Autopsy Practices Dhaneshwar Lanjewar, Pradeep Vaideeswar
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abdominal aorta, part of 39f
Abdominal cavities 17f, 18, 24, 103f
Abdominal incision 76
Abdominal pain 62
acute 62
chronic 62
Abortion
criminal 116
unsafe 116
Abrasion 12
Abscess 23, 103
large 72
multiple 72f
periannular 167
Abundant adipose tissue 164f
Acanthamoeba 162
Acanthosis nigricans 11
Acinetobacter pneumonia 194
Acquired immunodeficiency syndrome 10, 15, 150
Acromegaly 11
Acute respiratory syndrome, severe 15
Adenosine
diphosphate 11
triphosphate 11
Aerosols, limiting generation of 138
Ague cake spleen 92
Air embolism, method for 57f
ALC see anterolateral commissure
Alcoholic cirrhosis 74
Alcoholic liver cirrhosis 12f
Alcoholic micronodular cirrhosis 71f
Ambiguous genitalia 101f
Amebic liver abscess 72
Amenorrhea 176
AML see anterior mitral leaflet
Amniotic fluid embolism 108
Ampulla of Vater 103
Amyloidosis 89
Anasarca 14, 108
Anesthetic deaths 116
Angiodysplasia 68
Angioinvasive aspergillosis 185
Anorexia nervosa 10
Antemortem bone marrow trephine biopsy 194f
Anterior tricuspid leaflet 51, 52
Anterolateral commissure 51, 53, 167
Anthrax 138
Antiseptics 133
Antituberculous therapy 199
Aorta 39, 42, 43, 46, 48, 54, 165
abdominal 76f
ascending 23, 39, 42, 46, 48f, 52, 168, 191f
examination of 11
Aortic valve 52, 54, 168f
cusps 52
Aplasia 97
APM see anterior papillary muscle
Appendicitis 62
Arachnodactyly 11
Arrhythmia 168
Arterial embalming 151
Arterial thrombi 185f
Aspergilloma 185
Aspergillus 185, 186, 192, 196
aortitis 190
fumigatus 193, 194
mural endocarditis 190
species 188
Asphyxia, cases of 100
Asplenia 92
Atelectasis 103
Atheromatous plaques 45f, 49f
ATL see anterior tricuspid leaflet
Atrial appendages, morphology of 42
Atrophy 37
Autopsy 13, 7, 15, 16, 69
adult 100, 140
and law 118
audit of 16, 145, 147
before 140
beginning of 2
biosafety, general rules for 137
brain at 31
clinical audit monitors 147
complete 2, 17, 167
contributions of world leaders in 4t
designing of 135
diagnosis 199
equipment for 139
external examination at 10
guidelines for performing 154
history of 2, 5
isolation room for high-risk 133
negative 116
partial 2
pathological 1
pediatric 99, 100, 179
precautions for performing 154
procedure 1, 156
quality, aspect of 145
role of 108
room 40, 132
design of 130
size of 131
safety precautions 136
second 124
services, dimensions in 15
special situations 99
staff 133
care of 135
suites 130
table 131, 145
techniques of 15, 20
types of 1
high-risk 138
use of 15
AV see aortic valve
Avian influenza 174
virus infection 175
Axillary lymph nodes 13
Ayurvedic therapy 167
B
Bacteria, clumps of 167
Balamuthia mandrillaris 162
meningoencephalitis 163f
Basic functional areas 130
Betadine 150
Bickerstaff brainstem encephalitis 160
Bicuspid aortic valve 52
Biliary obstruction 62
Biliary system, xamination of 11
Biliary tract, normal 69f
Biliary tree, ligature of 170
Biowaste disposal 141
Bird flu virus 173
Bird-headed dwarfism 5
Bisected left lung 60f
Bladder mucosa 84f
Bleeding piles 167
Blood 141
cells 89
collection of 175f
Blood-borne antigens 89
Blunt dissection 19, 28
Blunt trauma 84
Body
fluid 141
restoration of 134
Bone marrow
biopsy, postmortem 196f
examination 97
Bowel gangrene 68
Bowel perforation 64
Brain 177, 178
after fixation, examination of 33
before fixation, examination of 31
coronal slice of 189f
examination of 27
fixation of 32
growth, greatest 100
knife 132
removal procedure 28
slices of 35f
Breast carcinoma 13, 22
Bronchial arterial diseases 58
