Autopsy
Sabrina Sanchez
April 27, 2015
Medicolegal Death Investigation
Prof Rhinehart
American Intercontinental University

Autopsy is an examination of a person’s dead body. The word autopsy comes from the Greek autopsia meaning “the act of seeing for oneself.” The first real examinations for the study of disease was done about 300 BCE by the Alexandian physicians Heophilus and Erasistratus. The first forensics or legal autopsy was requested by a judge in Bologna in 1302. The examination is done to determine the cause of to identify or describe the level of disease that the person may have had, or define whether a specific medical or surgical treatment has been effective. This procedure is done by a trained medical personnel with a purpose of finding the cause of death with an assistance of autopsy technicians and autopsy photographers. The body is looked at from the outside and the inside, all tissue and organs are removed and looked at. Autopsy have legal implications and are performed to define if death was an accident, homicide, suicide, or a natural event. Autopsies are common medical practice but are mostly done when a crime was done. A medical examiner can order an autopsy without the say-so of the family member. Deaths that are investigated by the medical examiner are all suspicious deaths. In other cases consent must be obtained from a family member before an autopsy can be done. The family member also has the right to limit the things done in an autopsy, like not wanting the brain to be examined. The range of an autopsy can vary from the examination of a single organ such as the heart or brain, to a very wide examination. Going-over of the chest, stomach, and brain is probably considered by most medical personnel as the normal extent of the autopsy. The autopsy begins with a complete external examination and ends with a complete internal examination.

Why do autopsy for? It is done to determine the cause of death when it is not known, to document injuries, to exclude other causes of death, to determine or exclude related factors to the death. Well it benefits the families, hospitals or medical personnel, and society. It can benefit the family because I can provide some type of closure knowing what happen to their loved one. They will know if foul play is a factor or natural cause. It can also not delay the process of insurance payment. The autopsy can also uncover any diseases that could affect other family members. The benefits for the hospital is that it can confirm the accuracy of the medical diagnoses and the relevance of medical care. The autopsy findings can help to educate physicians, nurses, residents, and students. Lawsuits are less common in autopsy cases, if a certain disease is found in an autopsy to be constantly misdiagnosed, a hospital can look into reasons for this inconsistency and find ways to improve diagnoses. Autopsies are important for hospital audits and quality guarantee purposes. The benefits to society are that many of the benefits of the autopsy are experienced by society as a whole. The autopsy helps in the assessment of new diagnostic tests, the assessment of new therapeutic interventions like drugs, devices, and surgical techniques, and the study of diseases. Autopsy data are useful in forming good death statistics. Information resulting from death certificates in the lack of autopsy data have continually been shown to be wrong. New medical information on current diseases that is resulting from autopsy-based research is clearly important for everyone. There is three steps of medicolegal death investigation. First is an investigation of the circumstances which is any and everything that leads up to the death of the individual. All info must be gathered before the body can be examined, the examination of a person should not be done until the circumstances is known. This might be gathered by investigating the scene, talking to witnesses and or family members, also getting medical records and the police reports. The circumstances of the death may tell the medical examiner just how much examining of the body is needed. The second step is the examination of the body, either autopsy or just observing the outside of the body. The third thing is dong lab test.

The body is taken to a medical examiner’s office or hospital in a body bag or evidence sheet. Each time a new sheet or body bag is used, never reuse the same bag or sheet. When it gets to the morgue to be logged in with a name, date and time of arrival, who transported it and who received it. A case number should be given to the body, and picture should be taken. If the autopsy isn’t done right away it is stored in the morgue until it’s time to be examined. The body has to be identified with a toe tag. The medical examiner will prepare himself by gathering his tools and proper gear before starting. There are several tools used at the time of the autopsy like aenterotome, which is large scissors used for opening he intestines. Skull chisels used to finish the separation of the top of the calvarium from the lower skull. The hagedorn needle is used for stitching up the body, the rib cutters which are used to cut through the ribs, there is also a scalpel which is used for reaching deeper into body cavities. Medical examiners use toothed forceps, scissors, and vibrating saws as well. The medical examiner must be properly dressed with its scrubs, gowns, gloves and face shields. Must protect himself from dropping any of his hair ad fibers on the clothing or body bag of the body. A general description of the body should be done like the age, sex, race, body build, height, weight and nourishment of the person. A small description of the clothing and the way the body looks. Degree and distribution of rigor or livor mortis, hair the length and color, any facial hair, how the eyes look and the color of them. How the teeth look, and scars or tattoos. All of this needs to be notated before anything is started.

