The autopsy process

Review of preliminary information

Prior to conducting a physical examination of the body, the initial stage of an autopsy involves the review of medical records, witness statements and/or circumstantial information and reports surrounding the death.  This information allows the pathologist to construct a differential diagnosis as to what underlying pathologies including disease and injuries may be present in the body.  This preliminary information allows a pathologist to focus on the important issues that may be in doubt about what happened. 

Preliminary tests

On completion of the review of background information, a number of preliminary examinations may have to take place.  These may include: the collection of samples including trace evidence from the surface of the body, removal of clothing and personal possessions for secure storage or examination, and non invasive procedures such as radiographs or xrays.  In some cases it may be necessary to undertake specialized imaging procedures including CT scans or MRI scans of the body.  Photography, including specialised invisible radiation photography such as infrared or ultraviolet imaging, may also be required in selected cases.

External Examination

The physical examination of the body starts with a detailed external examination of the body, which is very similar to the external examination of a living patient.  The eyes, ears, nose and mouth are checked together with the surface of the skin.  Scars and artificial marks such as tattoos are described, and these can assist with confirmation of identity.  Many internal diseases in the body are associated with changes that can appear in the skin, so that a detailed external examination of the body can be of considerable importance in focusing the subsequent internal examination.

Internal Examination

The internal examination of the body is carried out as an extended surgical technique.  The examination takes place in a mortuary environment using instruments that are the same as, or derived from, normal surgical instruments.  Occupational health and safety procedures need to be very carefully observed, as the pathologist and forensic scientific and technical staff  may in some cases be exposed to considerable infectious hazards.

Specimen Collection

During the course of the autopsy, body fluids and tissues may be collected for specialist chemical or toxicological analysis.  This is designed to indicate the presence or absence of particular drugs, poisons or chemicals.  This analysis may be very significant in reconstructing how the death occurred, and in many cases, may reveal the cause of death.  Depending on the types of drugs or poisons involved, it may take many weeks for the analysis of these fluids and tissues to be completed.

Tissue is also collected for histological analysis to help determine the nature and extent of disease or injury that may be relevant to the cause of death.

The Autopsy Report

On completion of all of the scientific and medical tests an autopsy report is completed which contains the results of the autopsy findings together with the results of any specialist tests that may have been undertaken.  In forensic cases, this report is forwarded to the Coroner and together with witness statements, forms the majority of the information the Coroner relies upon in arriving at their legal finding with regards of the death.  The Coroner is a magistrate (lawyer), not a medical practitioner, who makes the final determination as to who the deceased person was, where and when they died, how they died, and the cause of their death.  The findings of the pathologists form a very important part of the Coroner's investigation of the death and the pathologist is often involved in giving evidence at any subsequent inquest.