Bruises 12
Budd–Chiari syndrome 70
Buffered formalin 40
C
CA see celiac artery
Cachexia 10, 12f
Cadaver
handling of 140
injector 150
Candida species 188
Capsular surface, examination of 70
Carbolic acid 149
Cardiac dissection 48f
Cardiac pathology 38
Cardiac size 46
Cardiac surfaces 41
Cardiovascular diseases 38
Cardiovascular system 38, 110, 163, 166, 187
Carotid artery, left common 39, 46
Cavity embalming 152
Cavity-concentric hypertrophy 182
Celiac artery 76
Cellular pathology 5
Central nervous system 27, 110, 159, 162, 187
Cerebral malaria 23
Cerebral venous thrombosis 110
Cerebrospinal fluid 31, 105, 160, 173
Cervical canal 86
Cervical cancer, disseminated 12f
Cervicomedullary junction 179f
Cervix 204f
Chest
pain 201
X-ray 195f
Cholangiocarcinoma 73
Cholecystitis 62
Cholelithiasis 62
Choroid plexitis 35
Chronic diseases 10, 56
Circle of Willis 33
examination of 31
Circulatory system, anatomy of 148
Cirrhosis indicates, background of 71
Cirrhotic liver, assessment of 70
Clinical autopsy 118t, 154
Clinical Autopsy Program 7
Coagulative necroses 80
Coagulopathies 99
Coccidioidomycosis 138
College of American Pathologists 16
Colonic ulcers 68
Common congenital anomaly 52
Common iliac arteries 47
Complete abruptio placentae 114f
Concentric hypertrophy, moderate 182f
Conception, examination of products of 116
Congenital anomalies 99
Congested meningeal vessels 177f
Congestive heart failure 13
Coronary arterial
anatomy 44
dissection 44
ostia 40
Coronary artery, left 44, 52, 168
Coronary cusp, left 52, 168
Coronary sinus 49, 51
Coronavirus disease 2019 154
Coroner's autopsy 1
Cortical thymoma 187f
COVID-19
autopsy guidelines in 154
cadavers 154
infection 154
Cranial bones 101
Cranial cavity, examination of 22
Cranial nerves 30
Cribriform plates 31
Crista supraventricularis 52
Crohn's disease 67, 68
Cryptococcal meningitis 192
Cryptococcus 188, 192
CS see coronary sinus
CSV see crista supraventricularis
Custodial deaths 127
Cystic fibrosis 74
Cystic lesions 103
Cysts, small 78f
Cytokeratin immunohistochemistry 187f
Cytomegalovirus 105
D
De Humani corporis fabrica 1
Dead body, transportation of 157
Dehydration 22
Demyelination 37
Deoxyribonucleic acid 105
Dermatomyositis 173
Descending thoracic aorta 39, 46
Diabetes mellitus 38, 99
Diaphragmatic hernia, congenital 25f
Diarrhea 188
Diarrheal disease 105
DIC see disseminated intravascular coagulation
Dieulafoy's lesion 68
Dissection, alterations in 53
Disseminated intravascular coagulation 107, 109
Disseminated tuberculosis, diagnosis of 199
Diverticular disease 62
Diverticulitis 67
Donated bodies 2
Down's syndrome 101f
Down-draught ventilation 144
Dowry deaths 121
DTA see descending thoracic aorta
Duodenojejunal junction 63
Dwarfism 11
Dyspepsia 203
Dysplasia 97
E
Ear infection, middle 22
Early pregnancy bleeding 107
Ebola virus infections 15
Eclampsia 99
Edema feet 108
Electron microscopy 31
Embalming 148
machine 150
methods of 151
principle of 149
Embolism 109
Employee health 141
Encounters 127
Endocardium, thickened 51
Endocrine disorders 11
Endometrial cavity 86
Engorged abdominal veins 69
Eosin solution 149
Epicardial surface, appearance of 41
Epidural hemorrhage 22
Epigastric pain 203
Equipment required for embalming 150
Escherichia coli 194
Esophageal atresia 103
Esophageal carcinoma 65
Esophageal perforation 65
Esophageal varices 68
Esophagitis 62
Esophagus 65, 66f
carcinoma 62
Ethanol 149
Ethyl alcohol 149
Ethylene glycol 152
Eventual pyelonephritis 83
Evisceration, techniques of 19
Exophthalmoses 13
Extradural hematoma 34f
Extradural hemorrhage 22
