AUTOPSY

The autopsy is a complete evaluation of

an individual‘s death and the circumstances
surrounding that death.

It includes a full examination of the body, and

the autopsy has been called "the ultimate
physical examination."
This examination includes:
• A complete evaluation of the medical history and the
events leading to death
• The collection and documentation of trace evidence on
and around the body
• The photographing and cataloging of injuries
• A detailed external examination from head to toe
• An internal examination, including the dissection of
organs and tissues
• A microscopic examination of organs and tissues
• Laboratory and toxicological examinations of body
tissues and fluids
• A written report detailing the pertinent findings,
negative findings, and conclusions, including the cause
and manner of death
TYPES OF AUTOPSIES:

- HOSPITAL AND

- MEDICAL - LEGAL
 HOSPITAL AUTOPSY

• Hospital autopsies are performed on inpatients of

hospitals, upon the requests of families.

• Physicians cannot order these autopsies without permits

signed by the next of kin.

• Autopsy permits often grant physicians permission to

study only those body parts that might help answer a
specific medical question or determine the mechanism
of death.

• Most hospital autopsies are done in teaching hospitals,

where the examinations are often quite detailed and are
performed for institutional research and the education of
medical residents.
 MEDICOLEGAL AUTOPSY
• In the broadest sense, a medico legal autopsy
generates an evidentiary document that forms a
basis for opinions rendered in a criminal trial,
wrongful death civil suit, medical malpractice, civil
suit, or administrative hearing.
• In most states a board-certified pathologist must
perform these autopsies.
• The aim of medical-legal autopsies is to obtain the
cause and manner of death
• Because medical-legal autopsies are
comprehensive exams. , include a study of the
CNS, they exceed hospital autopsies in scope.
CASE
• The different aims of hospital and medical-
legal autopsies are illustrated in the
following example.
– A 92-year-old woman with significant cardiac
disease falls down her steps and suffers a hip
fracture. While convalescing in the hospital,
she dies suddenly, 3 days after her accident
and admission.
A hospital autopsy would focus on answering
these medical questions:
• Did she suffer a myocardial infarction or a
pulmonary embolus (mechanism of death) ?

• If her hospital care had been different (e.g., if

anticoagulants had been given more aggressively),
could her death have been prevented?

• If she was given a new anticoagulant under a

research protocol, was this new drug effective ?
(This involves evaluating new drug protocols.)
The medical-legal investigation and autopsy
would focus on:

• The injury (cause of death).

• The hip fracture.

• How the injury occurred (manner of death): Did

she trip (accident), or did she have a myocardial
infarction before falling down the steps (natural)?
If she were pushed down the steps, the manner
of death would be homicide.
• If it was shown that this woman slipped
and fell down the steps, sustained a hip
fracture, and developed blood clots that
embolized to the lung after 3 days of
hospitalization, the death certificate would
read as follows —
– Cause of Death: pulmonary embolus due to
fracture of the hip;
– Manner of Death: accident.
 WHAT IS THE PURPOSE OF THE AUTOPSY?
• The fundamental function of the jurisdictional authority
investigating the death is also the basic purpose of the
autopsy: to establish the cause and manner of death.

• An autopsy is done mainly to complete a death certificate

and to register the vital statistics.

• The cause of death is the disease or injury that sets into

motion the chain of events leading to the death.

• The manner of death is a classification system for deaths

(natural, homicide, suicide, accident, and undetermined).
CASES THAT USUALLY REQUIRE AN AUTOPSY

• Homicides • Deaths of persons in custody of

• Suicides the State or other agency
• Accidents that occur on the • Accidents that occur without a
job witness
• Drivers in single-car • Accidents in which natural
accidents (could be a suicide) disease is a factor
• Sudden, unexpected deaths • Sudden, unexpected deaths of
of children
apparently healthy persons
• Deaths of pilots in aircraft
crashes (usually younger than 15 years)
• Natural diseases that might • Deaths in which the manner of
impact the community (e.g., death is not readily apparent
meningitis) • Deaths in which litigation is
• Fire deaths reasonably expected
• Accidents caused by the • Hospital deaths in which the
negligence or reckless quality of care is an issue
behavior of others
• All suspicious deaths
• The essence of the autopsy involves working
backward from one undeniable fact: a death has
occurred.
• Forensic pathologists look back in time to the point
when a disease or injury set into motion a chain of
events that were ultimately, and tragically, fatal.
• Forensic pathologists do not work in a vacuum,
however.
• While collecting information from various sources,
they interact with crime scene investigators and
law enforcement, review statements of witnesses,
examine the scene, and follow leads that the
scene provides.
• Analysis of this information sets the foundation for
the autopsy procedure and the final opinions of the
pathologist including the cause and manner of
death.
A comprehensive medical-legal autopsy
has three phases:

• Premorgue analysis
• Morgue analysis, or the autopsy per se
• Postmorgue analysis
• Premorgue analysis involves
assessing the facts of the death scene
(including environmental conditions),
withness statements, and the known
circumstances surrounding the death.

