Weird Medicine

How Autopsy Works: What It’s Really Like To Examine Cause Of Death

Autopsies are carried out if a person's death remains a mystery, to help determine the cause and circumstances. Flickr / CC BY 2.0

Many states in the U.S. have laws that require mysterious deaths be investigated, particularly if they involved injury, poisoning, infectious complications, or foul play — and if the person had exhibited good health overall, prior to death. If someone’s death meets this criteria, the body is required to be examined afterwards in order to determine why and how they died.

The Anatomy Lesson of Dr Nicolaes Tulp The word "autopsy" has been used since the 17th century, but the practice dates back to 3000 BC, when the Egyptions became one of the first civilizations to dissect the body and remove organs during mummification. Rembrandt / Wikimedia

There are two types of autopsy: forensic and clinical. Forensic autopsies are done to define the cause and manner of death, and are often done to serve legal issues: in the U.S., deaths are classified as either natural, accidental, homicidal, suicidal, or undetermined. Clinical autopsies, on the other hand, are performed in order to provide scientists with greater information about pathology and also to keep a check on hospital care and ensure doctors are providing the best services they possibly can. Autopsies are done by forensic pathologists — physicians trained in examining corpses — also considered medical examiners.

The word "autopsy" is derived from ancient Greek, autopsia, which means "to see for oneself." In many ancient civilizations, autopsies were considered sacrilegous, as disfiguring the dead might prevent them from going into the afterlife. One of the first times it was used, however, was in ancient Egypt. The practice was used irregularly throughout Europe until the Renaissance, and in the 19th century the medical researcher Rudolf Virchow created some guidelines and standards for future autopsies.

Dissection, 19th century Though it may seem like a morbid job, autopsies actually provided the field of science and medicine with plenty of answers about illness, pathology, and death: only by opening up and studying the body could scientists see the effects of illness and discover how to better treat it. Wikimedia / CC BY 2.0

Before starting an autopsy, the medical examiners get as much information as they possibly can about the background of the person: including medical records, statements from doctors and family members, as well as the location, circumstances, and people involved with their death. Having this information can help them piece together what exactly happened. Then they delve into a several-step process, viewing the body at nearly every angle possible to help create a whole picture. During this time, the examiners take notes and record things in order to keep track of what they’re seeing.

External Exam

First, investigators inspect the outside of the body — this assists in identifying the person — then check weight and measurements of the body. They examine what might often be seen as the “superficial” qualities of a person — their eye and hair color, as well as the clothes they were wearing. This is also the point in time when the examiners look at the person’s skin, searching for gunpowder residue, or scratches or bruises.

Internal Exam

Then comes the messy part. During the internal examination, the investigators cut open the chest then remove and dissect the organs inside, and sometimes the brain as well. The body is placed on a rubber block to arch it and open up the chest, in order for the examiner to make a Y-shaped incision.

autopsy tools Above are examples of some of the medical examiner's tools used in making incisions and dissecting organs. Flickr / CC BY 2.0

“The most common error [in TV depictions of autopsy] is making the trunk incision wrong,” Dr. Ed Uthman, a pathologist in Texas, told LiveScience. “On women, the two arms of the Y are supposed to curve around under the breasts, but in films, they invariably show them straight and above the breasts. Also, in both sexes, they make the arms of the Y too short; they actually need to extend all the way up to each shoulder joint.”

But this process isn’t as messy as it may seem: because the heart isn’t pushing blood through veins, the body can’t exactly “bleed” when cut: only gravity creates pressure on blood. Using a rib cutter to remove the rib cage, the medical examiner then removes the intestines and the rest of the organs. These organs are often played in formalin for days before dissection, because this keeps them preserved and firms them up — allowing for more precise incisions.

In addition to examining all of the organs, tissue samples and bodily fluids, like blood, urine, bile, or vitreous gel found in the eyes, are also analyzed. This helps the medical examiners determine whether the person had been a drug user or had infections, among other things.

Brain autopsy This image shows a brain being dissected and showing signs of meningitis. CDC/ Dr. Edwin P. Ewing, Jr.

Putting The Body Back Together

Sometimes, the brain or other organs need to be preserved for later use and to find more answers. Otherwise, most organs are placed back into the body or cremated, depending on the law and/or family’s wishes. The body is then lined with cotton wool or another material and sewn shut, washed, and prepared for the funeral. Though seemingly unpleasant, autopsies have assisted researchers in better understanding how illnesses affect the body.