- For the former Death Metal band called "Autopsy", see Autopsy (band).
An autopsy (also known as a post-mortem examination or necropsy) is a medical investigation of a corpse to determine the cause of death.
The term "autopsy" derives from the Greek for "to see for oneself". "Necropsy" is from the Greek for "seeing a dead body".
There are two types of autopsies:
Forensic: This is done for medical-legal purposes and is the one that is normally seen on television or in the news.
Clinical: This is usually performed in hospitals to determine a cause of death for research and study purposes.
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.
There are two levels of examination of the body, external and internal.
The person responsible for handling, moving, cleaning the body is often called a diener (the German word for servant). After the body is received, it is first photographed. Then the examiner notes the clothes and the position of the clothes on the body before they are removed. Then evidences like gun powder residue, paint flakes etc are collected from the external surfaces of the body. Samples of hair, finger nails etc are taken at this stage. Sometimes special ultraviolet radiation is used to search the body for evidence that may not easily visible to the naked eye. The body may also be X-rayed at this stage.
Once the evidence is collected, the body is removed from the bag, undressed and the wounds if any are examined. This is followed by cleaning the body for the actual examination. After the body is cleaned, it is weighed and measured before being placed on the autopsy table. A plastic or rubber brick called the body block is placed under the back of the corpse causing the chest to protrude forward and making it easier to cut open. Then a general description of the body with regards to race, sex, hair color and length, eye color, age, and identifying features is recorded. A handheld voice recorder or a standard exam form is normally used to record this information.
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, a large and deep Y-shaped incision is made from shoulder to shoulder meeting at the breastbone extending all the way down to the pubic bone . The skin, muscles and soft tissues are then peeled back using a scalpel. Then the upper chest portion is pulled up over the face, exposing the ribcage and neck muscles. Two incisions are then made on each side of the ribcage to pull the ribcage from the skeleton after dissecting the tissue behind it with a scalpel.
At this stage all the organs are exposed. Then a series of cuts are made so that the organs can be detached and pulled out in one piece for further inspection and sampling. 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 its contents are examined and weighed. This could be useful to find the cause and time of death.
To examine the brain, a cut is made from behind one ear, across the forehead, to the other ear and around. 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 dura - the soft tissue membrane that covers the brain remains attached to the "cap". The brain's connection to the spinal cord is severed, and the brain can then be easily lifted out of the skull for examination.
Reconstitution of the body
An important aim of the autopsy is to reconstitute 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. The organs are replaced or incinerated, the chest flaps are 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.
The principal aim of an autopsy is to discover the cause of death, to determine the state of health of the person before they died, and whether any medical diagnosis and treatment before death was appropriate. Studies have shown that even in the modern era of use of high technology scanning and medical tests, the medical cause of death is wrong in about one third of instances unless an autopsy is performed. In about one in ten cases the cause of death is so wrong that had it been known in life the medical management of the patient would have been significantly different.
In the United States, and 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 learned from.
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) 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.