Extrahepatic biliary atresia 73
Extraintestinal diseases 63
Eyes 2
F
Face 2
shields 156
Facial appearance, abnormal 100
Fallopian tube 87
Fatal pulmonary thromboembolism 58f
Fatty liver
discoloration in 70f
mild 199f
Female genital tract, examination of 86
Femoral vein drainage 151
Fetal lobulations 78f
Fetal squamous cells 109f
Filariasis 14
First systematic cadaveric dissection 1
First-aid supplies 133
FO see fossa ovalis
Foci of scars and cysts 77
Fog spraying machine 139
Fogging machine 139
Foramen magnum 30
Forensic autopsy 118, 118t
Formaldehyde 149
Formalin acts 149
Fossa ovalis 51
Founder of Pathologic Anatomy 3
Fractures 100
Frontal lobes 30f
Fully-developed thymus 96
Fungal infection 13
Fusarium species 187
G
Gallbladder 69f
lumen 74
status of 74
Gamna–Gandy bodies 92
Gangrene 14, 64
absence of 13
Gastric carcinoma 204
Gastroenteritis 4
Gastroesophageal junction 66
Gastroesophageal reflux disease 62
Gastrointestinal bleeding 68
Gastrointestinal gastrinoma, small 73f
Gastrointestinal perforation 67
Gastrointestinal symptoms 62
Gastrointestinal system 111
Gastrointestinal tract 62, 181, 169, 200
examination of 68
Gastrosplenic ligament 88
Gaucher disease 89
General medical autopsy 27
Generative organs 88
Genital tract infection 108
Genital trauma 116
Gestational age babies 100
Ghon's method 20
Gigantism 11
Glomerulonephritis, chronic 78, 79
Glutaraldehyde 139
Glycerin 149, 152
Goggles 156
Granulomatous inflammation 193
Gravity tank method 150
Gray-white tissue 26f
Great arterial relations 44
Great arteries 23
Gross contamination and liquids 156
Growth factor-5β, transforming 115
Guillain-Barré syndrome 160
H
Hairy cell leukemia 89
Hand-sanitizers, alcohol-based 133
Handwashing 139
Hashimoto's thyroiditis 165
Heart 38
and lung block 39f, 180f
anterior surface of 41
diseases, congenital 11, 102
external examination of 41
fixation of 38
internal examination of 48
rate 179
Helicobacter pylori 66
HELLP see hemolysis, elevated liver enzymes, and low platelet count
Hemagglutinin protein, presence of 174
Hematemesis 201
Hematopoiesis 88
Hemoglobin 182, 188
Hemolysis, elevated liver enzymes, and low platelet count 107
Hemorrhage 37, 100, 116
antepartum 107
extensive intrauterine 114f
intra-alveolar 175
multifocal 36f
pneumonia 103
postpartum 107, 109
Hemorrhagic cystitis 84f
Hemorrhagic fever viruses 136
Hemorrhagic gastritis 111
Hemorrhagic ulcers 68
Hepatic amebiasis 72f
Hepatic outflow tract obstruction 73
Hepatic veins, examination of 73
Hepatitis
A 69
B 69
virus 136
C 69
virus 136
D 69
E 69
Hepatobiliary system 112
Hepatocellular carcinoma, development of 71f
Hereditary anemias 11
Herpes simplex 105
Heterotaxy syndromes 102
High-efficiency particulate air 133, 155
His hemogram 160
Homocystinuria 22
Horse-shoe shape 104
Hospital wards 130
Household bleach 139
Human brain tissue repository 15
Human immunodeficiency virus 12, 130, 136
Human nervous tissues 15
Humani corporis fabrica 3
Hydrocele 14
Hyperechoic polycystic kidneys 179
Hyperplasia 97
Hypersensitivity reactions 62
Hypertension
malignant 77
pregnancy-induced 115
Hyperthermia 116
Hypodermic embalming 152
Hypoglycemia 204
Hypoplasia 79, 103, 104
Hypothyroidism, congenital 11
I
Icterus 108
Ileal tuberculosis, transverse ulcers of 104f
Ileoileal intussusception 64f
Immunological tests 105
In situ examination 22, 63, 109
Infected peripartum 108
Infection 62, 64, 116
congenital 105
Infectious autopsies 130
Infectious disease, autopsy in 173, 175f
Infectious organisms 136
Infective endocarditis 23, 168
Inferior vena cava 14, 40, 43, 165
