An autopsy, or post-mortem examination, is a specialized medical procedure performed by a pathologist to investigate a death. The goals are to establish the specific cause of death (e.g., injury or disease) and the mechanism of death (the physiological derangement resulting in the cessation of life). The procedure also helps determine the manner of death, classifying it as natural, accident, suicide, homicide, or undetermined. The process is crucial for both forensic and clinical cases, providing essential medical and legal information that culminates in a final report.
The True First Step: External Examination and Documentation
The meticulous external examination and comprehensive documentation is the first stage of the autopsy process. Upon arrival, the body is assigned a unique case number, and the chain of custody is established. Initial photographs are taken while the body is still in the evidence bag or sheet, followed by documentation of the clothing and any trace evidence before removal.
This initial physical assessment involves measuring the decedent’s height and weight and noting all distinguishing features. The pathologist carefully documents any scars, tattoos, birthmarks, and evidence of medical intervention like surgical sites or intravenous lines. This visual inspection also records post-mortem changes, such as lividity (blood pooling) and rigor mortis (stiffening), which can help estimate the time of death.
A critical component of the external examination is the collection of trace evidence and biological samples. This can include swabbing for DNA or gunshot residue, collecting hair samples, and taking clippings from underneath the fingernails. The entire external surface is thoroughly examined for injuries, which are measured, described, and photographed before the internal procedure begins.
Transitioning to Internal Investigation
After external documentation, the pathologist begins the internal examination with a surgical incision to access the body’s major cavities. The body is positioned on the autopsy table, often with a block placed under the back to elevate the chest. Multiple incision patterns exist, with the standard method for the trunk often being the “Y” or “I” shaped incision.
The “Y” shaped incision, a common choice in forensic cases, begins at the shoulder tips and runs down to the breastbone before continuing as a single line down to the pubic bone. This cut allows for wide reflection of the skin and muscles, providing clear access to the underlying rib cage and abdominal organs. Special care is taken to avoid cutting into the abdominal organs, which could compromise potential evidence.
The pathologist begins evisceration, the removal of internal organs, once the cavities are open. Organs may be removed individually (Virchow method) or in blocks to preserve anatomical relationships (Letulle or Ghon methods). Each major organ, including the heart, lungs, liver, and kidneys, is meticulously weighed, measured, and examined for macroscopic signs of disease or trauma before dissection.
The Analytical Phase and Final Reporting
Following the physical examination, numerous samples are collected for specialized laboratory analysis. Small pieces of tissue from various organs are preserved for histology and subsequent microscopic examination. This analysis is often necessary to confirm or clarify findings from the gross examination, such as diagnosing early-stage disease or cellular damage.
Fluid samples are collected for toxicology screening to detect drugs, poisons, or other chemical substances. Blood is typically drawn from multiple sites, such as the femoral vein and the heart, to compare concentrations and improve accuracy. Urine and vitreous humor from the eye are also collected, as they provide valuable information about the presence and levels of various compounds.
Once the internal examination is complete and samples are collected, the organs are typically returned to the body, and incisions are carefully sutured. The pathologist then synthesizes all the information—external findings, internal observations, and laboratory results—into a comprehensive medical-legal document. This final report formally assigns the cause and manner of death.