Any case in which additional information is needed from examining the organs or closer inspection of injuries will necessitate an autopsy. This process is also often referred to as a “post-mortem examination.” In most cases, autopsies are performed by pathologists assisted by technicians. Each county varies slightly, depending on whether they are a Medical Examiner’s office or part of the Coroner system. The main difference is political in which the position of Coroner is an elected position and often co-joined with the county Sheriff’s department. That is the type of system I worked in and my experience is based in. Autopsies are done in what is commonly referred to as an autopsy suite. The room is outfitted with special workstations where the table/gurney can be rolled up to the sink area and locked into place with the end of the table resting over the sink. On either side of the sink are areas for the doctor to perform dissection and study of the organs. There is a scale that hangs over the sink for weighing of organs. Collection containers for body fluids and organ specimens are prepared and labeled prior to the start of the autopsy After the external examination has been completed and blood samples collected, the body is laid supine (flat on back) on the table. The head of the table is able to be raised if needed. The foot end of the table has a hole so the body fluids can drain down special channels in the outer edge of the table and out the hole into a large sink. A special block is placed under the decedent’s neck to raise the head for easier access to the skull and throat. Often, an additional block is placed under the shoulders to allow for easier Y incision.
The hair is parted across the top of the head, from ear to ear. The scalp is opened to the skull with a scalpel (within the ear to ear hairline part). The scalp is then manipulated and separated from the skull and folded down onto the face, and the back down over the back of the skull. When the skull is exposed, a Stryker saw is used to make a separation in the skull across the front, about the top of the forehead, and another cut is made towards the bottom, across the back of the head. The 2 cuts are made to intersect, usually about behind the ear area so the “skull cap” can be lifted off and a large opening allows access to the brain. When fully developed, the membranes coving the brain create a tight suction of the cap to the brain. This suction is usually broken with the use of a “skull key” which has a flat edged protrusion that looks much like a large standard screw driver. This is gently worked into the top cut and twisted just enough to break the suction. The membranes are removed from the inside of the skull cap to allow the pathologist to examine the inside for evidence of recent or past injury, including staining from brain injuries. The brain is gently separated from the skull sides by running a finger between the brain and the sides. Next, the top of the brain is manipulated to allow visualization of the brain stem. The brain stem is severed as deeply as possible with a scalpel, and the brain and stem are removed and weighed. The cleaned skull cap and remaining skull are examined thoroughly to look for indications of head injuries. Any fractures or staining (from bleeding in the head) are photographed and noted in detail by the pathologist.
Next a Y incision is made with a scalpel. The top of the Y starts at each shoulder and meets mid chest over the sternum. A single incision is then continued from the intersection over the sternum and down the torso, making a small departure around the navel and down to the pelvis. The tissue is then peeled back away from the ribs, and the incision is opened over the abdomen and through the Parietal Peritoneum, exposing the internal organs. Throughout each step the newly exposed area is inspected for trauma or other abnormalities. Pruning shears (or a similar tool) are then used to cut the sternum away from the ribs by cutting the connective tissue (costal cartilage) that holds the sternum to the ribs. The sternum plate is then removed and set aside. The organs in the chest and abdomen can now be removed. Some pathologists and technicians prefer to remove them in “blocks” which are several organs removed together and others prefer to remove the organs one at a time. As each organ is removed, it is weighed, then inspected by the pathologist who looks for injuries, as well as other anomalies such as tumors, scar tissue or congenital defects. As each organ is dissected, a small piece is placed into a “stock” jar to be stored for a determined amount of time, depending on the final cause of death. For example, natural death stock jars are usually kept for a year, traumatic deaths (suicide, traffic, accident, etc) are kept for 2-3 years and homicides are usually kept for an extended amount of time.
The empty chest and abdominal cavities are closely inspected for injury or anomalies. The bladder, reproductive organs, aorta, esophagus, trachea and bronchial tubes, epiglottis and tongue are removed. Again, these sections of tissue as well as the area they are removed from are examined for injury and anomalies.
When the intestines are removed, the connecting tissue is cut in order to be able to extend the intestines to their length. The intestines are then cut at the upper end, and the cut continues all the way to the end (rectum). This process is usually referred to as running the bowels. They are then rinsed clean and inspected by the pathologist.
In addition to the blood and vitreous samples taken at the beginning of autopsy, the contents of the stomach, urine, a liver sample and brain sample are collected during the autopsy.
When the internal and external examinations have been completed, the remaining organ and tissue is placed back into the body cavity inside a plastic bag before the remains are sewn closed and wrapped in plastic for transport to a mortuary.
The topics of TOXICOLOGY, INJURIES and CAUSE OF DEATH / MANNER OF DEATH will be covered in separate posts.