Influenza 133
virus A 174
Internal carotid arteries 30
Internal systemic examination 110
Interstitial edema 77
Interstitial lung diseases 61
Interstitial pneumonitis 61, 61f
Interventricular septum 54, 166
Intestinal coils 170f
Intestine
large 63
small 63, 202f
Intrahepatic cholangiocarcinoma 72, 73f
Intrauterine ischemic 102
Ischemia 64
Ischemic heart disease 38, 41f
Ischemic ulcers 65f
Isolation room 138
IVC see inferior vena cava
IVS see interventricular septum
J
Jaundice 188
color of skin for 69
disappearance of 171
Joint pain 188
K
Kayser–Fleischer ring 13
Kidney 79, 175
consistency of 77
cortex of 77
cut surface of 79
disease 180
external examination of 76
external surface of 78f, 80f
right and left 183f
Koilonychias 13
Kyphosis 13
L
LAA see left atrial appendage
LAD see left anterior descending artery
Law related to medicolegal postmortem 122
LBCA see left brachiocephalic artery
LCC see left coronary cusp
LCCA see left common carotid artery
Left anterior descending artery 50, 166
Left atrial appendage 39, 42, 43, 43f, 46, 48, 51, 54, 165
Left brachiocephalic artery 46
Left bronchus 58
Left lung, bronchiectasis of 61f
Left pulmonary
artery 40, 43, 52, 58f
vein 40, 43
Left renal artery 76
Left subclavian artery 39f, 46f
Left superior pulmonary 46
vein 39, 48
Left ventricular
apex 54f
free wall rupture 165
Legionellosis 138
Leprosy 133
Leptomeningeal exudates, chronic 189f
Leptomeninges 29
Leukoderma 12
Levocardia 41
Lienorenal ligament 88
LIPV see left inferior pulmonary vein
Liver 175
and intestine, examination of 3
color of 70
cut surface of 203f
enlarged 103f
examination of 11
parenchyma 104f
problems 69
slice of 113f
normal 69f
LMC see left main coronary artery
Lobular pneumonia 5
Lower limbs 176
Lower segment cesarean section 114
LPA see left pulmonary artery
LPV see left pulmonary vein
LRA see left renal artery
LSA see left subclavian artery
LSPV see left superior pulmonary vein
Luminal blood clot 183f
Lung 38
carcinomas of 22
diseases, chronic 19
dissection 57
examination of 59
hypoplasia, bilateral 180f
in fresh state 59f
tissue 102
Lyme disease 15
Lymph node 88
autopsy from enlarged 96f
enlarged 202f
examination of 93
mediastinal 95f
Lymphoid organ 88
largest 88
primary 88
Lymphoma 23
Lymphoreticular organs 88
Lymphoreticular system 88
examination of 88
M
Maceration, grades of 101t
Macronodular cirrhosis-autoimmune hepatitis 71f
Malabsorption syndromes 11
Malignant tumors 10
Mallory–Weiss tears 68
Massive splenomegaly 90f
Masson's trichrome 54
Mastoiditis 22
Maternal death
autopsy in 107
causes of 107t
Maternal medical disorders 99
Maternal mortality 107, 176
ratio 108
Medicolegal autopsy 118, 124, 164
Melena 201
Meningitis 22, 35
acute 178
Meningococcal meningitis 133, 136
Meningococcemia 138
Mesenteric lymph nodes 202f
Mesocardia 47
Metabolic diseases 103
Metabolism, inborn errors of 99
Metastasis 13, 22
Metastatic adenocarcinoma 96f
Metastatic deposits 24
Metastatic liver 73f
disease 73f
Metastatic nodes 95
Metastatic tumors 22
Mimic multicystic disease 82
Mitral leaflet, anterior 48, 5153, 168
Mitral valve 54
Modern embalming 148
Molluscum contagiosum, tumors 14
Mononuclear cell infiltrate 177f
Mortuary technician, countersignature of 134
Mouth 2
Mucoid inspissated secretions 93f
Multicystic dysplastic kidney 82
Multicystic renal dysplasia 104f
Multidrug resistant bacteria 133
Multinucleate giant cells 191f
Multiple pulmonary abscesses 175
Multiple tiny cysts 104f
Multi-system involvement 193
Muscular interventricular septum 52
MV see mitral valve
Mycobacteria 140
