Autopsy

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Autopsy
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Definition of Death

• UNIFORM DETERMINATION OF DEATH ACT
• Irreversible cessation of circulation of blood in
  the body
• Irreversible cessation of all respiratory
  functions
• Irreversible cessation of all function of the
  entire brain (including the brain stem)

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Autopsy

• An autopsy is also known as a post-mortem
  investigation.
• The word "autopsy" comes from the Greek words
  "auto" and "opsis", and it literally means "to
  see for oneself".
• An autopsy is performed to determine the cause,
  manner and mechanism of death.

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Autopsy

• The first known legal autopsy was ordered by a
  magistrate in Bologna in 1302.
• To understand the human anatomy better, and to
  improve their skills, the artists Leonardo da
  Vinci and Michelangelo each performed autopsies.
• The autopsy really became significant in 1761,
  when Giovanni Morganni published his great work
  On the Seats and Causes of Diseases as
  Investigated by Anatomy. This work contained
  descriptions of 700 autopsies.

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Autopsy

• Today there are two types of autopsies medical
  and legal.
• A medical or clinical autopsy is performed to
  determine the medical cause of death or for
  research purposes.
• A legal or forensic autopsy is performed when the
  cause of death is a possible criminal manner.

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Before Body Disposal

• Organ donation the removal of tissues from a
  recently deceased body or a living donor.
• Organs, tissues, stem cells and blood and
  platelets may be donated.
• Most people can be donors (HIV positive, cancer
  active or systemic infection cannot donate).

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Before Body Disposal (cont)

• The organs that may be donated are the kidneys,
  heart, lungs, liver, pancreas, and the
  intestines.
• Donated organs must be transplanted within 6-72
  hours and cannot be stored.
• Tissues, stem cells, blood and platelets may be
  stored for later use.

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Before Body Disposal (cont)

• Currently, 99,450 people are on the waiting list
  for a donation.

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Body Disposal

• There are many opinions about the correct way to
  dispose of a body.
• These opinions may be influenced by religion,
  fear, cultural beliefs and taboos.

• Methods of disposal include
• Burial
• Eco-Cemetery
• At sea
• Sky burial
• Cremation
• Mummification
• Medical Research
• Stuffed
• Lye
• Freeze dried

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Who Performs An Autopsy

• A medical autopsy will be performed by a
  pathologist at the hospital.
• A forensic autopsy will be performed by a Medical
  Examiner (M.E.) at the Morgue.
• A coroner does not perform an autopsy.
• A funeral director or mortician does not perform
  an autopsy.

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What is the Purpose of An Autopsy?

• The M.E. will perform an autopsy to
• Identify the deceased
• Establish approximate time and date of death
• Determine the manner, cause and mechanism of
  death
• Other duties of the M. E. include
• Collecting Evidence from the clothing and body of
  the deceased
• Protecting the estate of the deceased
• Notifying the next of kin

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The Body Arrives at the Morgue or M.e.s Office

• 1. The body bag is unsealed and opened.
• 2. The body is photographed in the body bag.
• 3. Description of the clothing is recorded.
• 4. Evidence is collected from the clothing and
  the body.

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The Body Arrives at the Morgue or M.e.s Office

• 5. If it is a homicide investigation, the hands
  will have been bagged at the scene. The M.E. will
  remove the bags and collect fingernail scrapings.
• 6. UV radiation is used to enhance any secretions
  that should be collected.
• 7. X-rays are taken.
• 8. The body is removed from the bag and undressed
  in preparation for the external examination.

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The External Examination

• During the external examination, any wounds,
  bruises, scars, etc. will be examined, measured
  and recorded.
• The body is also weighed and fingerprinted during
  this stage of the autopsy.

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The External Examination (cont)

• During the external examination, the M.E. will
  also observe and record all of the information
  related to decomposition.
• This information is very important for the
  determination of time of death, body position at
  the time of death and location of the body at the
  time of death.

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9 Ways of Estimating Actual Time of Death

• Rigor mortis
• Algor mortis Body Core Temperature
• Livor mortis (Lividity)
• Potassium levels in vitreous humor and the
  clouding of the cornea
• Stomach Contents
• Evidence of Decomposition
• Presence/absence of purge fluids
• Drying of the tissue
• Insect Larval Instars

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Rigor Mortis

• Rigor Mortis- is the state of rigidity that
  results from release of lactic acid after death
  the bodys pH changes from alkaline to acid.
• Rigidity begins with shorter muscles of the face
  and extremities, the fingers and toes then the
  neck moves down and out the long muscles of the
  extremities and the forearms with the legs
  stiffening last. The process is reversed in the
  same order until the body is no longer stiff.

