History of the autopsy 'Mortui vivos docent' - the dead teach the living. "A disease which is new and obscure to you, Doctor, will be known only after death; and even then not without an autopsy will you examine it with exacting pains."

Autopsies are a source of valuable medical information that can improve health care for the living. There are very many diseases and conditions that have been discovered or greatly helped by the use of autopsies.

Greek physicians performed autopsies 2,500 years ago, but it wasn't until 1769 that the first comprehensive pathology text was written. The Italian physician Giovanni Batista Morgagni published his book'The seats and causes of diseases investigated by anatomy.' Dissection of the dead human body has been central to medical education since the Renaissance. Anatomists of the past went to great lengths to obtain cadavers for student use.

What is an autopsy? An autopsy, also called a post-mortem examination, is a detailed and careful medical examination of a person's body and its organs after death to help establish the cause of death. The word autopsy is derived from a Greek word autopsia meaning 'seeing for oneself'. A physician, called a pathologist, who specializes in the study of human diseases, performs the autopsy. Surgical techniques are used to remove and examine each organ, and some tissue samples are selected for microscopic examination or other special tests as required.

An autopsy can be hospital-based (non-coronial) or coronial. Facts about autopsies An autopsy is usually carried out within 48 hours after the death of a person. An autopsy can be hospital-based (non-coronial) or coronial. Coronial autopsies are ordered by the state coroner, whereas hospital based autopsies may be performed at the request of the family of the deceased.

There are 3 levels of an autopsy 1.Complete - in which all body cavities are examined (including the head ) 2.Limited - which may exclude the head 3.Selective- where specific organs only are examined. Autopsies will usually include testing for any infections (microbiology), changes in body tissue and organs (anatomical histology), and chemicals, medication, drugs or poisons (toxicology and pharmacology). In certain circumstances an autopsy might not be carried out if the coroner and a forensic pathologist can decide the cause of death from medical history and a police report.

Your rights Can you object to an autopsy? From the moment a death is reported the coroner is in charge of the body until it is released for the funeral. The coroner is responsible for finding the specific cause of death. It is their decision as to whether an autopsy / post-mortem is needed. The deceased's next of kin can make a formal objection to an autopsy. The state coroner will seriously consider any objections. Objections can be made on religious, cultural or personal grounds. Hospital autopsies are different from coronial autopsies. A hospital autopsy is not performed without first seeking permission of the next of kin. Families have the right to say no and hospital staff will always have to respect the families wishes. A family may request a doctor to arrange for a hospital autopsy to help determine why the person died.

Type of system by state

Steps to performing an autopsy

The pathologist records the results of the external examination and lists all physical characteristics. The body must be measured and weighed and placed on an autopsy table. An autopsy table is waist-high stainless steel with running to facilitate washing away all the blood that is released during the procedure. The autopsy table is a slanted tray (for drainage) with raised edges (to keep blood and fluids from flowing onto the floor).

3. The first cut known as the 'Y' incision is made 3. The first cut known as the 'Y' incision is made. The arms of the Y extend from the front of each shoulder to the bottom end of the breastbone. The tail of the Y extends from the sternum to the pubic bone and typically deviates to avoid the navel. The incision is very deep, extending to the rib cage on the chest, and completely through the abdominal wall below that. The skin from this cut is peeled back, with the top flap pulled over the face.

4. The ribs are then sawn off and the sternal plate or anterior chest wall is cut away, to expose the organs underneath. The most common way to remove the organs is known as the Rokitansky method. Organs are removed by cutting off their connections to the body and are usually removed as one.

5. The brain is removed using a transverse incision (in a crosswise direction) through the brainstem, cutting the connection from the base of the brain to the spinal cord. The brain is then either cut fresh or is placed in a 20% solution of formalin to fix it for future analysis.

Fixing the Brain In cases like homicide or where there is a complex pathology of the brain, a detailed study of the brain may be necessary. In its fresh state the brain is very difficult to cut, so in order to make it easier for the neuropathologist to examine, the brain will be fixed in a solution of formalin for up to two weeks. Although two weeks is the optimal time to fix the brain, it can be sufficiently fixed in a shorter period in order to facilitate the return of the brain to the body prior to burial in selected cases. Should the pathologist need to retain the whole brain it would typically be discussed with the relatives of the deceased first, prior to the release of the body for the funeral. Once the study of the brain has been completed the brain would either be returned to the body, or in the case where the funeral has already taken place the pathologist will consult with the family to determine the most appropriate manner of disposing of the brain.

6. All removed organs are weighed and studied individually 6. All removed organs are weighed and studied individually. Most organs are cut up in sections by a scalpel.

7. Intestines are drained in a sink to remove undigested food and feces that remains. 8. The stomach is cut open on its greater curvature and the contents are examined. 9. Microscopic samples of most organs are taken for further analysis.

10. Finally, all major blood vessels are cut open and examined lengthwise. 11. The organs are placed back in the body, and the body will sometimes be filled with a filler material. The head and body are then sewn up. The brain is returned to the body, except in the cases where the brain has been retained for further tests.

12. Once the Y incision is sewn up, the autopsy (without brain and tissue analysis) is complete.

This concludes autopsy procedure

Video National geographic The real CSI: Crime Autopsies ( may be blocked, must have internet connection) http://video.nationalgeographic.com/video/player/science/health-human-body-sci/human-body/real-csi-sci.html