When it is time to begin the autopsy, the seal is broken from the bag and the medical examiner will open the bag and observe the body, then take notes of the clothing. The notes should have the type of clothing and the condition of it. Pictures will need to be taken before any clothing is removed and before it’s taken out of the bag or sheet. Up close and further back range phots should be taken, of the body and clothes. The medical examiner will then collect any evidence on the outer part of the body. They will make note of stains on clothes, remove dried blood with swab or by scraping it into a jar. Make note of any damage to clothing like bullet holes, looking at the size and shape. This will help figure out the position from which person was attacked. They will collect hair samples, do fingernail scrapings, collect any fibers or anything found outside of the body and take note of anything found. If there was a bag wrapped around the hands it will also be submitted with the samples as part of the evidence.

Once the medical examiner has done a thorough examination over the body and has collected all that is needed and made sure to note it, then the medical examiner will take the body out the bag and then undress the body. The medical examiner will be careful on how e clothes is removed, don’t want to ruin any evidence on the clothing. Each piece of clothing will be stored separately in plastic bags. Wet clothes must be air dried first in case shrinkage changes between wounds and holes in clothing. Now the body’s wounds and the rest of the body are looked at closely before getting rinsed off. Pictures will also need to be taken of the body without the clothes. After that the body will be rinsed off cleaning the body and then it will be weighed and measured. Once the medical examiner has taken note of this the medical examiner will put the body on the autopsy table. The autopsy table is aluminum with raised edges that has several faucets and drains used to wash away blood during the inside body investigation. The body is placed on its back and a body block is placed underneath the body’s back. A block is usually a rubber or plastic brick that causes the body’s chest to make it stick out forward. All notes will also include hair color, length, exact age, and any identifying marks like birthmarks and tattoos.

When the body is cleaned the medical examiner will once again look at the wounds and measure the size of the wounds and take note. Taking a close look at the whole body looking for outside of the body signs of disease, other wounds, scars, needle marks and things like that. Looking at the face, hands, legs and arms, checking for any bruising. There is a piece of paper that has the human body on it, where the medical examiner draws on the parts of where all wounds are, along with measurements. This is done both front and back. Also the medical examiner can take an x-ray of the body. Samples of hair from the scalp, face, eyebrows, and pubic will need to be taken labeled and stored. Once this is done then the medical examiner is ready to start on the examination of the inside of the body. The medical examiner will need to record he weight, size, shape, color and the consistency of each organ and note any inflammation, abnormalities, hemorrhage, surgical procedures or injuries. They will take sections of normal and any abnormal areas of each organ for a closer examination with a microscope, and take samples of any broken bones to look and see they can see when it happen. The genital area should be checked for signs of rape like bruising and tearing. Pictures will be needed to taken of the body and close ups of any marks on the body like the wounds and bruises. Blood will need to be taken to see if the person was using drugs or have alcohol in there system, or to check for poisoning and it can be used for DNA purposes.

Body fluids need to be taken from the body like blood taken from a main vein that will be used to test for alcohol, blood type, poisons and glucose. A sample of the urine is needed to test for alcohol and poisons. Cerebo-spinal fluid is taken at the start of the autopsy, vitreous humour is the liquid behind the eye that can help determine the time of death. The stomach contents, intestinal contents and the liver is also collected. The medical examiner will now do and examination of the inside of the body, they will start by make a Y shaped incision from each shoulder across the chest to the middle and then straight line down the middle to the pubic region. They will cut thru the skin and pull the skin back so that the rib cage is showing. Shears are used to open the chest cavity. It is also ok to use a simple scalpel blade. A scalpel is used to remove any soft tissue that is still attached to the posterior side of the chest plate. The medical examiner uses the tool to saw through the ribs on the sides of the chest cavity to allow the sternum and attached ribs to be lifted as one chest plate. The rib cage is then sawed open so that the neck and chest organs are exposed. The medical examiner will then look at all the organs while they are in place.