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Approximate Time Frame of Rigor Mortis

• Time After Stage of Rigidity
• Death
• 1-4 hours jaws neck rigid rest of body limp
• Up to 8 hrs everything down to the legs is
  rigid
• For 12 hrs everything remains rigid
• 24 hrs jaw is limp but everything else is rigid
• 30-32 hrs everything but the legs are limp
• 36 hrs no rigidity

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Circumstances that effect rigor mortis

• Starvation thinner bodies stiffen faster
• Extreme temperatures cooler temperatures slow
  onset of rigor
• Physical exertion right before death speeds the
  onset of rigor
• Victims of drowning will not show signs of rigor
  until removed from the water

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Algor Mortis

• Algor Mortis- process in which the body
  temperature continually cools after death until
  it reaches room temperature. It is also called
  the death chill.
• The body temperature will be taken at the crime
  scene. The temperature may be a rectal or liver
  reading.
• The body generally loses 2 degrees in the first
  hour and then at a rate of 1 to 11/2 degrees per
  hour.
• Once a body has reached ambient temperature,
  temperature will no longer aid in time of death.

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Circumstances that effect Algor Mortis

• Body Size a larger body cools much slower.
• Clothing- the more clothing on the body the
  slower it cools.
• Body temperature at time of death if someone
  has a fever when they die that must be considered
  when calculating rate of cooling.
• Ambient Temperature if someone dies in a cold
  location then the body will cool off sooner.

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Rigor mortis And Algor mortis used together
Temperature of Body to the touch Stiffness of Majority of the Body Time since Death
Warm Not Stiff Dead for less than 3 hours
Warm Stiff Dead between 3 and 8 hours
Cold Stiff Dead between 8 and 36 hours
Cold Not Stiff Dead longer than 36 hours
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Livor Mortis

• Livor mortis is the settling of the blood,
  causing the skin to change colors. Due to
  gravity, blood settles in the lowest parts of the
  body. However, body parts that are in contact
  with the floor or other objects will not develop
  lividity patterns.
• Lividity indicates the position of the body after
  death. When lividity becomes fixed, then the
  distribution of the lividity pattern will not
  change even if the bodys position is altered.
• Lividity usually becomes fixed between 10 and 15
  hours after death.

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Livor Mortis

• Time after death when lividity patterns are
  visible
• ½ hour - 1st seen on a fair-skinned individual
• 4-8 hrs- lividity is fixed

• The lividity patterns indicate that this person
  died while lying on their back.

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Importance of Livor Mortis

• 1. Patterns can help to establish time of
  death.
• 2. Patterns can indicate if the body has been
  moved.

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Clues from the eyeball
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Stomach contents

• The stomach empties 4-6 hours after a meal.
  Therefore, if the stomach is empty, death likely
  occurred several hours after eating.
• If the small intestine is empty, death probably
  occurred 24 hours after the victims last meal.
• If the colon is empty, death likely occurred
  48-72 hours after last meal.
• The type of food eaten and the amount will affect
  this timeline.

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Decomposition, Purge Fluids and dry decay

• Decomposition begins immediately after death.
• The bacteria in the intestinal tract is released
  into the rest of the body where it begins to
  breakdown tissues. This process is known as
  putrefaction.
• Enzymes in the cells break down the cells and
  begin self-digestion throughout the body. This
  process is known as autolysis.
• Both of these processes release gas which is
  responsible for the smell associated with
  dead/decaying organisms.

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Decomposition, Purge Fluids and dry decay

• The breakdown of the tissues may take several
  days up to several years.
• This occurs in four stages
• 1. Fresh or Initial
• 2. Putrefaction
• 3. Black Putrefaction
• 4. Dry Decay

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Decomposition, Purge Fluids and dry decay

• Fresh/Initial decay (first 24 hours)
• Corpse appears normal, but internal bacterial
  decay and autolysis has begun.
• Putrefaction (2-5 days)
• Corpse is swollen due to build up of gases and an
  odor is obvious. The corpse has a greenish color.
  Skin blisters form, eyeballs collapse, hair
  begins to fall out and the skin recedes from
  nails.
• The skin begins to look marbled due to blood
  vessels forming a web-like pattern.

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Decomposition, Purge Fluids and dry decay

• Black Putrefaction (5-10 days)
• There is a very strong odor. The flesh appears
  black, gases continue to escape and the corpse
  collapses.
• Purge fluids leak from the mouth and nose.
• Skin slippage occurs and eyeballs liquify.
• Dry Decay (10 days until complete)
• Corpse is almost dry so further decay slows from
  lack of moisture. Approximately one year must
  pass before all smell is gone from the bones.

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Insect larval Instars

• This will be a factor if the body was located so
  that insects had access to the body.
• Flies will lay eggs on the body. Maggots hatch
  from the eggs within 24 hours. The maggots mature
  through three different instar stages. The length
  of the maggot will indicate which instar stage
  and aid the M.E. to estimate time of death.

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Internal Examination

• After the external examination and decomposition
  analysis is complete and all information is
  recorded, the M.E. will prepare the body for the
  internal examination.
• A body block will be placed under the back of the
  body to cause the arms and neck to fall backwards
  and the chest to protrude forward. The makes it
  easier to make the Y-incision on the torso.

