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autopsy

 
Medical Encyclopedia: Autopsy
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Definition

An autopsy is a postmortem assessment or examination of a body to determine the cause of death. An autopsy is performed by a physician trained in pathology.

Description

An autopsy can be described as the examination of a deceased human body with a detailed exam of the person's remains. This procedure dates back to the Roman era when few human dissections were performed; autopsies were utilized, however, to determine the cause of death in criminal cases. At the beginning of the procedure the exterior body is examined and then the internal organs are removed and studied. Some pathologists argue that more autopsies are performed than necessary. However, recent studies show that autopsies can detect major findings about a person's condition that were not suspected when the person was alive. And the growing awareness of the influence of genetic factors in disease has also emphasized the importance of autopsies.

Despite the usefulness of autopsies, fewer autopsies have been performed in the United States during the past 10-20 years. A possible reason for this decline is concern about malpractice suits on the part of the treating physician. Other possible reasons are that hospitals are performing fewer autopsies because of the expense or because modern technology, such as CT scans and magnetic resonance imaging, can often provide sufficient diagnostic information. Nonetheless, federal regulators and pathology groups have begun to establish new guidelines designed to increase the number and quality of autopsies being performed.

Many experts are concerned that if the number of autopsies increases, hospitals may be forced to charge families a fee for the procedure as autopies are not normally covered by insurance companies or Medicare. Yet, according to several pathologists, the benefit of the procedure for families and doctors does justify the cost. In medical autopsies, physicians remain cautious to examine only as much of the body as permitted according to the wishes of the family. It is important to note that autopsies can also provide peace of mind for the bereaved family in certain situations.

— Jeffrey P. Larson, RPT


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Dictionary: au·top·sy   (ô'tŏp'sē, ô'təp-) pronunciation
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n., pl., -sies.
  1. Examination of a cadaver to determine or confirm the cause of death. Also called necropsy, postmortem, Also called postmortem examination.
  2. A critical assessment or examination after the fact: a post-election campaign autopsy.
tr.v., -sied, -sying, -sies.

To subject to an autopsy.

[Greek autopsiā, a seeing for oneself : auto-, auto- + opsis, sight.]

autopsic au·top'sic or au·top'si·cal adj.
autopsist au'top'sist n.

World of the Body: autopsy
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In a moment made familiar by television dramas and films, a detective views a dead body, turns to the doctor examining the corpse, and asks for the cause of death. The doctor inevitably remarks, ‘Ah, we'll have to wait for the autopsy to be sure.’ An autopsy is a standardized biomedical procedure during which trained medical pathologists examine the exterior of the body, dissect the corpse, view the vital organs for any obvious abnormality and weigh them, and collect specimens of tissues and fluids for further analysis. The procedure takes 2-4 hours and ends with the body being prepared either for storage until it can be released, or to go to the undertaker for embalming and burial or cremation. After additional laboratory work on the tissues and fluid specimens to detect the presence of drugs and/or coexisting medical conditions, the pathologist forms an opinion on the cause of death.

A typical autopsy begins with a Y-shaped incision from each shoulder to the lower end of the sternum and in a single incision from there to the pubic bone. The pathologist retracts the skin and superficial muscles from the chest and abdomen, and cuts the cartilages holding the ribs to the sternum, which is then removed. The pathologist removes, weighs and inspects the heart and lungs, often taking a sample of blood from the heart; the abdominal organs are also inspected, removed, and weighed, taking fluid samples as appropriate. The skull is opened by making an incision through the scalp on the back of the head and detaching it from the bone to lie over the face. The skull is then cut through with a bone saw, the bone removed and the brain extracted. Throughout these steps (which can occur in a different order) the pathologist removes sections of tissues to be preserved, with particular attention to those that appear diseased or injured. Photographs may be taken of parts of the body or of organs still in place or after removal. The flaps from the Y-incision are laid back over the thorax and abdomen and loosely sutured; the removed section of skull is replaced and the skin drawn back, which usually means that the face may be viewed during the funeral.