Mycobacterium tuberculosis 130, 136, 188
Myelofibrosis 89
Myeloid leukemia, chronic 89
Myocardial ischemia 62
Myocardial pathology 47
Myocardium 54
Myocyte caliber 110
N
Nasal swab, collection of 175f
National Human Right Commission 121
Necrotic granuloma 194f
Necrotic parenchyma 186f
Necrotizing aspergillosis, chronic 185
Necrotizing papillitis 82
Negri body in purkinje cell 161f
Nephritic syndrome, causes of 77
Nephritis, end stage of 79
Nephronophthisis 81
benign 78, 78f, 82
Nephrotic syndrome 80
Neurofibromatosis 11
Neuromuscular causes 62
Neuronophagia 161f
Neutrophils 167
Nitabuch's layer 113
No objection certificate 150
Nodular enlargement 13
Nodular hyperplasia and carcinomas 86
Nodule
abnormally sized 71
texture of 71
Noncirrhotic liver, assessment of 72
Normal anatomy 2
Nutritional requirements 176
O
Obstetric haemorrhage, causes of 107t
Obstetric hysterectomy 116
Obstructive lung disease 181
Ochronosis 11
Oligohydramnios 181
One-point injection 151
Opening heart and heart weight 47
Opsis 1
Organs
abdominal 19
demonstration of 141
Otitis media 23
Oxalate 149
P
Pampiniform plexus 85
Panchanama 126
Pancreas 69f, 112, 202f
cystic fibrosis of 11
examination of 11, 75
Pancreatic disease 62
Pancreatic neoplasms 62
Pancreatitis
acute 62
chronic 62
Papillary muscles 51, 52
anterior 51, 52, 168
posterior 5153, 168
Paralytic rabies 160
Parenchyma 185
Parenchymal lymphocytic inflammation 161f
Parenchymal tumors, benign 82
Parietal pericardium 23, 42f
Passive venous congestion, chronic 70
Patchy pneumonia, bilateral 173
Pathogenic microorganisms 136
Pathologia indica 7f
Pathology museums 6
Pelvic mucosa 79
Pelvic ultrasonography 177
Pelvis, distortion of 172f
Peptic ulcer disease 67, 68
Perfumes 149
Pericardial cavity 23
Pericardial effusion, moderate 42f
Peripheral cyanosis 11
Peripheral lymphoid organs 88
Perirenal fat, normal 77
Perirenal tissue 76
Peritoneal adhesions 67
Peritoneal cavities 132
peritoneum or 67
Peritoneal fluid, cytology of 201
Peritoneal nodules metastasis 25
Peritoneum covers 86
Peritonitis 67, 182
Periventricular leukomalacia 102
Personal protective
attire 139
equipment 155
Petechial hemorrhages 13, 78f
Peutz–Jeghers
polyp 103
syndrome 11
Peyer's patch 198f
Phenol 149, 152
Pituitary disorders 11
Pituitary gland
enlarged 178f
necrosis 110
Placenta penetrates myometrium 113
Placenta previa 113
Plague 133, 136, 138
Plastination 152
Platelets 188
Pleural cavities 190
and lungs 24
Pleural effusion, pre-existing 24
Pleural mesothelioma 24
Plumbing 132
related leakages 132
PMC see posteromedial commissure
PML see posterior mitral leaflet
Pneumonia 4, 23
Pneumonitis 62
Pneumothorax 56, 61, 109
demonstration of 55f
Polycystic kidney disease 81f, 180
Polycythemia 22
Polymerase chain reaction 27, 162
Polyvalent alcohol 152
Porphyria 11
Portal veins, examination of 73
Postanalytical phases 145
Posterior descending artery 166f
Posterior mitral leaflet 48, 51, 53
Posteromedial commissure 51, 53
Postexposure prophylaxis 138
Postmortem 1
examination 1
second 125
investigations 105
PPM see posterior papillary muscle
Preeclampsia 72, 115
development of 115
syndrome 72
Pregnancy, acute fatty liver of 112, 112f
Preliminary anatomic diagnosis 147
Preliminary skin incisions 17
Prematurity, common signs of 101t
Prion disease 133
Prostate 76
carcinomas of 22
examination of 86
middle lobe of 84
Protozoal infections 24
Proximal duodenum 62
Pseudallescheria 187
Pseudomembranes 64
Pseudomembranous colitis 65f
Pseudomonas 188
PT see pulmonary trunk
PTL see posterior tricuspid leaflet
Puerperal sepsis 115
