Introduction to autopsy

What are the basic aims of the autopsy? First of all, to discover and record all the identifying characteristics of the deceased. Secondly, to discover and record all the pathological processes, that is diseases, including injuries which are present. Thirdly, to draw conclusions about the identity of the deceased, where that is necessary. And fourthly, to draw conclusions as to the cause of death and factors contributing to death.

The importance of external examination in forensic pathology cannot be over-emphasized. Sometimes it may take two to three times as long as the internal examination or even longer, and it must not be rushed. The proper completion of this part of the examination is one of the core competencies of forensic pathology. It’s a means by which much of the data which will form the basis of opinions and conclusions, is assembled. Such opinions and conclusions are crucial and the data upon which they’re based must be correct, otherwise the conclusions may wrongly convicted an innocent person or wrongly exculpate a guilty one.

So the main element of external examination include measurements, linear measurements of height. They could include linear measurements of leg circumference, cranial circumference, chest abdominal circumference, length of the arms. They’re all circumstances where they may be relevant. Measurement of weight. Whether the body is clothed or unclothed has to be known at that point. Body mass index calculated. General description of eyes, eyebrows, lashes, lids, conjunctiva, sclera, eyeballs. Ears, behind them, in front of them, looking in them with an otoscope. The mouth, the lips, buckle mucosa, the gums, the teeth. The whole face, the scalp, the abdomen. Well you can go on, you can see for the whole body right down to the feet.

All the findings need to be accurately located by description, using technical anatomical terms and fixed points of anatomical reference. This is particularly true of injuries. Where the injuries are, what sort of injuries they are, and their size enables a forensic pathologist to come to conclusions about whether a person has been assaulted, sustained some form of accident or possibly even self-inflicted the injuries.

An internal examination can be as limited or as extensive as required. Maybe in a particular case only a liver biopsy is needed to identify the type of tumor known to be present. At the other end of the spectrum, a full three cavity, cranial cavity, chest and abdominal cavity, three cavity internal examination might be necessary, as it usually is, in a potentially unlawful death.

But in the case of a passenger in a motor vehicle accident who was ejected from the car during a high speed crash with a tree, a crash which was witnessed by several other people, where the multiplicity of severe injuries is obvious and where there has been a comprehensive external examination undertaken and perhaps blood and urine samples taken for alcohol and possibly drug analysis, the extra information to be gained from an internal examination does not justify its performance in most circumstances. Decisions about autopsy should be made in each and every case, not made on a default basis. By which I mean this is that sort of case, therefore autopsy.

But rather these are the circumstances in this case and these are the sorts of questions we need to answer. We can get some of the answers this way or that way. But the only way we can get the answer to the cause of death, perhaps in this potentially unlawful death, a cause of death which may be scrutinized intensely at a trial, is to undertake a full autopsy.

Serious possibility of contamination is that equipment used in previous examinations have not been adequately cleaned. So that, for example, semen taken one examination might contaminate samples taken in a subsequent examination of a different individual. More mundane, but with very serious consequences is contamination within the one examination. So, for example, semen may be present on the outside of the genitalia and in the course of taking samples from inside the vagina, where for the purpose of this example, there is in fact no semen. When introducing or removing the swab stick, it inadvertently collects some of the externally placed semen.

The results of this testing will thus make it appear that there was semen in the vagina, exposing the alleged defendant to much more serious charges. Likewise, semen running out of the vagina over the perineum, the space between a vagina and the anus and running around the entrance to the anus, can easily be caught in swabs of the anal canal. So that is contamination, which may misidentify, the offence rather than the offender. Pathologists need to be able to describe the measures they take to prevent this. In my own case and at my institution, we deal with this by getting experts at taking such samples, sexual assault physicians to do this part of the examination.