There are two basic kinds of autopsy: the forensic autopsy and the medical autopsy. A forensic autopsy, as the name implies, is one performed to satisfy the law. In most Western nations, an autopsy must be performed if a person died in suspicious circumstances, was unexpectedly found dead, died without having recently seen a physician who can attest to a cause of natural death, or is suspected of having had a disease that possibly threatens the public's health. In these circumstances, the state requires an autopsy and does not need permission from the deceased's relatives to perform one. If murder is suspected, the autopsy is required to establish the cause of death, to determine if the findings support the suspected crime, and to provide as much evidence as possible about how, when, and where such a crime might have occurred.

The medical autopsy has different goals. In these cases, physicians are already satisfied that the person died a natural death. Pathologists then use the autopsy to investigate the details of that natural death. Sometimes they seek additional information about the treatment that the patient had received, such as internal healing after a surgical procedure or evidence of a response to medications, even if these had nothing directly to do with the death. The medical autopsy also serves researchers studying a disease process such as cancer or bone deterioration, and who need specimens from a patient for whom they have a clinical record. Most medical autopsies require the consent of the immediate family, which normally includes permission for the pathologists to take and to preserve organs and specimens of use to medical science.

The word ‘autopsy’, comes from the Greek terms meaning ‘seeing (or seen) for oneself’. The medical and legal use of ‘autopsy’ to mean anatomical dissection to discover the cause of death carries with it that sense of personal inspection and, when necessary, personal testimony, in court or at a case conference about what the observer saw within the body. ‘Post-mortem’ (Latin: ‘after death’) is often used as a synonym for ‘autopsy’, but post-mortem examination is actually a general term for inspection of a corpse that does not necessarily include dissection.

History and cultural issues

Most cultures have historically had a strong aversion to mutilating the dead human body or to dissecting it simply to learn normal anatomy. Yet the world's ancient and classical civilizations had equally strong prohibitions against murder. In India, in China, and around the Mediterranean, the ruling orders developed legal systems that defined murder and established procedures in which witnesses testified that external marks on the body, or other visible signs, distinguished suicides, accidental deaths, and natural deaths from murder. In medieval Europe, twelfth-century legal scholars first extended the common practice of viewing the external signs on a body to identify probable cause of death, to examining the internal marks of violence or disease. The question of which wound corresponded to the fatal blow, for instance, could be crucial for picking out the murderer from those involved in a group assault. Poison, too, was thought to leave visible marks in the stomach that an expert might identify. Opening the body to serve justice thus outweighed distaste for such procedures. Early autopsies were likely to be quite short and minimally defacing because the inspection was limited to the area of the thorax or abdomen under particular scrutiny. The history of the autopsy in Western Europe and Great Britain is thus closely tied to the evolution of legal systems and court procedures. In English (and later American) law, the development of the duties of the coroner, a lay person, kept the decision to order a medical inspection, whether external or internal, out of the hands of medical experts until the nineteenth century.

Forensic autopsy procedures antedated the introduction of lawful human dissection into medical schools, which first emerged in medieval universities in the early fourteenth century. It is important to distinguish autopsies, where legal officials sought the cause of death, from anatomical dissections, where anatomists and, much later, medical students, learned normal anatomy. The former had a legal purpose; the latter only seemed to satisfy human curiosity. When dissection was introduced into universities and surgical guilds throughout the late medieval and early modern periods, secular rulers only permitted dissections of executed criminals. The continued association of dissection with mutilation and post-mortem punishment helped to maintain cultural aversion to autopsies.

