The art and science of medicine did not advance past myth and “bad humors” until the 1700s, when autopsy started identifying different disease states.
Below is a respectful guide of procedure during autopsy. It is meant to demystify the process and separate the facts of routine autopsy from the fiction that we see on TV or read about in novels.
The pathologist first examines the outside of the body. A great deal can be learned in this way. Many pathologists use scalpels with rulers marked on their blades.
The body is opened using a Y-shaped incision from shoulders to mid-chest and down to the pubic region. If the head is to be opened, the pathologist makes a second incision across the head, joining the bony prominences just below and behind the ears. When this is sewed back up, it will be concealed by the pillow on which the dead person's head rests.
The pathologist uses a scalpel for these incisions. There is almost no bleeding, since a dead body has no blood pressure except that produced by gravity.
The incisions are carried down to the skull, the rib cage and breastbone, and the cavity which contains the organs of the abdomen. The scalp and the soft tissues in front of the chest are then reflected back. Again, the pathologist looks around for any abnormalities.
One pathologist prepares to open the skull, using a special vibrating saw that cuts bone but not soft tissue. This is an important safety feature.
Another pathologist cuts the cartilages that join the ribs to the breastbone, in order to be able to enter the chest cavity. This can be done using a scalpel, a saw, or a special knife, depending on the pathologist's preferences and whether the cartilages have begun to turn into bone, as they often do in older folks.
The third pathologist explores the abdominal cavity. The first dissection in the abdomen is usually freeing up the large intestine. Some pathologists do this with a scalpel, while others use scissors.
The skull vault is opened using two saw cuts, one in front, and one in back. These will not show through the scalp when it is sewn back together.
When the breastbone and attached rib cartilages are removed, they are examined. Often they are fractured during cardiopulmonary resuscitation.
Freeing up the intestine takes some time. The pathologist cuts along the attachment using a scalpel.
The top of the skull is removed, and the brain is very carefully cut free of its attachments from inside the skull.
The chest organs, including the heart and lungs, are inspected. Sometimes the pathologist takes blood from the heart to check for bacteria in the blood. For this, he uses a very large hypodermic needle and syringe. He may also find something else that will need to be sent to the microbiology lab to search for infection. Sometimes the pathologist will send blood, urine, bile, or even the fluid of the eye for chemical study and to look for medicine, street drugs, alcohols, and/or poisons.
Then the pathologist must decide in what order to perform the rest of the autopsy. The choice will be based on a variety of considerations. Usually the team will remove organs individually. After the intestines are mobilized, they are opened using special scissors.
Inspecting the brain often reveals surprises. A good pathologist takes some time to do this.
The pathologist examines the heart, and generally the first step following its removal is sectioning the coronary arteries that supply the heart with blood. There is often disease here, even in people who believed their hearts were normal.
After any organ is removed, the pathologist will save a section in preservative solution. Of course, if something looks abnormal, the pathologist will probably save more. The rest of the organ goes into a biohazard bag, which is supported by a large plastic container.
The pathologist weighs the major solid organs (heart, lung, brain, kidney, liver, spleen, sometimes others) on a grocer's scale. The smaller organs (thyroid, adrenals) get weighed on a chemist's triple-beam balance.
The next step in this abdominal dissection will be exploring the bile ducts and then freeing up the liver. The liver is cut at intervals of about a centimeter, using a long knife. This enables the pathologist to examine its inner structure.
After weighing the heart, the pathologist completes the dissection. There are a variety of ways of doing this, and the choice will depend on the case. If the pathologist suspects a heart attack, a long knife may be the best choice.
The liver is then removed and examined. Next, the pathologist removes the neck organs, large airways, and lungs in one piece. This requires careful dissection. The pathologist always examines the neck very carefully.
The lungs are almost never normal at autopsy. The pathologist will inspect and feel them for areas of pneumonia and other abnormalities.
The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative.
The rest of the team is continuing with the removal of the other organs. They usually take the urinary system as one piece, and the digestive system down to the small intestine as another single piece. This will require careful dissection.
One pathologist holds the esophagus, stomach, pancreas, duodenum, and spleen. He will open these, and may save a portion of the gastric contents to check for poison.
Another pathologist holds the kidneys, ureters, and bladder. Sometimes these organs will be left attached to the abdominal aorta. The pathologist will open all these organs and examine them carefully.
Dissecting the lungs can be done in any of several ways. All methods reveal the surfaces of the large airways, and the great arteries of the lungs. Most pathologists use the long knife again while studying the lungs. The air spaces of the lungs will be evaluated based on their texture and appearance.
Before the autopsy is over, the brain is usually suspended in fixative for a week so that the later dissection will be clean, neat, and accurate. If no disease of the brain is suspected, the pathologist may cut it fresh.
The kidneys are weighed before they are dissected.
When the internal organs, have been examined, the pathologist may return all but the portions they have saved to the body cavity. Or the organs may be cremated without being returned. The appropriate laws, and the wishes of the family, are obeyed.
The breastbone and ribs are usually replaced in the body. The skull and trunk incisions are sewn shut. The body is washed and is then ready to go to the funeral director.
Pathologists will submit the tissue they saved to the histology lab, to be made into microscopic slides. When these are ready, they will examine the sections, look at the results of any lab work, and draw their final conclusions.
A final report is ready in a month or so. The glass slides and a few bits of tissue are kept forever, so that other pathologists can review the work.
-- The Internet Journal of Forensic Medicine and Toxicology
UPDATED: 10-30-2005
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Dr. Margaret Uthman is an associate professor of pathology and director of hematopathology at the UT Medical School.
See Dr. Uthman also at:
Dr. L. Maximilian Buja is a professor in pathology and vice president of Academic Affairs for UT Health Science Center at Houston.
See Dr. Buja also at:
Food Irradiation
and Safety
On August 22, 2008, the Food and Drug Administration (FDA) published a final rule that allows the use of irradiation to make fresh iceberg lettuce and fresh spinach safer and last longer without spoiling.
Irradiating fresh iceberg lettuce and spinach will help protect consumers from disease-causing bacteria such as Salmonella and Escherichia coli O157:H7 (E. coli). Illnesses from these bacteria range from uncomfortable symptoms to life-threatening health problems.
The foods affected by the final rule are
Irradiation (also sometimes termed "ionizing radiation") is a process of treating products with a measured dose of radiation. Food irradiation is not new. FDA has conducted irradiation safety evaluations for more than 40 years and has determined the process to be safe for use on a variety of foods.
After studying the safety of irradiating fresh iceberg lettuce and fresh spinach, FDA has determined that these greens, when irradiated under the conditions specified in the final rule, retain their nutrient value and are safe to eat.
FDA considers irradiation a complement to, not a replacement for, proper food-handling by producers, processors, and consumers. Irradiation is just another tool to reduce the levels of disease-causing microorganisms on fresh iceberg lettuce and fresh pinach.
Irradiation does not take the place of washing. FDA continues to recommend that consumers wash fresh and bagged produce before eating unless the packaging specifically states that the product has been pre-washed.
For more information, go to: http://www.fda.gov)
