Legal Med 1.

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Dr. Bernabe
EXAMINATION OF THE DEAD AND ENGLISH FORENSIC PATHOLOGY July 2, 2014

OUTLINE  None of these terms have a specific meaning which allows the extent
I. Autopsy IV. Procedures or precise nature of the investigation to be inferred from their use.
a. Short history V. Reporting  In modern practice, an autopsy is usually taken to indicate a detailed
b. Modern history VI. Making opinions examination which includes (1) external examination of the corpse,
c. Definition VII. From the Lecture and, (2) evisceration and subsequent careful dissection of the
d. Variations contents of the cranial, thoracic, abdominal and pelvic cavities.
e. Other terms
VARIATIONS
II. Principles E/N: After talking with the lecturer, he really  Nonetheless, examinations restricted to a particular body cavity
III. Methods or technique wouldn’t give a specific reference, but in the end, he (either by the relatives’ wishes or because of some infectious
a. View and Grant said to just refer to the content of the slides. Some data hazards), or to the sampling of the organs in the unopened body with
b. Rokitansky was added to further appreciate it, though (reference a biopsy needle are also regarded as autopsy examination.
c. Virchow at the end of the trans). Good luck to all of us. Seems
 In some countries, such as Scotland, where a ‘view and grant’ system
d. Le Tulle or Ghon like we’ll really need it with this one. XP
of death certification exists, the term ‘post-mortem examination’
may refer only to the external examination with no effort being
AUTOPSY made to examine the internal organs.
 Examination of the Dead
OTHER TERMS
SHORT HISTORY  DISSECTION - refers solely to the process of cutting apart or
 Hirophilus (330-255 BC), Greece, started human dissection with separating tissues and organs from one another for further study.
some regularity and purpose.  Anatomisation – a term that has fallen into disuse, but carries the
 Galen (AD 129-216), Europe, used comparative anatomy to deduce connotation of a degree of dissection that sounds extreme
human anatomy o To cut in pieces in order to display or examine the structure
 Italy in 1286, birthplace of modern autopsy performed by an and use of the parts (Merriam-Webster)
unnamed doctor as told by Fra Salimbene.
PRINCIPLES
 Andreas Vesalius (1514-1564) challenged Galenic thinking (1542)
 Respect for Culture
and ushered scientific human dissection.
 Minimalism and Adequacy
 Antonio Benivieni (1443-1502) used autopsy to understand
 Scientific Method
pathology
o “The entire pathological report reads ‘It was found that the  Truth vs. Justice
opening of his stomach had closed up and it had hardened METHODS OR TECHNIQUES
down to the lowest part with the result that nothing could  View and Grant
pass through to the organs beyond and death inevitably.’”  Rokitansky
(King and Meehan, 1973)  Virchow
 The history of the autopsy examination in its modern day form  Le Tulle or Ghon
begins in Padua in the mid-Eighteenth century with the work of
Giovanni Battista Morgagni (1682-1771) VIEW AND GRANT
 Inhospitable environment
MODERN HISTORY
o Cliffs, alps, middle of the ocean, deserts
 Xavier Bichat
 Speed is essential
o ‘You may take notes for 20 years, from morning to night at
 Cultural and religious prohibitions with known death circumstances
the bedside of the sick, upon the diseases of viscera, and all
 View the dead body, grant your opinion
will be to you only a confusion of symptoms…a train of
IN-SITU EXAMINATION (ROKITANSKY)
incoherent phenomena. Open a few bodies and this obscurity
 Circumstances where histopathology examination is limited or
will disappear.’
meaningless
 Karl Rokitansky (1804-1878), Father of Modern Autopsy
 Far advanced decomposition
o Performed more than 30,000 autopsies[1]
 Drowning
o Author of Handbook of Pathological Anatomy, influencing the
 Burns
growth of the autopsy into an important and integral part of
 Cultural and Religious prohibitions
medicine during the first half of the 19th century[1]
o Technique: (1) Examine and open all organs in situ, (2) SYSTEMATIZED REMOVAL OR ORGANS (VIRCHOW)
preserve all abnormal relationships. [1]  Any case
 Rudolf Virchow (1821-1902), working in Berlin emphasized  Histopathology is necessary
pathology and histopathology in autopsy  Takes a minimum of 80 minutes
o Applied microscopic examination to diseased tissues and
recognized cellular alterations[1] EN BLOC REMOVAL OF ORGANS
o Founder of modern pathology [1]  En bloc – as a whole; in a mass
o Technique: (1) examine organs and relationships in situ, (2)  Ghon – removing the organs in regional and functional groups;
remove organs one at a time, (3) further dissection of organs easier for one person to carry out[1]
outside body, (4) preservation of regional organ relationships, o One block – includes all organs in a system
if indicated.[1] o In toto
o En masse – everything in a single group
DEFINITION  Le Tulle – removing the organs together in toto[1] (as a whole; totally
 AUTOPSY – to see for oneself; synonymous with the terms ‘post- or completely); less dissection within the confines of the body cavity,
mortem’, ‘post-mortem examination’ and ‘necropsy’ offering greater safety to the prosecutor and assistant [1]
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o Two or more blocks o After inspection – a large and deep Y-shaped incision can be
o Modified Virchow made starting at the top of each shoulder and running down
o By cavity or by system the front of the chest, meeting at the lower point of the
sternum. OR the incision can be done across the neck – which
PROCEDURES is more preferable because it is less disfiguring.