Medical autopsies, where the body is opened simply to determine the cause of a natural death, emerged in Europe only after the rise of the study of normal anatomy in the sixteenth century. Even then, physicians and elite surgeons performed such inspections only sporadically until the eighteenth century, primarily because the dominant theory of the humours, which explained both health and disease in terms of individualized balances of the body's main fluids, accounted for the visible marks of pathology on organs as being the effects of underlying disease imbalances. Such hidden signs, usually inaccessible to the physician, were not considered particularly useful for understanding or treating disease in the living. In the eighteenth century, however, especially with the publication of Giovanni Battista Morgagni's De sedibus et causis morborum per anatomen indigatis (1761), practitioners began to investigate more thoroughly the internal changes associated with diseases, and by the end of the century the study of morbid anatomy was well under way. The early to mid nineteenth century witnessed extensive correlations between the anatomical changes observed at autopsy and the clinical course of diseases in previously living patients, particularly in the bodies of the poor dying in hospitals. With improvements in the microscope, moreover, the enthusiasm for gross pathology shifted to the pathology of tissues and cells, which dominated research in the second half of the nineteenth and well into the twentieth centuries. At the same time, the emergence of biochemistry added chemical investigation of human fluids and tissues to the pathologist's ability to detect both the signs of medical disorders and, eventually, the presence of alcohol and other drugs in a corpse.

Most inhabitants of the industrialized West now see autopsy as a necessary legal and medical protocol. For others, however, an autopsy represents a violation of the spiritual integrity of the recently dead human being. Traditional Hindus prohibit autopsies; Islamic law forbids mutilation of the corpse. While Islamic jurists have long argued that this prohibition does not apply to respectful legal and medical procedures necessary to determine a cause of death, Qur'anic statements about the resurrection of the physical body influence cultural resistance to the procedure. Similarly, modern arguments that humans have ethical obligations to protect life by increasing medical knowledge, and to ensure that justice is done by gathering evidence about crimes, have eased, but not necessarily eliminated, the antagonism towards autopsies held by Orthodox Jews and traditional Christians. As important as autopsies are in the abstract for law and medicine, they will continue to carry important cultural and emotional meanings as humans face the deaths of relatives and friends.

— Susan Lawrence

Bibliography

  • Forbes, T. R. (1985). Surgeons at the Bailey: English forensic medicine to 1878. Yale University Press, New Haven.
  • Encyclopedia of Bioethics (1995). Macmillan, New York

See also anatomy; death; dissection; murder.

Dental Dictionary: autopsy
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n

A postmortem examination performed to confirm or determine the cause of death.

Britannica Concise Encyclopedia: autopsy
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Dissection and examination of a dead body to determine cause of death and learn about disease processes in ways that are not possible with the living. Autopsies have contributed to the development of medicine since at least the Middle Ages. Beyond revealing causes of individual deaths, autopsy is crucial to the accuracy of disease and death statistics, the education of medical students, the understanding of new and changing diseases, and the advancement of medical science.

For more information on autopsy, visit Britannica.com.

 
Columbia Encyclopedia: post-mortem examination
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post-mortem examination or autopsy, systematic examination of a cadaver for study or for determining the cause of death. Post-mortems use many methodical procedures to determine the etiology and pathogenesis of diseases, for epidemologic purposes, for establishment of genetic causes, and for family counsel. Post-mortems may be performed at the request of the authorities in cases of unexplained and suspicious death or where death was not attended by a physician. In other circumstances post-mortem examination may be performed only with the consent of the deceased's family or with permission granted by the person himself before death. These examinations are more frequently being used for the acquiring of organs and tissues for transplantation. Valuable medical information can be learned from a post-mortem examination. Legionnaire's disease, for example, was discovered as a result of autopsies, and improved safety standards have resulted from the examination of the bodies of crash victims.

Law Encyclopedia: Autopsy
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This entry contains information applicable to United States law only.

The dissection of a dead body by a medical examiner or physician authorized by law to do so in order to determine the cause and time of a death that appears to have resulted from other than natural causes.

This postmortem examination, required by law, is ordered by the local coroner when a person is suspected to have died by violent or unnatural means. The consent of the decedent's next of kin is not necessary for an authorized autopsy to be held. The medical findings must be presented at an inquest and might be used as evidence in a police investigation and a subsequent criminal prosecution.

See: forensic science.

Veterinary Dictionary: autopsy
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Examination of a body after death to determine the actual cause of death; called also postmortem examination and necropsy. Autopsies are also valuable sources of medical knowledge.

