What Happens During An Autopsy / Pathological Examination?

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Autopsies. What happens during an autopsy?

We’ve all seen it in cop shows, we’re in a cold white morgue, a dead body lies on a slab, the cop comes in, the pathologist pulls back a plastic sheet, and wham, we see an obvious injury, and if you’re lucky you get to see some boobs, bush, bott-bott or (for the ladies) a wiggly bit of winkle.

Admit it! I know you all pause those scenes in Silent Witness, and if anyone comes into the room you say “oh I just paused it whilst I was just making a cup of tea, that’s all, and I definitely wasn’t ogling the dead man’s rather delightful blue-veined piccolo, pink obo, or fleshy love-trumpet”. Unless – of course - it’s Tom Hardy, but he’ll never pop his lad out in the flicks as he’s a classy actor now.

That said, he did, in that film Bronson, remember that? Where he was stark bollock naked for like half the film and (in that one scene) he shouted “lube me up”, which the prison guard did, with handfuls of Vaseline? What? Didn’t you know about that? That explains why you’re all sweaty. Look, if you ladies or gents weren’t aware that Tom Hardy is totally starkers in Bronson, feel free to go and download it on Netflix, we’ll wait for you, don’t worry. (Whistles). Hmm, they may be a while. I tell you what, we’ll carry on without them, they won’t be able to concentrate anyway.
 
So, what is an autopsy?
Also called a post-mortem examination or a necropsy, an autopsy can be either an external and/or an internal examination of a whole body, or just a single organ, to determine cause of death, whether by accident, homicide, suicide, negligence, infectious disease or natural event. Autopsies are also used to identify a person in times of natural or manmade disasters, and for research purposes. Autopsy derives from the Greek word autopsia: meaning "to see with one's own eyes".

Does every death require an autopsy?
No. Only if the manner of death is suspicious, unexpected, undetermined or could present a significant risk to public health, or has legal or financial ramifications. Autopsies can be requested by the health authority, police, hospital, coroner or the family themselves.
 
What happens before an autopsy?
This is a key step overlooked by TV shows, but the body has to be transported to the mortuary, and to ensure any vital evidence is preserved, the body is placed in a HRP (a human remains pouch, also known as a body bag). Conceived during World War One, originally this was a simple cotton cover, by the Vietnam war it had been replaced by a thick black rubber sack, but today HRP’s are thick sealed waterproof plastic bags, designed to retain even the smallest of remains (whether hair, blood, purge fluid, powder, dirt etc), and that’s the reason the bags are white.

A new body bag is used for each person and they are completely sterile. Any body parts which are believed to hold significant evidence (whether fingers or feet) are also wrapped in paper sacks and are sealed and taped shut. The body is then tagged and catalogued to avoid confusion.
 
The autopsy is split into two parts; an external and an internal examination, although the type of examination is entirely dependent on what the perceived death is. First is an external examination:
Step #1 – the body is photographed before it is moved, creating a record of how it was received, the pathologist also notes down the position of the body, any clothing, visible scars or injuries.
Step #2 – with the body still in the HRP, the body’s basic details are recorded; age, sex, race, weight, height, hair, skin and eye colour, tattoos, surgical scars, birth marks, etc.
Step #3 – any unnatural residue (such as dirt, oil, paint) is collected from the surface of the body for examination, and an Ultraviolet light is used to check for any residue not visible to the naked eye.
Step #4 – samples of hair, skin and blood are taken (if required) and – if needed – the body is radiographically imaged using an MRI, to see inside before a single incision has been made

These four steps are done all whilst the body is still in the HRP, to ensure that any evidence is retained inside the white plastic bag. Only then can we reach…

Step #5 – the body is removed from the HRP by the diener (also known as an APT - Anatomical Pathology Technician) and placed onto a sterile aluminium examination table. Here the body is undressed, cleaned, weighed, measured and prepared for an internal examination, if needed. Steps 1-4 are repeated, now that the body is out of the HRP, and the HRP itself is examined.

Throughout the autopsy, the pathologist will verbally record each stage of the process, as well as writing notes on a pre-printed autopsy report and marking it on a diagram of the body…
…and will probably have a good old ogle at their boobs, bush, bot-bot or bell-end.

