human killing another human. Murder, for example, is a type of homicide. It can also describe a person who has committed such an act, though this use is rare in modern English...

  • Suicide
    Suicide
    Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

  • Undetermined


In some jurisdictions, the Undetermined category may include deaths in absentia
Death in absentia
Death in absentia is a legal declaration that a person is deceased in the absence of remains attributable to that person...

, such as deaths at sea and missing persons declared dead in a court of law; in others, such deaths are classified under "Other". But, medical examiners also 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, the quantity of those chemicals. 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.

Most states require the State medical examiner to complete an autopsy report and many mandate that the autopsy be videotaped.

Following an in-depth examination of all the evidence
Evidence
Evidence in its broadest sense includes everything that is used to determine or demonstrate the truth of an assertion. Giving or procuring evidence is the process of using those things that are either presumed to be true, or were themselves proven via evidence, to demonstrate an assertion's truth...

, a medical examiner or coroner
Coroner
A coroner is a government official who* Investigates human deaths* Determines cause of death* Issues death certificates* Maintains death records* Responds to deaths in mass disasters* Identifies unknown dead* Other functions depending on local laws...

 will assign a manner of death as one of the five listed above, and 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
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

 processes and determine what factors contributed to a patient's death. 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 only be carried out 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.

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%) resulted in post-mortem examinations and there were 28,300 inquests, 570 with a jury.

In the United States, autopsy rates fell from 17% in 1980 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 or hospital in a body bag
Body bag
A body bag is a non-porous bag designed to contain a human body, used for the storage and transportation of corpses. Body bags can also be used for the storage of corpses within morgues. Before purpose-made body bags were available, cotton mattress covers were sometimes used, particularly in...

 or evidence sheet. A new body bag is used for each body to ensure that only evidence
Evidence
Evidence in its broadest sense includes everything that is used to determine or demonstrate the truth of an assertion. Giving or procuring evidence is the process of using those things that are either presumed to be true, or were themselves proven via evidence, to demonstrate an assertion's truth...

 from that body is contained within the bag. Evidence sheets are an alternate way to transport the body. An evidence sheet is a sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...

 sheet that the body is covered in when it is moved. If it is believed there may be any significant residue on the hands, for instance gunpowder
Gunpowder
Gunpowder, also known since in the late 19th century as black powder, was the first chemical explosive and the only one known until the mid 1800s. It is a mixture of sulfur, charcoal, and potassium nitrate - with the sulfur and charcoal acting as fuels, while the saltpeter works as an oxidizer...

, 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
Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...

, biochemical tests
Medical test
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. For example:* to diagnose diseases, and preferably sub-classify it regarding, for example, severity and treatability...

 and/or genetic testing
Genetic testing
Genetic testing is among the newest and most sophisticated of techniques used to test for genetic disorders which involves direct examination of the DNA molecule itself. Other genetic tests include biochemical tests for such gene products as enzymes and other proteins and for microscopic...

 often supplement these and frequently assist the pathologist in assigning the cause or causes of death.

External examination


At many institutions the person responsible for handling, cleaning, and moving the body is often called a diener
Diener
The word Diener is German for servant. In English, it is generally used to describe the person, in the morgue, responsible for handling, moving, and cleaning the corpse...

, the German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....

 word for servant. In the UK this role is performed by an Anatomical Pathology Technologist who will also assist the pathologist in eviscerating the deceased and reconstruction after the autopsy. After the body is received, it is first photographed
Photography
Photography is the art, science and practice of creating durable images by recording light or other electromagnetic radiation, either electronically by means of an image sensor or chemically by means of a light-sensitive material such as photographic film...

. 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
Ultraviolet light is electromagnetic radiation with a wavelength shorter than that of visible light, but longer than X-rays, in the range 10 nm to 400 nm, and energies from 3 eV to 124 eV...

 light may also be used to search body surfaces for any evidence not easily visible to the naked eye. Samples of hair
Hair
Hair is a filamentous biomaterial, that grows from follicles found in the dermis. Found exclusively in mammals, hair is one of the defining characteristics of the mammalian class....

, nails
Nail (anatomy)
A nail is a horn-like envelope covering the dorsal aspect of the terminal phalanges of fingers and toes in humans, most non-human primates, and a few other mammals. Nails are similar to claws, which are found on numerous other animals....

 and the like are taken, and the body may also be radiographically imaged
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...

.

Once the external evidence is collected, the body is removed from the bag, undressed, and any wounds present are examined. The body is then cleaned, weighed, and measured in preparation for the internal examination. The scale
Weighing scale
A weighing scale is a measuring instrument for determining the weight or mass of an object. A spring scale measures weight by the distance a spring deflects under its load...

 used to weigh the body is often designed to accommodate the cart
Cart
A cart is a vehicle designed for transport, using two wheels and normally pulled by one or a pair of draught animals. A handcart is pulled or pushed by one or more people...

 that the body is transported on; its weight is then deducted from the total weight shown to give the weight of the body.

If not already within an autopsy room, the body is transported to one and placed on a table. A general description of the body as regards ethnicity, sex
Sex
In biology, sex is a process of combining and mixing genetic traits, often resulting in the specialization of organisms into a male or female variety . Sexual reproduction involves combining specialized cells to form offspring that inherit traits from both parents...

, age, hair color
Hair color
Hair color is the pigmentation of hair follicles due to two types of melanin: eumelanin and pheomelanin. Generally, if more melanin is present, the color of the hair is darker; if less melanin is present, the hair is lighter...

 and length, eye color
Eye color
Eye color is a polygenic phenotypic character and is determined by two distinct factors: the pigmentation of the eye's iris and the frequency-dependence of the scattering of light by the turbid medium in the stroma of the iris....

 and other distinguishing features (birthmark
Birthmark
A birthmark is a 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, melanocytes, smooth muscle, fat, fibroblasts, or...

s, old scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...

 tissue
Biological tissue
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

, moles
Mole (skin marking)
A melanocytic nevus is a type of lesion that contains nevus cells .Some sources equate the term mole with "melanocytic nevus". Other sources reserve the term "mole" for other purposes....