 Perimortem Narrative (Clinical or Investigative) o A singular, midline incision is more preferred vs. Y incision
 External Examination (esp. for Muslims) since it is more aesthetic
 Internal Examination o Stroke Autopsy: For haemorrhagic stroke, open head and
 Special Examination check for bleeding.
 Microscopic Examination o If you make an incision around the neck, you can anchor the
 Other Specialty Examination (Toxicology, Serology, DNA analysis, repairs at suprasternal notch.
Microbiology, Ultrastructure) o If head is decomposed, you have to reconstruct the face
REPORTING through trial and error, since the soft tissue of the face varies
Laboratory Reporting Consultant Reporting o If jaws and other bones are crushed, open the skin, release the
Accurate Detailed gas and liquids. Obtain the bones that can also be used for
Brief/short, concise Long identification and put it back after. One can set it back using
Coherent Comprehensive super glue. So you can do facial reconstruction right at the
Emphasis on findings Emphasis on interpretation, correlation and autopsy table. (E/N: Just think: Dr. Temperance Brennan )
opinion  “Do not do unto the dead what you don’t want to do with the living.”
 Always remember that there are a lot of different cultures. Respect
MAKING OPINIONS each of them.
 Must contain:  According to sir: for Chinese and Muslims, you must not touch the
o Cause – any injury or disease dead. For Jews, there should be no loss of tissue, including blood. If
o Manner – circumstances you suck up all the blood, the Jewish family would have to bury the
o Mechanism – physiologic processes machine together with the blood.
o Time – post-mortem interval  If you could not give a proper cause of death, state that the cause of
 Death is a process and not an event death is undetermined. This must be sent to the higher authorities
 The less cuts you have to [make] to find what you have to find, the
DEATH HELPS THE LIVING better
Reality Checks  Autopsies can be repeated
 Two pathologists recognized as forensic pathology practitioners by  AUTOPSY MUST FOLLOW SCIENTIFIC METHOD
UP-PGH and Philippine Society of Pathologists Inc.  When you do an autopsy, it is better to have a history first to take
 Five pathologist recognized as forensic pathology and forensic note of any special procedures you have to perform. You can remove
medicine examiners by the PNP and Philippine Academy of Medical the organs (en bloc) to examine further. Remove the heart, then the
Specialists, Inc. wind pipe with both lungs, afterwards, you may remove the GIT from
 More than two pathologists at the National Bureau of Investigation pharynx down to rectum, lastly, both kidneys and ureters and urinary
 One forensic pathologist at STUH bladder. Spleen and other endocrine organs are examined inside the
 Forensic histopathologist at Makati Medical Center body. After examining all organs outside, put in plastic or sac and
 Three retired forensic pathologists of unknown affiliation. return them to the body. If full autopsy, remove the brain. If a
FROM THE LECTURE specific disease is suspected, you may also remove the spinal cord,
 Never [say] that the first pathologist is wrong! which will later be put back in the body. The brain is usually put in a
separate container. Sometimes, all organs are put in a single bag and
 It would be very hard to learn autopsy without hands-on practice.
placed on anterior body.
 Rokitansky and Virchow – don’t forget them! They always appear in
 Special dissections: neck dissections, removal of spinal cord,
exams
skin/face removal, microscopic examination (in government has
 American way: To explore death as to cause, manner and
additional costs)
mechanism, but not all cultures see it this way.
 Two ways to repost an autopsy: short and long way (but would be
 PNP crime lab – used to determine the cause of death ONLY.
discussed in different lecture)
 Can an autopsy be done among chickens??? (Yes, this is a real issue
raised by the lecturer) NO. (E/N: this was the lecturer’s personal opinion, I REFERENCES
believe. The story was about him being asked to perform an autopsy on ***Unless otherwise indicated, content is from the presentation and
chickens to determine the cause behind a lot of farm animals dying in an
recording
area. He refused to do so, saying that wasn’t part of protocol.)
1. Autopsy Pathology: A Manual and Atlas, 2nd Edition
 VIRTUOPSY or VIRTUAL AUTOPSY
o Uses a CT scan machine to visualize the body of the dead.
Usually done at remote places where forensic pathologists are
not available. CT scan images may be sent to the forensic
pathologist who may be miles away. GOD HAS THE ANSWER
o Also used in dangerous situations (like, Ground Zero), where a “Call unto me and I will answer you and tell you great and
distance of 3km must be maintained to ensure safety unsearchable things you do not know.”
Jeremiah 33:3
 Techniques:
o Inspect on all sides: Look at the dead body from all sides in
different positions: Turn the body over in swimming position -
raise one arm, butterfly position - two arms. Hands on the side,
one on the back and the other in front.
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