Medlink Conference – Day 4 Venue: University of Nottingham
The Autopsy
An autopsy is a full external and internal examination of the body performed either to confirm the nature of a disease, educate, identify the cause of death or aid in the creation of health statistics.
I learnt a lot about the details in which an autopsy can be carried out and the two different types: the Coroner’s Autopsy and the Consent Autopsy. The Cononer’s Autopsy has the aims to answer who, when, where, how and in what circumstances they died. It is requested by the Coroner and no consent is needed. I was quite surprised to learn that an autopsy was allowed to be carried out without consent in this manner, however, I can now understand why it may be necessary in certain circumstances which I will mention later.
The Consent Autopsy aims to answer clinical questions. It is often requested by a Clinician but requires permission from the next of kin. There are certain situations in which the Coroner must be contacted if a person died in that manner and he/she is then able to request an autopsy. These circumstances include of the death is unknown, violent, suicide, an accident, if the person wasn’t seen by a doctor within fourteen days prior to the death, if it’s suspected that the death may be due to an abortion, death in police custody or any other place in which they do not have their own freedom. This was a real eye opener for me as I had always thought autopsies were only carried out with the request of the family, I was not aware that there was a strict set of guidelines which are used to decide whether a person’s must have an autopsy or not.
I also learnt about ten basic procedure in which an autopsy is carried out. One of the most important aspects which was emphasised was that all materials must be reunited with the body and can only be kept with the express permission of the next of kin. The basics steps for the procedure is as follows:
- External Examination: this is similar to a clinical examination with a living patient. Injuries and signs of disease are noted and X-rays may also be conducted. Tattoos are used to help with identification if the person has not yet been identified and to help build a prediction of their background. Specific wound and marks can also be examined to attempt to identify the cause of the death.
- Internal Examination: the body is dissection with a Y-shaped incision from each rear lobe, around the neck and then down the best and the abdomen. All the organs are then removed and dissected further. The brain is also removed in all cases.
- Other Investigations: this involves referring certain aspects of the findings to different departments such as Histology, Microbiology, Toxicology and Genetic Studies.
I was able to see photographs of each stage and I was quite overwhelmed by the detail of which the autopsy was carried out. It appeared to be really thorough which is not how I had imagined it to be. I previously thought that an autopsy would only focus on the part of the body which appeared to have been causing the problems, but this clearly isn’t the case as all the organs are always examined.
I am now able to reflect on some of the benefits of carrying out an autopsy for the family, clinical staff and society as a whole. It will allow the family to feel content with a final answer and perhaps provide them with relevant genetic information which could enhance their care. Clinical staff could benefit through further education of a particular disease through an autopsy or even just confirming the diagnosis. Autopsies also allow an evaluation of surgical procedures, to create mortality statistics and allow further investigation of new and prevalent diseases – these will all benefit the wider population.
Forensic Pathology
Forensic Pathologists work for the Coroner and deal with more suspicious deaths than Histopathologists. They are involved in scene examinations, autopsies and court cases. I surprised to learn that there is only 36 Forensic Pathologists in the UK!
Who? Forensic Pathologists use primary identification methods to attempt to answer this question, such as fingerprints, DNA or other unique characteristics such as surgical implants. Secondary identification methods include looking for a driver’s licence or bank card. These are less reliable as you can’t be sure it belongs to the individual. Body modifications such as tattoos can also be a clue and other distinctive marks such as radiotherapy scarring. However, these are also not as reliable as they may not be unique and therefore cannot be solely relied upon to identify the person.
Where? In order to answer this question they must go to the crime scene.
When? I learnt that the only correct answer they can give to establish the time of death is by saying the person died between the time they were last seen and the time they were found dead. However, they can try to narrow this down a little by making an educated guess due to the amount of decomposition.
How? Abrasions, they can look at bruises and their patterns; lacerations; incised wounds and their shapes; bite marks which could lead them to the offenders DNA. Projectiles can also be used as with shotgun injuries it can indicate whether it was shot from a distance by somebody else or close up which could suggest it was suicide.
I found this rather fascinating due to the minute details which must be considered in order to come to a conclusion. I am able to conclude that in order to hold down a job within the field of Medicine you must be very self aware and have an eye for detail. It is very important to poses the ability to notice something which may be undulating and therefore indicate towards a certain disease or illness. I think this would be a very useful quality to possess or develop.
Life of a Medic 