Pulmonary arterial
bifurcation 42
diseases 58
Pulmonary arteries 40f, 56
Pulmonary aspergillosis 185
Pulmonary embolism 23
Pulmonary thromboembolism 109
Pulmonary trunk 23, 39, 42, 46, 48, 52, 165
Pulmonary tuberculosis 144
Pulmonary valve 52
Pulmonary vein, left inferior 39, 46, 48
Purified protein derivative 141
PV see pulmonary valve
Pyelonephritis 77
acute 81f
chronic 78f
Pyemic abscess 77
Pyogenic meningitis 23, 175
R
RAA see right atrial appendage
Rabies 133, 136, 138
meningoencephalitis 160f, 161f
Rapes 127
RBCA see right brachiocephalic artery
RCA see right coronary artery
RCC SE Right coronary cusp
RCCA see right common carotid artery
Recordkeeping 133
Refrigeration 134
Regional lymph nodes 172
Relation with relatives 135
Renal agenesis 104
Renal arterial
ostia 76
ostium, right 76f
Renal cell carcinoma 82, 82f, 172
Renal diseases 79
Renal function test 193
Renal injury 80
Renal parenchyma 172f
Renal pelvis 203f
Renal rickets 11
Renal sinus 79
Resection anastomosis 116
Respiratory complications 99
Respiratory syndrome coronavirus 2, acute 154
Respiratory system 110, 187
examination of 55
Retention cyst 81, 81f
Retroperitoneal hematomas 25
Rheumatic mitral stenosis 53f
Rib markings 56
Rickettsioses 138
Right atrial appendage 39, 42, 43, 43f, 46, 54, 168
Right atrium 51
Right brachiocephalic artery 39, 46
Right bronchus 58
Right common carotid artery 46
Right coronary
artery 44f, 52
cusp 52
Right inferior pulmonary vein 39, 46
Right lenticular hemorrhage with edema 36f
Right pulmonary
artery 40, 52
vein 40
Right renal artery 76
Right subclavian artery 46
Right superior pulmonary vein 39
Right ventricle leads 51
Right ventricular cavity 166
Rigor mortis 11
RIPV see right inferior pulmonary vein
Rokitansky method 20
RPA see right pulmonary artery
RPV see right pulmonary vein
RRA see right renal artery
RSA see right subclavian artery
RSPV see right superior pulmonary vein
Rubella 105
RVC see right ventricular cavity
S
Saddle-shaped thromboemboli 56
Saliva 62
Saphir's method 20
Scars, small superficial 200f
Sella turcica, diaphragm of 31
Seminal vesicles 83
examination of 86
Sepsis 116
Septal band 51
Septal tricuspid leaflet 51
Septic spleen 92
Septicemia 68
Serum creatinine 167
Sharp instruments, safe use of 138
Sheehan's syndrome 110
Shock 11
Sickle cell anemia 22
Signet ring cell 204f
carcinoma 203
Sinoatrial node 43f
Sinus, sagittal 110
Sinuses-of-valsalva 52
Skeletal development 100
Skin
abdominal 18
changes in 11
infection 12, 23
reflection 55
tests 141
Skull
cap 29f
cavity 100
cut edges of 29f
Slender fibrous septa 172f
SMA see superior mesenteric artery
Small intestine
coils of 201
loop of 183f
Sodium
borate 149
citrate 149
hypochlorite 139
solution 157
Solitary cyst 93f
Specimen
handling 144
storage of 130
Spinal cord 160
examination 27
and sampling 36
removal of 32
Spleen 69f, 88, 89, 175
absent 92
cut surface of 93f
enlarged 91f
examination of 74, 89
hilum of 91
removal of 89
Splenic lesion 94f
Splenic touch imprint 93
Splenomegaly 89
Splinter hemorrhages 13
Split injection 151
Staphylococcus aureus 175
Stauffer syndrome 173
Sternoclavicular joints 18
STL see septal tricuspid leaflet
Stomach content, collection of 66
Stryker saw 28
Subclinical thyroid disease 165
Subcutaneous tissue 56
Subdural empyema 31
Superior mesenteric artery 76
Superior vena cava 42, 43, 51
left 46
Supraclavicular lymph nodes 13
Surface embalming 152
SVC see superior vena cava
Syphilis 105
Systemic examination 27, 63, 102
T
Tap water 149
TC see terminal crista
Terminal crista 51
Testes
examination of 85