Once the examiner has looked at the organs they will now cut out the trachea, thyroid gland, parathyroid glands, esophagus, heart, thoracic aorta and lungs. The organs can be removed in several ways like the "en masse technique of Letulle" where they are all removed as one, the second is the "en bloc method of Ghon" and the most popular in the UK is a changed version of this method it is divided into four groups of organs. One way is the "pericardial sac" it’s opened to see the heart. Before removing the heart, the pulmonary artery is opened in order to search for a blood clot. The heart can then be taken out 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 heart and lungs are looked at again in more detail, make sure that they are normal, and a second blood sample will be taken directly from the heart. The heart will be taken out weighed and cut through to make sure there isn't any disease present. The lungs will be taken out one by one measured compared to each other and weighed, it will be cut through to check for any irregular things. The medical examiner should be recording or taking note of anything that need to be known and take a tissue sample in case further examination is needed.

The abdominal organs can be removed one by one after first examining their relationships and vessels. The medical examiner will do the same thing with the lower body organs. All these organs will be taken out one by one looked at closely for any abnormalities. They will be weighed, measured and documented. Sometimes partially digested food is used to determine time of death. A urine sample should be taken from the bladder so it can be tested for drugs or poison. Abdominal organs include the intestines, liver, gallbladder and bile duct system. Also the pancreas, spleen, adrenal glands, kidneys, ureters, urinary bladder, abdominal aorta, and reproductive organs. Everything needs to be checked to make sure the death was by some type of disease or long time ago wound. The organs tell it all, how you were when you were alive. So the medical examiners have study how the inside of the body looks and how everything should be in place

Next the examiner will need to examine the head to check for trauma to the skull like fractures and bruises. The examiner should carefully examine the eyes broken blood vessels can be a sign of strangulation. The skull will need to be removed so the medical examiner can look at the brain. To remove the brain, it will be cut from the back of the skull from one ear to the other. The scalp is cut and pulled forward. The top of the skull is removed using a saw. The whole brain is then taken out. The spinal cord may also be taken by removing the anterior or posterior portion of the spinal column. The brain will be weighed and cut into to make sure no disease is present. Once all of the organs have been taken out and weighed and measured and notated any unusual things seen, the examiner will be able to state the cause of death and why they came to this conclusion. After it’s done the organs that are put back inside the body and the incision is stitched up. Listing any and all details found during the examination of the body, based on the findings, the examiner can issue a death certificate. The body can now be returned to the family so funeral arrangements can be made. The autopsy will not prevent it from being an open casket service.

All these different steps are taken to perform an autopsy on an individual that dies suspiciously. Not every person gets one of these, a homicide had to occur or someone who has questions about their loved one can request one. The autopsies are a good thing to have. Western medicine came from the practice of autopsy, which led to the first looks into the connections between a patient's clinical symptoms and diseased organs found after death. Autopsy played a serious role in learning new diagnosed diseases, such as AIDS, the Ebola virus infection, and Lyme disease, by letting investigators to compare tissue changes with epidemiologic and clinical data. The autopsy continues to provide new insights into diseases. IT helps out at the end to learn what different organs look like at a certain stage in death and also the age the person. Some facts about the autopsy is it may be restricted to one part of the body, it is used for learning, legal purposes and to determine the cause of death. The body is opened in a way that it does not interfere with an open casket service. This was just enough information on what happens during an autopsy and where it comes from. Back in the day, they didn’t study the dead body for why someone did, but for preserving the organs.

References:

* Autopsy: Learn About the Post-Mortem Procedure http://www.medicinenet.com/autopsy/article.htm * Autopsy http://www.sciencemuseum.org.uk/broughttolife/techniques/autopsy.aspx * Maio, V., & Dana, S. (2007). Handbook of forensic pathology (2nd ed.). Boca Raton: CRC/Taylor & Francis. * Man Autopsy https://www.youtube.com/watch?v=a4lzq47qMug * Autopsy http://en.wikipedia.org/wiki/Autopsy