  • a. data — data from autopsies used to illustrate the natural history of diseases and changes in their frequency are often flawed by the non-random way in which cases are selected for autopsy.
  • a. record — includes data identifying the corpse including name, address of owner, species of subject, age, sex, breed, use (as occupation in man), identifying marks, plus observations on the gross postmortem examination, the histopathological or other examinations conducted and finally an opinion about the cause of death. Useful additional documents are permission from the owner to conduct the autopsy and details of any insurance or legal interest in the examination.
Word Tutor: autopsy
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pronunciation

IN BRIEF: The examination of a dead body by dissection to determine the cause of death.

pronunciation The autopsy showed that the victim died of natural causes.

Wikipedia: Autopsy
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"Post-mortem" redirects here. For other uses, see Post-mortem (disambiguation).
This article is about the medical procedure. For other uses, see Autopsy (disambiguation).
The Anatomy Lesson of Dr. Nicolaes Tulp, by Rembrandt, depicts an autopsy.

An autopsy—also known as a post-mortem examination, necropsy (particularly as to animals), autopsia cadaverum, or obduction—is a medical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

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

Contents

History

See also: History of dissection

The term "autopsy" derives from the Ancient Greek autopsia, "to see for oneself", derived from αυτος (autos, "oneself") and όψις (opsis, "eye").[1] Around 3,000 BC, the ancient Egyptians were one of the first civilizations to practice the removal and examination of the internal organs of humans in the religious practice of mummification.[2][1]

Autopsies that opened the body to determine the cause of death are attested at least in the early third millenium 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[3] (as with the Egyptians, who removed the organs through tiny slits in the body).[1] Notable Greek autopsists were Erasistratus and Herophilus of Chalcedon, who lived in 3rd century BC Alexandria, but in general, autopsies were rare in ancient Greece.[3] In 44 BC, Julius Caesar was the subject of an official autopsy after his murder by rival senators, and the physician's report noted that the second stab wound Caesar received was the fatal one.[3] By around 150 BC, ancient Roman legal practice had established clear parameters for autopsies.[1]

The dissection of human remains for medical reasons continued to be practiced irregularly after the Romans, for instance by the Arab physicians Avenzoar and Ibn al-Nafis, but the modern autopsy process derives from the anatomists of the Renaissance. Giovanni Morgagni (1682–1771), celebrated as the father of anatomical pathology,[4] 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).[1]

The two great nineteenth-century medical researchers Rudolf Virchow and Carl von Rokitansky built on the Renaissance legacy to derive the two distinct autopsy techniques that still bear their names. Their demonstration of correspondences between pathological conditions in dead bodies and symptoms and illnesses in the living opened the way for a different way of thinking about disease and its treatment.

Purpose

The principal aim of an autopsy is to determine the cause of death, the state of health of the person before he or she died, and whether any medical diagnosis 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 editor 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 be due to an unnatural cause. These examinations are performed under a legal authority (Medical Examiner or Coroner or Procurator Fiscal) and do not require the consent of relatives of the deceased. The most extreme example is the examination of murder victims, especially when medical examiners are looking for signs of death or the murder method, such as bullet wounds and exit points, signs of strangulation, or traces of poison. Many religions such as Judaism and Islam usually discourage the performing of autopsies on their adherents. Organizations such as Zaka in Israel 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 and assist continuous improvement.

A study that focused on myocardial infarction (heart attack) as a cause of death found significant errors of omission and commission,[5] 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 of studies of the autopsy calculated that in about 25% of autopsies a major diagnostic error will be revealed.[6] 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 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.[7] Also, it is thought that over one fifth of unexpected findings can only be diagnosed histologically, i.e. by 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 "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others".[8]

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".[9]

In veterinary medicine

A field post-mortem exam of a ewe.

