An autopsy is a systematic medical examination of a body after death to determine the cause, manner, and mechanism of the demise. The process is highly structured, performed either for medical purposes (clinical autopsy) to learn more about a disease or for legal purposes (forensic or medicolegal autopsy) to investigate a suspicious or unexpected death. The examination methodically proceeds from background investigation to the physical examination, ensuring all facts surrounding the death are established.
Administrative and Historical Review
The first actions in an autopsy procedure occur entirely outside the examination room, beginning with the necessary legal and administrative formalities. Securing the proper authorization is paramount, whether through legal instruction from a coroner or medical examiner for a forensic case, or consent from the next of kin for a clinical examination. This step legally permits the pathologist to proceed with the postmortem investigation.
Once authorized, a detailed review of all available background information provides crucial context for the physical examination. This review includes the deceased’s medical history, police reports, and documentation from the death scene, such as witness statements or paramedic notes. The identity of the deceased must also be positively confirmed through methods like fingerprinting, dental records, or unique physical identifiers. Maintaining an unbroken chain of custody for the body and all associated evidence is meticulously documented from the moment the body is received to ensure the integrity of the findings.
External Examination and Documentation
The physical autopsy procedure begins with a thorough external examination of the body before any modifications are made. With the body placed on the autopsy table, a detailed visual inspection is conducted from the top of the head down to the tips of the toes. This phase establishes a baseline condition and documents any evidence present on the body’s surface.
Standard forensic photography is performed, capturing the body as received, including any clothing, medical devices, or external injuries. Specialized photography, such as ultraviolet or infrared, may be used to document trace evidence or patterned injuries not visible to the naked eye. The pathologist records standard measurements, including the height and weight of the deceased.
This inspection also involves documenting postmortem changes like livor mortis (discoloration from blood pooling) and rigor mortis (stiffening of the muscles), which help estimate the time of death. Any signs of trauma, such as abrasions, contusions, or lacerations, are precisely measured, described, and diagrammed. Trace evidence, which may include hairs, fibers, or gunshot residue, is carefully collected from the skin surface and fingernails before the body is cleaned or moved.
Initial Internal Access and Sample Collection
The transition to the internal procedure begins with the creation of a standard incision to access the major body cavities. The most common approach for the torso is the Y-shaped incision, extending from the shoulders down to the pubic bone, or a modified straight cut (I-incision) running vertically. This opening allows the pathologist to examine the thoracic and abdominal contents.
An immediate and time-sensitive step after gaining access is the collection of initial biological fluids for toxicology and chemical analysis. Samples are preferentially collected from peripheral sites, such as blood from the femoral vein, to minimize potential redistribution artifacts that occur after death. Urine and vitreous humor (the fluid from the eye) are also collected, as these samples are less prone to contamination and provide valuable data on drug or alcohol levels.
The collection of these samples must occur before the organs are removed or manipulated to prevent cross-contamination. Collecting uncontaminated specimens sets the stage for the full internal analysis, providing necessary evidence to determine if chemical agents or poisons contributed to the cause of death.