THE AUTOPSY

• Jurisdiction: Australia

A short history ............................................................................................... [33A.1000]

The modern autopsy ..................................................................................... [33A.1010]

Preliminary investigations ............................................................................. [33A.1020]

Radiology and imaging ................................................................................. [33A.1030]

The general autopsy ..................................................................................... [33A.1040]

Health and safety .......................................................................................... [33A.1050]

External examination..................................................................................... [33A.1060]

Body morphometry........................................................................................ [33A.1070]

Injuries........................................................................................................... [33A.1080]

Post-mortem change ..................................................................................... [33A.1090]

Internal examination ...................................................................................... [33A.1100]

Organs retained for later examination .......................................................... [33A.1110]

The face and head ........................................................................................ [33A.1120]

The neck ....................................................................................................... [33A.1130]

The torso ....................................................................................................... [33A.1140]

The genitalia .................................................................................................. [33A.1150]

The limbs....................................................................................................... [33A.1160]

Post-surgical deaths ...................................................................................... [33A.1170]

Specialist injury examination ......................................................................... [33A.1180]

Post-autopsy investigations .......................................................................... [33A.1190]

Reconstruction of the body ........................................................................... [33A.1200]

Tissue sampling and specimens ................................................................... [33A.1210]

Recording of findings .................................................................................... [33A.1220]

Quality assurance ......................................................................................... [33A.1230]

The interpretation of injuries ......................................................................... [33A.1240]

Mechanisms of Injury .................................................................................... [33A.1250]

Injury documentation and description ........................................................... [33A.1260]

[33A.1000] A short history

An autopsy (also known as a post-mortem examination or necropsy) is a medical investigation of a corpse: see Jones (2000). The term "autopsy" comes from the Greek word autopsia or "seeing with your own eyes". "Necropsy" is from the Greek for "seeing a dead body" and is semantically considered the most accurate description of dissection of the dead body.

The "modern" process of autopsy dissection probably began in the 12th century University of Bologna, which included a highly influential law school and later a medical faculty. Indeed, it was the law school that stimulated the interest in autopsies to help resolve medico-legal problems relating to the cause of death. At that time there were prohibitions on any dissection of human corpses; Pope Boniface VIII in 1300 had issued a papal bill prohibiting the cutting up of dead bodies. The edict was designed to stop crusaders from removing the flesh from the skeletons of their fallen comrades so that the bones could be returned home for burial. The idea probably had its roots in the theological doctrine that the body would be resurrected in the afterlife, and, therefore, interference with the mortal remains was to be avoided. While the intention of the edict was limited, the effect was to prohibit all forms of dissection. The only way of circumventing it was if the examination was required for medico-legal purposes. Thus the forensic autopsy in the western world was the means by which human anatomical dissection and analysis began to be systematically performed.

In the 16th century the University at Padua had taken over from Bologna as the main European medical school and Andreas Vesalius became the great reformer of anatomy. He based his teaching on direct observation rather than accepted dogma laid down in the works of Claudius Galen. In 1543, Vesalius published De humani corporis fabrica, a text illustrated with engravings by Jan Stevenszoon val Calcar. This work caused concern among followers of Galen, including the Catholic Church, but it led scholars of the Renaissance period, including artists, to engage regularly in dissection of the human body to improve their knowledge of its structure. It was Giovanni Battista Morgagni who published extensively on the role of anatomical dissection not only to uncover the structure of the body but also to describe and attempt to understand disease processes. His description of disease in some 700 autopsies in De sedibus et causis morborum per anatomen indagatis was influential in encouraging dissection as a means to understanding disease and death.

In 1575, Ambroise Pare, considered by many to be the father of modern forensic medicine, produced a book outlining medico-legal reports. This was followed by numerous works on medico-legal matters in late 16th century and 17th century in Europe. This includes one of the greatest of the earliest work in forensic medicine by Paulus Zacchias, an Italian physician to the Pope and legal advisor to the Papal court of appeal entitled Quaestiones medico-legales (Medico-legal Questions). His work remained the authority in legal medicine until early 19th century.

In the 19th century Karl Rokitansky in Vienna and Rudolf Virchow in Berlin further established the scientific process of the autopsy and instituted many of the standard procedures for dissection that are still in use. It was Rudolf Virchow who used the pathology knowledge gained at autopsy to improve public health and safety - a radical concept at that time.

Dissection of the body after death permitted the development of a detailed knowledge of anatomy, a prerequisite to the science of surgery. It also contributed to the knowledge of the function of body systems (physiology) and the determination of the nature of disease processes that lead to illness and cause death (pathology).

[33A.1010] The modern autopsy

There are two major types of autopsy. The first is the clinical or hospital autopsy where it is performed on behest of the clinicians with the consent of the family. It is performed for the main purposes of understanding of disease process and effects of medical treatment. It may also be performed for research purpose, clinical audit and medical education. In recent years there has been a substantial decrease in the number and rate of clinical autopsies.

The medico-legal or coroner's autopsy is performed under the orders of the coroner. The major aims of the medico-legal autopsy include:

• determination of the cause of death;
• confirmation of the identity of the deceased;
• identification, determination of the extent and interpretation of the injuries;
• determination of natural disease and its role in the causation of death, by deciding if it is plays a direct or contributory role;
• reconstruction of the circumstances surrounding the death; and
• collection of trace evidence for police investigations.

Indirectly, it may play a role similar to that of the hospital autopsy. This includes academic benefits for medical profession, evaluation of effects of medical or surgical treatments, provision of tissue or bodily fluids for use in medical research and therapeutic procedures and informing next-of-kin of potential genetic conditions.

The modern forensic autopsy is no longer limited to the dissection of the body alone. First, it incorporates expertise from different fields of forensic science and, therefore, cooperation from different forensic scientists. Identification may require assistance from the forensic odontologist, anthropologist, forensic DNA analyst and fingerprint analyst. Collection of trace specimens may be performed by the forensic scientist. Radiologists may be required to interpret post-mortem CT scan. Toxicology tests are usually required in overdoses and trauma cases. Various ancillary tests may be required to interpret some conditions. Molecular studies (also known as molecular autopsy) confirm some disease, for example, those of cardiac sudden death.

[33A.1020] Preliminary investigations

The first element of an autopsy is the identification by the pathologist of the goals or purpose of the examination. The main aims differ from case to case. For example, in a young individual dying from a natural disease, not only the cause of death but also the possibility of the condition being hereditary may be significant. In a house fire with multiple fatalities, identification of the deceased persons would take priority. In a homicide case, the requirements of the police with regards to the mechanism of injury may take precedent.

The review and evaluation of information is therefore important before the commencement of the autopsy. In most jurisdictions, the pathologists are given information derived from police investigation. In most instances, the information is adequate...