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Autopsy
An autopsy, also known as a post-mortem examination or an obduction, is a medicalprocedure that consists of a thorough examinationof a corpseto determine the cause and manner of a person's deathand to evaluate any diseaseor injurythat may be present. It is usually performed by a specialized medical doctor called a pathologist. A necropsy is a post-mortem examination performed on an animal and it is vulgar usage to apply this term to human beings.
General informationThe term "autopsy" derives from the Greekfor "to see for oneself". "Necropsy" is from the Greek for "seeing a dead body". There are two types of autopsies:
While dissectionof human remains for medical reasons has been practised irregularly for millennia, on channel 4 autopsies have been shown and have been very controversial, the modern autopsy process derives from the anatomistsof the Renaissance. The two great nineteenth-centurymedical researchers Rudolf Virchowand Carl von Rokitanskybuilt on the Renaissance legacy to derive the two distinct autopsy techniques that still bear their names. Their demonstation of correspondences between pathologicalconditions in dead bodies and symptomsand illnesses in the living opened the way for a different way of thinking about diseaseand its treatment. Forensic autopsyIn United Stateslaw, deaths are placed in one of five categories of causes:
Following an in-depth examination of all the evidence, a medical examiner or coronerwill assign a cause of deathas one of the five listed above. The processThe body is received at a medical examiner's office or hospital in a body bagor evidence sheet. A brand new body bag is used for each body to ensure that only evidencefrom that body is contained within the bag. Evidence sheets are an alternate way to transport the body. An evidence sheet is a sterilesheet that the body is covered in when it is moved. If it is believed there may be any significant residueon the hands, for instance gunpowder, a separate paper sack is put around each hand and taped shut around the wrist. There are two parts to the physical examination of the body: the external and internal examination. Toxicology, biochemical testsand/or genetic testingoften supplement these and frequently assist the pathologistin assigning the causes or causes of death. External examinationThe person responsible for handling, cleaning and moving the body is often called a diener, the Germanword for servant. After the body is received, it is first photographed. The examiner then notes the kind of clothes and their position on the body before they are removed. Next, any evidence such as residue, flakes of paint or other material is collected from the external surfaces of the body. Ultravioletlight may also be used to search body surfaces for any evidence not easily visible to the naked eye. Samples of hair, nailsand the like are taken and the body may also be X-rayed. Once the external evidence is collected, the body is removed from the bag, undressed and any woundspresent are examined. The body is then cleaned, weighed and measured in preparation for the internal examination. The scaleused to weigh the body is often designed to accommodate the cartthat the body is transported on; its weight is then deducted from the total weight shown to give the weight of the body. If not already within an autopsy room, the body is transported to one and placed on a table. A general description of the body as regards race, sex, age, hair colorand length, eye colorand other distinguishing features (birthmarks, old scartissue, moles, etc) is then made. A handheld voice recorderor a standard examination form is normally used to record this information. Internal examinationIf not already in place, a plastic or rubber brick called a "body block" is placed under the back of the body, causing the arms and neck to fall backward whilst stretching and pushing the chestupward to make it easier to cut open. This gives the prosector, a pathologist or assistant, maximum exposure to the trunk. After this is done, the internal examination begins. The internal examination consists of inspecting the internal organsof the body for evidence of traumaor other indications of the cause of death. For the internal examination, a large and deep Y-shaped incisionis made from shoulder to shoulder meeting at the breastboneextending all the way down to the pubic boneand will make a slight deviation to the side to avoid the navel. If the body is that of a woman, the incisions are made to go around the breasts so that the arms of the "Y" have a slightly curved appearance. Bleedingfrom the cuts (if there even is any) is minimal, because gravityis producing the only blood pressure. An electric sawdubbed a "Stryker saw" is most often used to open the chest cavity. The prosector uses the toolto saw through the ribs on the lateral sides of the chest cavity to allow the sternumand attached ribs to be lifted as one chest plate; this is done so that the heart and lungs can be seen in situand that the heart, in particular the pericardial sacis not damaged or disturbed from opening. A scalpelis utilized to remove any soft tissue that is still attached to the posterior side of the chest plate. Now the lungsand the heart are exposed. The chest plate is set aside and will be eventually replaced at the end of the autopsy. At this stage all the organsare exposed. Then a series of cuts, along the vertebral column, 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 vesselsare cut open and inspected at this stage. Next the stomachand its contents are examined and weighed. This could be useful to find the cause and time of death. The body block that was utilized earlier to elevate the chest cavityis now used to elevate the head. To examine the brain, a cut is made from behind one ear, across the forehead, to the other ear and around. These incisions are made on the back of the headso that when the autopsy is completed, the incisioncan be neatly sewn up and is not noticed when the head is resting on a pillow in funeralwhere it is open casket. The scalpis pulled away from the skullin 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 sawto create a "cap" that can be pulled off, exposing the brain. The dura- the soft tissue membranethat covers the brain remains attached to the "cap". The brain's connection to the spinal cordis severed, and the brain can then be easily lifted out of the skull for examination. If the brain needs to be preserved before being inspected, it is contained in a jar of formalin(Ten percent solution of formaldehydegas in buffered water) for at least two weeks. This not only preserves the brain, but also makes it firmer allowing easier handling without corrupting the tissue. Reconstitution of the bodyAn 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 cavitywith 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 shroudand 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 parlorafter embalming. Other informationThe principal aim of an autopsy is to discover the cause of death, to determine the state of health of the person before he or she died, and whether any medical diagnosisand 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 most Western countriesthe number of autopsies performed in hospitals has been decreasing every year since 1955. Critics, including pathologistand former JAMAeditorGeorge 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 lessons learned. 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 murdervictims, especially when medical examiners are looking for signs of death or the murder method, such as bulletwounds and exit points, signs of strangulation, or traces of poison. See also
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fr:Autopsie gl:Autopsia it:Autopsia id:Otopsi ja:検死 nl:Autopsie pl:Sekcja zwłok pt:Autópsia fi:Ruumiinavaus Categories: Death| Pathology
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