• Morgue analysis includes examination

of the body and the associated trace
evidence.
• Postmorgue analysis occurs over the
ensuing weeks to months and includes
analysis of microscopic slides of tissues
sampled during the autopsy procedure.
Toxicologic, microbiologic culture,
chemical, and other laboratory results are
also reviewed in this phase and special
forensic tests such as DNA identification
are performed.
Through the investigation and the subsequent
autopsy, the goal is always to answer the
numerous other questions that arise, including
the following:

• What was the date and time of death?

• What was the location of death?
• When and where was the deceased last seen alive?
• When and where was the deceased injured?
• What was the location and position of the body at death?
• How was the deceased injured and killed?
• What killed the deceased?
• Who killed the deceased?
• At times, the questions are only partially answered
REQUEST LETTER
BODY TAG
AUTOPSY REPORT
UNIVERSAL
PRECAUTION
Proper
protection of the
pathologist and
all assistants
from infectious
diseases is
essential.
IDENTIFICATION OF THE BODY
• Direct Identification by Family Members
• Personal Features
• Objects in the Body
• Fingerprints
• Dental Identification
• Deoxyribonucleic Acid
Colour Atlas of Autopsy, Wagner SA, 2007
 External Examination:
CLOTHING AND VALUABLES

• The clothing of the deceased is also evidence and may

contain additional trace evidence.
• To protect all evidence from contamination or loss, and
for practical reasons, the clothing is not removed in the
uncontrolled environment of the scene. An exception to
this rule is made in rare cases when moisture could alter
a substance on the clothing; for example, condensation
may form in the body bag when the body is placed in a
cooler.
• The clothing can be quite helpful in a death investigation,
since it is intimately associated with the body.
 External Examination:
CLOTHING AND VALUABLES

• For example, the range of fire in a gunshot wound is often

determined from a shirt the victim was wearing when shot.
• Unburned particles from the weapon will tattoo the bare
skin. If clothing intervenes between the weapon and the
skin, the majority of the unburned particles form a pattern
on the clothing, with very few particles going through the
clothing to the skin.
• This clothing can be analyzed by a forensic scientist, who
can estimate the range of fire of the weapon and the width
and configuration of the pattern correlated to the distance
of the shirt from the weapon.
TRACE EVIDENCE
• Common objects collected at the scene include
hair, small fibers, or paint flakes that could easily
be lost.
• Since scene lighting is often poor and the setting
inappropriate, trace evidence is best taken at the
autopsy suite.
• One method of preparing the body for transport
is to drape a clean sheet over the body and then
place it in a clean body bag.
FOUR SIGNS OF DEATH

• Rigor Mortis
• Algor Mortis
• Livor Mortis
• Decomposition
• The external examination of the deceased is a
focused head-to-toe examination of the body.
• This exam is similar to a physical exam one
might get from a physician.
• All parts of the body are examined, from the hair
on top of the head to the toenails.
• Most pathologists use a systematic examination
process to make a detailed survey of all systems,
being careful not to overlook any area of the
body
When examining an organ, a tissue, or a
region of the body, the pathologist looks
for:

• Traumatic injuries, both old and new

• Natural disease processes, such as tumors or
atherosclerosis
• Congenital defects or deformities
• Toxicologic, thermal (burns), and chemical
injuries
• Trace evidence
• Infectious disease processes
• Anything abnormal, unusual, or unexpected
When examining an organ, a tissue, or a
region of the body, the pathologist looks for:

• Documenting Traumatic Injuries:

Diagrams And Descriptions
• Radiology And Imaging
• Photography And Video As
Documentation Tools
 Specific Injuries
• Blunt Force Injuries
– Laceration
• A laceration is the tearing or splitting of skin
by a blunt force object carrying force.
Lacerations show at least three
characteristics:
–Undermined margins
–Tissue bridging
–Abraded margins
Laceration of the scalp with marginal abrasion. Blunt force striking the
skin with sufficient force tears the skin, resultingintissue bridging,
undermined margins, and a marginal abrasion.
Abrasion
An abrasion is the denuding of skin or tissue caused by a
blunt or rough object. An abrasion is commonly known
as a "scrape." There are four major types of abrasions:

– A usual abrasion or scrape is due to an object

contacting skin or tissue parallel to its surface
– A sliding abrasion is more linear than a usual
abrasion and is caused when movement or sliding is
involved. The abrasion lines show the direction of
sliding
– A pressure abrasion is due to a heavy or forcefully
projected blunt object contacting or compressing skin
or soft tissue in a perpendicular fashion
– A pattern abrasion is the combination of usual and
pressure-type abrasions, usually forming a pattern
reminiscent of the blunt object that
forcefully contacted the skin
Contusion