Post-mortem examination is far more common in veterinary medicine 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 two main types of autopsies:[10]

  • Forensic or coroner's autopsies seek to find the cause and manner of death and to identify the decedent.[10] 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.[10]
  • Clinical or academic autopsies are performed for research purposes. They aim to determine, clarify, or confirm medical diagnoses that remained unknown or unclear prior to the patient's death.[10]

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 law, deaths are placed in one of five manners:

In some jurisdictions, the Undetermined category may include deaths in absentia, such as deaths at sea and missing persons declared dead in a court of law; in others, such deaths are classified under "Other".

Following an in-depth examination of all the evidence, a medical examiner or coroner 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 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.[11]

In the United States, autopsy rates fell from 17% in 1980[12] to 14% in 1985[12] and 11.5% in 1989,[13] although the figures vary notably from county to county.

Process

Cadaver dissection table. Similar to those used in medical or forensic autopsies.

The body is received at a medical examiner's office or hospital in a body bag or evidence sheet. A brand new body bag is used for each body to ensure that only evidence from that body is contained within the bag. Evidence sheets are an alternate way to transport the body. An evidence sheet is a sterile 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, 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, biochemical tests and/or genetic testing 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, the German 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. 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 light may also be used to search body surfaces for any evidence not easily visible to the naked eye. Samples of hair, nails and the like are taken, and the body may also be radiographically imaged.

Once the external evidence is collected, the body is removed from the bag, undressed, and any wounds present are examined. The body is then cleaned, weighed, and measured in preparation for the internal examination. The scale used to weigh the body is often designed to accommodate the cart 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, age, hair color and length, eye color and other distinguishing features (birthmarks, old scar tissue, moles, 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.[citation needed]

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 upward to make it easier to cut open. This gives the prosector, a pathologist or assistant, maximum exposure to the trunk. After this is done, the internal examination begins. The internal examination consists of inspecting the internal organs of the body for evidence of trauma 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 in forensic autopsies so as to allow maximum exposure of the neck structures for later detailed examination. This could prove essential in cases of suspected strangulation.
  • 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. This initial cut is used more often to produce a more aesthetic finish to the body when it is re-constituted as stitching marks will not be as apparent as with a Y-shaped incision
  • 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 from the cuts is minimal, or non-existent, due to the fact that the pull of gravity is producing the only blood pressure at this point, related directly to the complete lack of cardiac functionality. However, in certain cases there is anecdotal evidence to prove that bleeding can be quite profuse, especially in cases of drowning.

An electric saw dubbed a "Stryker saw" after a common manufacturer of the tool, is most often used to open the chest cavity. However, in some cases, due to the large amount of dust created when the bone is cut by the saw, 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 and that the heart, in particular the pericardial sac is not damaged or disturbed from opening. A scalpel 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 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 vessels are cut open and inspected at this stage. Next the 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.

A brain autopsy demonstrating signs of meningitis. The forceps (center) are retracting the dura mater (white). Underneath the dura mater are the leptomeninges, which appear to be edematous and have multiple small hemorrhagic foci.

The body block that was used earlier to elevate the chest cavity is now used to elevate the head. To examine the 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. The scalp is pulled away from the 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 an electric 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 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 gas in buffered 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 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 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 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 after embalming.