, etc.) is then made. A handheld voice recorder or a standard examination form is normally used to record this information.
In some countries e.g. France, Germany, and Canada, an autopsy may comprise an external examination only. This concept is sometimes termed a "view and grant". The principles behind this being 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 "body block" is placed under the back of the body, causing the arms and neck to fall backward whilst stretching and pushing the chest
Chest
The chest is a part of the anatomy of humans and various other animals. It is sometimes referred to as the thorax or the bosom.-Chest anatomy - Humans and other hominids:...

 upward to make it easier to cut open. This gives the prosector, a pathologist or assistant, maximum exposure to the trunk
Torso
Trunk or torso is an anatomical term for the central part of the many animal bodies from which extend the neck and limbs. The trunk includes the thorax and abdomen.-Major organs:...

. After this is done, the internal examination begins. The internal examination consists of inspecting the internal organs of the body for evidence of trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

 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. This is the approach most often used.

  • a T-shaped incision made from the tips of both shoulder, in a horizontal line across the region of the collar bones to meet at the sternum (breastbone) in the middle.

  • a single vertical cut is made from the middle of the neck (in the region of the 'adam's apple' on a male body)


In all of the above cases the cut then extends all the way down to the pubic bone (making a deviation to the left side of the navel).

Bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...

 from the cuts is minimal, or non-existent, because the pull of gravity is producing the only blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...

 at this point, related directly to the complete lack of cardiac functionality. However, in certain cases there is anecdotal evidence to prove that bleeding can be quite profuse, especially in cases of drowning.

At this point, shears are used to open the chest cavity. It is also possible to utilise a simple scalpel blade. The prosector uses the tool to saw through the ribs on the lateral sides of the chest cavity to allow the sternum and attached ribs to be lifted as one chest plate; this is done so that the heart and lungs can be seen in situ
In situ
In situ is a Latin phrase which translated literally as 'In position'. It is used in many different contexts.-Aerospace:In the aerospace industry, equipment on board aircraft must be tested in situ, or in place, to confirm everything functions properly as a system. Individually, each piece may...

 and that the heart, in particular the pericardial sac is not damaged or disturbed from opening. A scalpel
Scalpel
A scalpel, or lancet, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, and various arts and crafts . Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have attached, resharpenable blades or, more commonly, non-attached, replaceable...

 is used to remove any soft tissue that is still attached to the posterior side of the chest plate. Now the lungs and the heart are exposed. The chest plate is set aside and will be eventually replaced at the end of the autopsy.

At this stage the organs
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

 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 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 or the pulmonary veins. Before removing the heart, the 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 and pulmonary artery, and the superior vena cava. 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, 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.

Some pathologists, however, prefer to remove the organs all in one "block". Then a series of cuts, along the vertebral column, are made so that the organs can be detached and pulled 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
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

s are cut open and inspected at this stage. Next the stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

 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
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...

, 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
Funeral
A funeral is a ceremony for celebrating, sanctifying, or remembering the life of a person who has died. Funerary customs comprise the complex of beliefs and practices used by a culture to remember the dead, from interment itself, to various monuments, prayers, and rituals undertaken in their honor...

. The scalp
Scalp
The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and posteriorly.-Layers:It is usually described as having five layers, which can conveniently be remembered as a mnemonic:...

 is pulled away from the skull
Human skull
The human skull is a bony structure, skeleton, that is in the human head and which supports the structures of the face and forms a cavity for the brain.In humans, the adult skull is normally made up of 22 bones...

 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 what is called a Stryker saw, named for its manufacture, 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
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

 are severed, and the brain is then 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
Formaldehyde is an organic compound with the formula CH2O. It is the simplest aldehyde, hence its systematic name methanal.Formaldehyde is a colorless gas with a characteristic pungent odor. It is an important precursor to many other chemical compounds, especially for polymers...

 gas in buffered water
Water
Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in 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 chest cavity 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
Human Tissue Act 2004
The Human Tissue Act 2004 is an Act of the Parliament of the United Kingdom which consolidated previous legislation and created the Human Tissue Authority to "regulate the removal, storage, use and disposal of human bodies, organs and tissue."...

 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 an appropriate material, the organs are then placed into a plastic bag to prevent leakage and 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
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, winding-cloths or winding-sheets, such as the famous Shroud of Turin or Tachrichim that Jews are dressed in for burial...

 and it is common for relatives of the deceased to not be able to tell the procedure has been done when the deceased is viewed in a funeral parlor
Funeral home
A funeral home, funeral parlor or mortuary, is a business that provides burial and funeral services for the deceased and their families. These services may include aprepared wake and funeral, and the provision of a chapel for the funeral....

 after embalming
Embalming
Embalming, in most modern cultures, is the art and science of temporarily preserving human remains to forestall decomposition and to make them suitable for public display at a funeral. The three goals of embalming are thus sanitization, presentation and preservation of a corpse to achieve this...

.

External links



  • Autopsy - a detailed description by a pathologist complete with cartoon figures.
  • The Virtual Autopsy - a site from the University of Leicester
    University of Leicester
    The University of Leicester is a research-led university based in Leicester, England. The main campus is a mile south of the city centre, adjacent to Victoria Park and Wyggeston and Queen Elizabeth I College....

    where one examines the patient, looks at the (medical) history and gets a try at the diagnosis.
  • How Stuff Works - Autopsies
  • Autopsy of a Murder - 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.