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Internal Examination

• The V-part of the Y incision is cut from the left
  shoulder, down under the nipples and over to the
  right shoulder. Then the scalpel is placed in
  the pit of the abdomen, below the sternum and cut
  straight down and left of the belly button to
  form the rest of the Y incision.
• Shears are used to open the chest cavity.
• A saw is used to cut through the ribs and
  sternum. The entire chest plate is removed.

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Internal Examination

• Next, the organs will be removed from the body.
  There are two Methods for Organ Removal. Each
  method was designed by and named for German
  pathologists.
• The Rokitansky procedure organs are removed all
  at once and then examined.
• The Virchow procedure each organ is removed
  separately and immediately examined.

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Internal Examination

• No matter how they are removed from the body,
  each organ is weighed and examined.
• Small slivers may be cut from an organ for
  microscopic examination.

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Internal Examination

• The organs will be inspected for the following
• Heart- trauma damage stenosis ventricular
  fibrillation
• Lungs- trauma toxic gases, vapors and dusts
  fire CO, heroin overdose lung disease
• Liver cirrhosis trauma damage

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Internal Examination

• Stomach- drug overdose stomach contents
• Bowel- sliced and stripped trauma and disease
  drug packages
• Head- brain removed, weighed, sectioned and
  checked for internal trauma
• Kidneys- failure jaudice BUN test ( urea
  nitrogen in blood)

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Internal Examination

• Next, the brain is examined.
• The M.E. makes a cut from ear to ear on the back
  of the head.
• The scalp is peeled forward to expose the skull.
  The skull is examined for any contusions.
• A skull saw is used to cut off the top halve of
  the skull and expose the brain.

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Internal Examination

• The brain is observed while in the skull and then
  removed.
• If the brain needs to be preserved for later
  inspection it is placed in formalin.

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The Final steps

• All of the organs are placed in a plastic bag to
  prevent leakage. The bag is placed inside the
  body cavity.
• The chest plate and skull cap are replaced.
• The chest flaps and scalp are sewn back together.
• The body is then returned to the family and
  disposed.

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m.e.s report

• The M.E. uses all of the information from the
  autopsy to determine the cause, manner and
  mechanism of death.
• These will be listed on the Death Certificate.
• These findings also determine if the death was
  due to a crime.

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The Cause of death

• The cause of death is the illness or injury that
  actually begins the dying process. Examples
  include
• Gunshot wound
• Drowning
• Blunt Force Trauma
• Strangulation
• Stab Wound

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The Mechanism of Death

• The mechanism of death is the physiological
  reason that a person dies.
• Examples include
• Lack of oxygen
• Loss of Blood
• Shock
• Sepsis

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The Manner of death

• There are five manners of death
• Accident
• Homicide
• Natural Causes
• Suicide
• Undetermined
• The manner of death may be changed once on a
  death certificate. An undetermined manner is only
  used until a final decision is made.

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Cause, manner and mechanism of death

• One can die of a massive hemorrhage (the
  mechanism of death) due to a gun shot wound
  through the head (cause of death) as a result of
  being shot (homicide), shooting yourself
  (suicide), dropping a gun and it discharging
  (accident), or not being able to tell which
  (undetermined). All of which are manners of
  death.

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Medical Examiner vs Coroner

• Many areas of the United States do not have the
  demand or budget to support a Medical Examiners
  office. In this case, a coroner will investigate
  the death and complete the death certificate.
• However, a coroner cannot perform an autopsy. So
  they will have to have the nearest M.E. perform
  the autopsy.

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Medical Examiner vs Coroner

• A medical examiner is a medical doctor, usually a
  pathologist and is appointed by the governing
  body of the area. There are 400 forensic
  pathologists throughout the U.S.
• A coroner is an elected official who usually has
  no special medical training. Many coroners have
  only a high school education.
• Sometimes the local funeral director will also be
  the coroner.

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MedicalExaminersReport
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Body DisposalBurial

• After death, most families use the services of a
  funeral home.
• A funeral home, funeral parlor or mortuary, is a
  business that provides burial and funeral
  services for the deceased and their families.
• The funeral home will embalm the body and help
  with burial arrangements.
• The word burial comes from the word birgan which
  means to conceal.

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The Process of Embalming

• Embalming is done to delay decomposition and
  allow time for the funeral.
• Blood and body fluids are removed and replaced
  with embalming fluid.

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Body DisposalBurial

• Tom M Wages Funeral Services, LLC located in
  Lawrenceville, Georgia

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Body DisposalBurial

• A coffin is the general term for the container in
  which a corpse is buried.
• Coffins have been made of clay, stone,
  papier-mache, turtle shells, baskets, fabrics,
  and metals.
• Coffins are sculpted to the body shape.

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Body DisposalBurial

• For many years, coffins were a symbol of social
  status.
• The poor were buried in a shroud.
• However, the poor were transported to the
  cemetery in a slip-coffin.
• A slip-coffin had a hinged bottom to allow the
  body to drop into the grave.
• The coffin was then returned to the church for
  reuse.