Autopsy Procedure

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For a wonderful guide to autopsies, written for the screenwriter who knows nothing about such matters, see the Autopsy Screenwriters' Guide.

See the separate page on dead bodies for information on what information the autopsy can reveal.

Important note: This whole section has been compiled from books and websites, with occasional help from people working in this field. Like the rest of Deep Background (of which this is only a small part), this information is designed for writers of X-Files fiction, and covers only those things that they might be expected to need. It is not a comprehensive guide to the subject.

When an autopsy is done

By no means all bodies get an autopsy done on them, although the family of the deceased can always request an autopsy even if the hospital doesn't think it necessary. (In this case, they call in a private pathologist and have to pay for it.) Generally, an autopsy is only done when there is some cause of doubt as to the cause of death.

When, where, who....

Immediately after death the body is wrapped and sent to the morgue, where it is kept refrigerated until the autopsy. Unlike Scully's exciting 11.21pm autopsies (as in "Miracle Man"), most autopsies are done somewhere between 8 and 4 or so, including weekends and holidays.

Small hospitals usually have to send the body away to somewhere with the facilities, but larger ones have their own autopsy suites, next to the morgue.

The trained pathologist who performs the autopsy is called the "prosector". To be a certified pathologist requires a four or five year residency in anatomic pathology, although larger teaching hospitals will let pathology students perform the autopsy. During the autopsy the pathologist is assisted by a "diener" - a morgue assistant. They fetch the body at the start, and assist right through the procedure. Other specialists and students could also sometimes be there. Everyone present wears protective clothes - scrubs, gowns, gloves, face shields etc

Implements

Dissecting knife used constantly. Usually have a metal handle which contains several retractible 4 inch blades.
Brain knife with 12 inch brain to make clean cuts through brain
Scissors with long handles, short blades and rounded ends. Also sometimes another shorter pair with sharp ends.
Saws for cutting through bone. Very sharp. A special electric saw is used to take skull cap off.
Skull key. A T-shaped chisel for leverage when removing skull cap.
Scalpels not often used
Forceps with serated edge. However, fingers are said to be more useful than forceps in autopsies.
Chisels used with a mallet in bone work.
And, of course, the autopsy table. This is waist-high and made of aluminum, with various taps and things to enable blood and other stuff to drain away. It is slanted, for drainage, and has raised edges so thigns don't drain right off onto the floor.

Preliminary

Body has been wrapped in a plastic sheet since leaving crime scene (remember all those scenes in which Scully dramatically unzips a body from the plastic bag its in). The autopsy assistant take the body out of storage and lays it out on the table.
A "body block" is placed under the body, under the back. This looks rather like a brick and causes the chest to stick out and the arms to slump away, exposing the bits the pathologist wants to get to.
Check toe-tag - make sure this is indeed the right person you're supposed to be autopsying.
Weigh and measure body
When unzipping bag, check that no hairs and fibres etc have been detached. Bags will have been placed over hands and head at the scene to preserve trace evidence. Remove these and carefully search them for any trace evidence that has adhered to them. Send them to lab.

Examining clothed body

Record stains on clothes etc Remove dried blood with swab or by scraping into jar.
Record any damage to clothing eg bullet holes - size and shape. This will help people work out position from which person was attacked.
Carefully examine fingernails for any evidence behind them. Scrape each nail separately.

Remove clothing

Each item stored separately in plastic bags.
Damp items must be air dried first in case shrinkage alters relationship between wounds and holes in clothing.
If victim was stangled, cut the ligature so the knot is preserved for examination.

External Examination

Any matter exuded from body - eg froth at the mouth in cases of asphyxia and some poison. Take samples - some may indicate poisons upon analysis.
Vaginal and rectal swabs to check for semen, and thus for sexual assault. This is always done, even if there is no reason to assume sexual assault.
Examination of the conjunctivae on eyes. Blood spots indicate asphyxia. Carbon monoxide poisoning makes it pink.
Close examination of the whole body looking for external signs of disease, wounds, needle marks etc. There is a pre-printed form which shows the human body, upon which the pathologist draws on position of all wounds, along with measurements. This is done both front and back.

Before dissection starts

The body is washed thoroughly
Samples taken of hair - scalp, face, eyebrows, pubic etc - and labelled and stored
X-raying of body. This may show up things like repeated healed fractures - may be evidence of child abuse, for example.

Dissection

Every pathologist does it differently, but usually make simple incision from neck down to groin, diverting at navel (which is tough and hard to cut through).
It strangulation is suspected, usually make a V-shaped incision so can take out and examine neck.

Collecting bodily fluids

Blood: Take at least 20 ml of clean blood and store in sterile container. Usually taken at start of autopsy from any main vein, but usually the jugular. Blood will be used in tests for: Alcohol, Blood type, Poisons, Glucose.
Urine Obtained with a ladle or pipette through an incision in the bladder and then stored in a sterile container. Urine will be used in tests for alcohol and metallic poisons.
Cerebo-Spinal Fluid Collected by lumbar puncture at start of autopsy. Easiest to take it with body sitting up, head slumped over. A needle is inserted between two vertebrae. Can also be taken by a needle directly into brain.
Stomach Contents The stomach must be exposed, then carefully pulled out and held over another container. Scissors are used to open the stomach wall and the contents are examined. In suspected poisoning cases the whole stomach will be bagged up for further analysis.
Intestinal Contents If necessary the whole small intestine will be removed for further analysis later.
Liver Vital in poisoning cases. After the pathologist has done his visual examination, the whole liver is bagged up for analysis by the toxicologist.
Vitreous Humour The liquid behind the eye is extracted with a syringe. An equal amout of water is injected in, just for cosmetic reasons. This can be used to determine time of death

After the autopsy

Weigh all organs
Reassemble the body and sew it up.
Make report, based upon recorded notes dicated while working, other observations, photographs etc This will be forwarded to whoever is on the case.
Refrigerate body to preserve it. In long-running murder trials this may have to kept up for ages. Sometimes defense lawyer will want to order an independent autopsy
Send tissue samples to the lab, after labelling them correctly and recording where they're going.

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