References

  1. ^ a b c d e Rothenberg, Kelly (2008). "The Autopsy Through History". in Ayn Embar-seddon, Allan D. Pass (eds.). Forensic Science. Salem Press. pp. 100. ISBN 978-1587654237. 
  2. ^ [1]
  3. ^ a b c Schafer, Elizabeth D. (2008). "Ancient science and forensics". in Ayn Embar-seddon, Allan D. Pass (eds.). Forensic Science. Salem Press. pp. 43. ISBN 978-1587654237. 
  4. ^ Giovanni Battista Morgagni -- Britannica Online Encyclopedia
  5. ^ Ravakhah K (2006). "Death certificates are not reliable: revivification of the autopsy". South. Med. J. 99 (7): 728–33. doi:10.1097/01.smj.0000224337.77074.57. PMID 16866055. 
  6. ^ Shojania KG, Burton EC, McDonald KM, Goldman L (2003). "Changes in rates of autopsy-detected diagnostic errors over time: a systematic review". JAMA 289 (21): 2849–56. doi:10.1001/jama.289.21.2849. PMID 12783916. 
  7. ^ Roulson J, Benbow EW, Hasleton PS (2005). "Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review". Histopathology 47 (6): 551–9. doi:10.1111/j.1365-2559.2005.02243.x (inactive 2008-06-20). PMID 16324191. 
  8. ^ Combes A, Mokhtari M, Couvelard A, et al. (2004). "Clinical and autopsy diagnoses in the intensive care unit: a prospective study". Arch. Intern. Med. 164 (4): 389–92. doi:10.1001/archinte.164.4.389. PMID 14980989. 
  9. ^ Papadakis MA, Mangione CM, Lee KK, Kristof M (1991). "Treatable abdominal pathologic conditions and unsuspected malignant neoplasms at autopsy in veterans who received mechanical ventilation". JAMA 265 (7): 885–7. doi:10.1001/jama.265.7.885. PMID 1992186. 
  10. ^ a b c d Strasser, Russell S. (2008). "Autopsies". in Ayn Embar-seddon, Allan D. Pass (eds.). Forensic Science. Salem Press. pp. 95. ISBN 978-1587654237. 
  11. ^ UK Department for Constitutional Affairs (2006), Coroners Service Reform Briefing Note, p. 6
  12. ^ a b Center for Disease Control (1988) , Current Trends Autopsy Frequency -- United States, 1980-1985, Morbidity and Mortality Weekly Report, 37(12);191-4
  13. ^ DA Pollock et al (1993), Temporal and geographic trends in the autopsy frequency of blunt and penetrating trauma deaths in the United States, JAMA, 269(12):1525-31 PubMed

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Translations: Autopsy
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Dansk (Danish)
n. - obduktion
v. tr. - udføre en obduktion

idioms:

  • carry out an autopsy    udføre en obduktion

Nederlands (Dutch)
lijkschouwing, autopsie, persoonlijke waarneming, kritische beschouwing

Français (French)
n. - autopsie
v. tr. - autopsier, pratiquer une autopsie

Deutsch (German)
n. - Autopsie, Leichenöffnung, Obduktion
v. - eine Autopsie durchführen

Ελληνική (Greek)
n. - (ιατρ.) νεκροψία, αυτοψία
v. - διενεργώ νεκροψία

idioms:

  • carry out an autopsy    διενεργώ νεκροψία

Italiano (Italian)
autopsia

idioms:

  • carry out an autopsy    fare un'autopsia

Português (Portuguese)
n. - autópsia (f), necrópsia (f)
v. - autopsiar

idioms:

  • carry out an autopsy    executar uma autópsia

Русский (Russian)
аутопсия, вскрытие

idioms:

  • carry out an autopsy    производить вскрытие

Español (Spanish)
n. - autopsia, necropsia
v. tr. - hacer una autopsia o necropsia

Svenska (Swedish)
n. - obduktion, kritisk analys
v. - obducera

中文（简体）(Chinese (Simplified))
尸体解剖, 验尸, 现场验证, 亲自勘察, 实地观察, 解剖, 剖验尸体

idioms:

  • carry out an autopsy    完成验尸, 完成解剖

中文（繁體）(Chinese (Traditional))
n. - 屍體解剖, 驗屍, 現場驗證, 親自勘察, 實地觀察
v. tr. - 解剖, 剖驗屍體

idioms:

  • carry out an autopsy    完成驗屍, 完成解剖

한국어 (Korean)
n. - 검시, 현장 검증
v. tr. - 검시하다

idioms:

  • carry out an autopsy    현장 검증을 실시하다

日本語 (Japanese)
n. - 検死

العربيه (Arabic)
‏(الاسم) تشريح الجثه (فعل) يشرح الجثه‏

עברית (Hebrew)
n. - ‮נתיחה שלאחר המוות, חקירה, בדיקה, אוטופסיה‬
v. tr. - ‮ביצע נתיחה שלאחר המוות‬

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