What pathologists don’t do (which TV shows love pretending that they do) is they don’t nibble on a kebab, puff on a ciggie, or swig a hot cup of Bovril, whilst slicing up a cadaver or examining a body, as the mortuary is a sterile environment, and any external factors are considered contamination… which could either destroy or compromise the evidence.

If an internal examination is required, to make the torso easier to examine, a rubber brick called a "head block" is placed under the shoulders, this causes the neck to hyperflex, arching the spine backwards, which pushes the chest upward, making any incision easier.

Bleeding is minimal or non-existent in most cases, as (with no heart to pump blood) gravity causes blood and other fluids to pool at the lowest part of the body and – if possible - no incisions are made which would be visible at an open-casket funeral.

There are four different types of incisions made, depending on which organs need to be examined:
#1 - a large and deep Y-shaped incision, starting at the top of each shoulder, running down the front of the chest and ending at the base of the breastbone (known as the sternum)
#2 – a curved incision from the tips of each shoulder and down across the second ribs
#3 – a single vertical incision from the base of the neck to the base of the sternum (one used on TV)
#4 – a u-shaped incision from the tips of the shoulders down the sides of the chest

Using a prosector (like a set of garden sheers), the pathologist will cut through the ribs to open the chest cavity, the sternum is removed and set aside for later, so the heart and lungs can be examined in situ for evidence of disease, injury or trauma. As the heart and lungs are our blood and oxygen supply - and without them we are dead - they are usually the first internal organs examined.

Once this is complete, the other organs can be examined, but depending on the pathologists preferred style or requirement from the autopsy, the organs are either removed one by one in a slow systematic fashion, or en masse, in one large block, especially with infants or babies.

Each organ is examined, weighed and tissue samples are taken in the form of several thin slices, which will neatly fit onto microscope slides. The major blood vessels are inspected for clotting, ruptures, swelling and infection, and the contents of the stomach are checked to determine a time of death, as certain foods digest at different rates. Bodily fluids may also be checked – such as urine, blood, vitreous gel from the eyes, or bile from the gallbladder — for drugs, infection, chemical composition or genetic factors.

A toxicology report can be requested to determine what or if any drugs or poisons have been taken or ingested, but this is not always essential, and is limited to the most commonplace of toxins. As it is impossible to search for every type drug, poison or toxin, the pathologist can recommend a broad spectrum report, and/or a search for a few very specific poisons… but not everything.

If an examination of the brain is required to determine meningitis, an incision is made from behind one ear, over the crown of the head, to the other ear, the scalp is pulled away in two flaps; one over the face and one over the back of the neck. With the skull exposed, a cranial cut is made using a semi-circular saw, around the skull like a cap, which can neatly be removed, and the brain can be observed in situ. If required, the cranial nerves and spinal cord can be severed, and the brain removed.

Once the autopsy is complete, the cap can be refitted, the scalp flaps can be pulled back into place and stitched, and the scar won’t be visible in an open casket. Any organs not required for examination are placed in plastic bags to prevent leakage, returned to the body, the lining of the body cavity is filled with cotton wool, or an absorbant material, and the body is sewn shut, in what is regarded as a “baseball stitch”. The body is then ready to be embalmed by a funeral director.

There you go, you are now a fully-fledged pathologist and qualified to conduct your own autopsies. Well, you’re as qualified as any TV actor playing a pathologist. And just think, if Tom Hardy (steady ladies) if Tom Hardy dies in a TV drama, or film, I’m sure there would be a rush of you who are suddenly RADA trained actors and part-time morticians eager to pretend that you can determine his time of death, according to the smoothness of his chest, the smell of his armpits, the taste of his lips and (your own specific scientific method) the length of his willy.

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If you found this interesting? Check out the Mini Mile episodes of the Murder Mile UK True-Crime Podcast, or click on the link below to listen to an episode.

Michael J Buchanan-Dunne is a writer, crime historian, podcaster and tour-guide who runs Murder Mile Walks, a guided tour of Soho’s most notorious murder cases, hailed as “one of the top ten curious, quirky, unusual and different things to do in London”, nominated "one of the best true-crime  podcasts at the British Podcast Awards 2018", and featuring 12 murderers, including 3 serial killers, across 15 locations, totaling 50 deaths, over just a one mile walk