An autopsy, also known as a post-mortem examination, is a systematic medical investigation performed by a specialized medical doctor called a pathologist to determine the cause and circumstances of death. Autopsies serve two primary purposes: clinical and forensic. A clinical autopsy aims to better understand disease progression or confirm diagnoses for medical knowledge and quality assurance. A forensic autopsy is performed for legal purposes, seeking to establish the cause, mechanism, and manner of death in suspicious or unnatural cases.
Preliminary Steps and External Examination
The process begins with documentation and verification. Staff confirm the identity of the deceased, typically by checking toe tags or wristbands. If the death is medico-legal, a strict chain of custody is established and maintained for the body and all evidence.
The initial stage involves a thorough external examination where the pathologist assesses the body from head to toe. The body’s height and weight are recorded, and the exterior surface is inspected for distinguishing features. This includes noting scars, tattoos, birthmarks, and signs of prior medical intervention.
The pathologist documents post-mortem changes, such as rigor mortis (stiffening) and livor mortis (pooling of blood due to gravity). Skin color is observed, as discoloration can indicate specific causes of death, such as carbon monoxide poisoning or asphyxia. Clothing and personal effects are documented, photographed, and carefully removed, with pockets searched for evidence.
Initial samples are collected to preserve trace evidence before the body is cleaned. Swabs may be taken from external surfaces, and samples of hair and fingernail clippings are secured. This external survey ensures that superficial injuries or evidence are cataloged before the internal procedure begins, providing a complete picture of the body’s condition.
The Internal Examination
The internal examination starts with the body positioned on the autopsy table, often with a block placed under the back to elevate the chest. This positioning allows for maximum exposure of the trunk for the primary incision. The standard procedure for opening the body cavity involves a deep incision commonly shaped like a “Y” or a “T.”
The Y-incision begins at the front of each shoulder, runs down to the breastbone, and continues vertically to the pubic bone. This cut extends through the skin and muscle layers, allowing the pathologist to reflect the chest wall flaps. A vibrating electric saw is then used to cut through and remove the rib cage, exposing the thoracic and abdominal organs.
The organs of the chest and abdomen are removed either individually (Virchow technique) or all together as a single block (en masse or Rokitansky technique). Each organ is weighed, measured, and examined for abnormalities like tumors, fluid accumulation, or signs of disease or trauma. The stomach and intestines are opened to examine their contents, which can provide clues regarding the time of death or ingested substances.
To examine the brain, an incision is made across the scalp, allowing the scalp to be pulled back. A specialized saw is used to remove the top portion of the skull, creating a “cap” to expose the brain. The brain is removed, weighed, and often fixed in a formalin solution before being sectioned and examined days later. Small tissue samples are collected from various organs throughout the internal process and preserved for microscopic analysis.
Analysis and Final Reporting
Once the physical examination is complete, the organs are typically returned to the body cavity, often with filler material, and the incisions are meticulously sutured. This reconstruction ensures the body can be viewed by family members if desired, as the external appearance is maintained. The conclusion of the autopsy then moves from the examination room to the laboratory.
The collected samples undergo a series of laboratory tests. These include toxicology screening to detect drugs, alcohol, or other chemical substances, and microbiology studies to identify infectious agents. Histology involves preparing small tissue samples by embedding them in paraffin blocks, slicing them, and staining them for microscopic examination.
The pathologist correlates all findings: external observations, internal examination results, and laboratory studies. This synthesis of data allows the pathologist to form a definitive medical conclusion about the death. The final official pathology report is then drafted, detailing all findings and formally stating the cause of death. For forensic cases, the report also includes the mechanism of death and the manner of death, which is classified into one of five categories: natural, accident, suicide, homicide, or undetermined. While a preliminary report may be available within a few days, the final comprehensive report often takes between 30 and 90 days to complete.