• A contusion,
commonly known as
a bruise, is a hemor-
rhage into skin or
tissues caused by a
blunt force tearing
blood vessels.
Avulsion

• An avulsion is the tearing away of skin

and/or tissue, usually as a result of blunt
force. An avulsion can have characteristics
of contusions, lacerations, and even sharp
force injuries if the avulsing object has a
sharp edge.
Sharp Force Injuries
• Stab Wounds:
– Stab wounds are generally deeper than they are long
• Incised Wounds:
– Incised wounds are generally longer than they are
deep.
• Defense Wounds:
– Defense wounds (cuts) are special types of incised
wounds received when victims attempt to defend
themselves from knife attacks
• Puncture Wounds:
– Puncture wounds are special sharp force wounds that
are much deeper than they are wide.
• Chopping Wounds:
– Chopping wounds are caused by objects with
a sharp edge and substantial weight, such as
an axe or a machete
• Gunshot Wounds:
– Gunshot wounds are usually produced from four main
types of weapons in North America: revolver, pistol,
rifle, and shotgun. The revolver, pistol, and rifle
produce a single entrance wound under normal
circumstances. The shotgun can produce a single
entrance wound if a slug is the type of round used or
multiple entrance wounds if buckshot is fired
 Incised Wounds

Stab Wounds:

Puncture Wounds

Defense Wounds
Chopping Wounds Gunshot Wounds
Internal Examination
• During the internal exam, these leads are investigated. As
with any investigation, some findings are completely
unexpected.
• This means that the pathologist must examine all tissues
carefully and objectively.
• Going into an autopsy with preconceived notions about
potential findings can cause the pathologist to overlook
the unexpected.
 Internal Examination
For this reason, each internal exam includes, at minimum,
an examination of the following:
• Heart, including coronary • glands
arteries and heart
valves • Bladder
• Chest cavity and mediastinum • Prostate
• Lungs and lung hilum • Uterus and ovaries
• Liver and gallbladder • Neck organs, including
• Spleen larynx and thyroid
• Stomach and esophagus gland
• Small and large intestines • Vertebral column
• Bowel mesentery • Skull
• Brain and its coverings
• Peritoneal cavity
• Body walls
• Aorta and its branches
• Kidneys and adrenal
Organ and Tissue Removal
CLASSIC AUTOPSY TECHNIQUES

• TECHNIQUE OF R. VIRCHOW
– Organs are removed one by one. This
method has been used most widely, often
with some modifications. Originally, the
first step was to expose the cranial cavity
and, from the back, the spinal cord,
followed by the thoracic, cervical, and
abdominal organs, in that order.
CLASSIC AUTOPSY TECHNIQUES
• TECHNIQUE OF C. ROKITANSKY This
technique is characterized by in situ dissection,
in part combined with the removal of organ
blocks.

• TECHNIQUE OF A. GHON Thoracic and

cervical organs, abdominal organs, and the
urogenital system are removed as organs blocks
(“en bloc” removal). Modifications of this
technique are now widely used.
CLASSIC AUTOPSY TECHNIQUES

• TECHNIQUE OF M. LETULLE Thoracic,

cervical, abdominal, and pelvic organs are
removed as one organ block (“en masse”
removal) and subsequently dissected into organ
blocks. This technique requires more experience
than the other methods but has the great
advantage that the body can be made available
to the undertaker in less that 30 min without
having to rush the dissection. Unfortunately, the
organ mass is awkward to handle.
Dissection of chest skin and soft tissue. The skin and subcutaneous tissue are dissected back to expose the
underlying muscle and bone. The natural yellow color of the subcutaneous fat can be seen here.
COLLECTING BLOOD, URINE, BILE, AND VITREOUS SPECIMENS FOR TOXICOLOGY
 Examination of the Head, Skull,
Brain, and Spinal Cord
• All medical-legal examinations require the
examination of the head, skull, and brain.
This includes careful examination of the
scalp, skull, and dura mater, the fibrous
membrane that tethers the brain in place.
• Since the brain is the supreme organ
system, giving orders to the rest of the
body, no examination is complete without
assessment of the brain and its coverings.
Incising the scalp. The scalp skin, subcutaneous tissue, and galea
aponeurotica (thick fibrous layer) are cut down to the bone. The cut is
started behind the ear, extended around the vertex (top of the head), and
completed behind the other ear.
Examination of the dura. The top
portion of theskull (calvarium) is
examined here. The grey membrane is
the dura mater. The dura mater has
been partially stripped away . from the
skull. The tip of the scissors is in the
epidural ("above the dura") region The
subdural space is the region below the
dura.
Removing the brain. The brainstem is cut and the brain is removed
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