size of 14
test for normal 85f
Tetanus 136
Thick gallbladder with choledocholithiasis 75f
Thoracic and abdominal viscera 19f
Thoracic cavity 102, 156
left 101f
Thoracic organs, block of 19
Thorax, in-situ examination of 176f
Thrombophlebitis 14
Thymic abnormality 97
Thymic dysgenesis 97
Thymic lesions 97t
Thymus 96
normal 97f
Thyroid
carcinomas of 22
gland 13
Thyrotoxicosis 22
Tiny blood vessel in lung 109f
Tiny ligaments 88
Tissues
microscopic examination of 105
transport of 140
Torsion 93
Toxoplasma 105
Trabeculo septomarginalis 52
Trachea 58
Tracheal bifurcation 58f
Tracheoesophageal fistula 65, 103
Transmissible spongiform encephalopathy 143
Transmural myocardial infarction, acute 50f
Tricuspid leaflet, posterior 51, 168
Tricuspid valve 54
Trophoblastic invasion 115
Tropical ulcers 14
TSM see trabeculo septomarginalis
Tuberculosis 4, 10, 67, 133, 181
particularly 56
Tubular necroses, acute 77, 80
Tumor
absence of 13
cells 204
TV see tricuspid valve
Typhoid 4
pulmonary complications of 5
U
Ulcerative colitis 68
Ulcers, absence of 13
Unilateral edema 14
Upper motor neuron palsy 176
Uremia 62
Uremic medullary cystic disease 81
Ureters 83
examination of 83
Urinary bladder, examination of 83
Urinary system 181
Urinary tract 171
anomalies of 104
Urogenital system 112
Urogenital tract 76
Urothelial carcinoma 23, 84f
Urticaria pigmentosa 11
Uterine atony 113
Uterine perforation 116
Uterus 204f
V
Vaginal discharge 108
Valvular heart diseases 38
Vascular endothelial growth factor 115
Venous thrombosis 33
Ventilation 132
system 133
Ventriculitis 35
Vertebral column 32, 100
Vesicocutaneous 85
Vesicointestinal fistulas 85
Vesicovaginal 85
Viral encephalitis and rabies 31
Viral hemorrhagic fevers 138
Virchow triad 5
Virchow's method 20, 53
Virchow's node 95
Virtual autopsy 2
Visceral layers 56
Visceral pleura 56
Vitiligo 12
W
Wandering spleen 93
Waste disposal, cleaning and 157
Waterproof bandages 133
Wilm's tumor 82, 104f
large 104f
Y
Yersinia 67
Y-shaped incision 23
Z
Ziehl–Neelsen stains 94f
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Chapter Notes

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Autopsy: Introduction and HistoryCHAPTER 1

Dhaneshwar Lanjewar
 
INTRODUCTION
Since the evolution, human beings have struggled for survival and knowledge. In earlier ancient time, the first systematic cadaveric dissection was performed on animals by hunters, butchers, and cooks to find edible organs. The observations of animal dissection fascinated human beings and stimulated them to know structure of human body. The work on anatomy by Andreas Vesalius (De humani corporis fabrica, 1543), which initiated a concept of pathologic anatomy, confirms that anatomy is the beginning of pathology; more importantly it emphasized that pathology is best studied on the autopsy table. The word “autopsy” is derived from Greek words, autos means oneself and opsis means sight or view, i.e., to see for oneself. The word “autopsy” has been used since 17th century. Necropsy (necros means dead, opis means to view) means viewing of the dead body. Necropsy is the most accurate term for the investigative dissection of the dead body, but the term autopsy is commonly used and is more popular. Other synonyms include postmortem, postmortem examination, and autopsia cadaverum. Autopsy procedure comprises thorough examination of the corpse to determine cause and manner of death and to evaluate any disease. It is considered as akin to a “surgical” operation performed by a specialized medical doctor, which is either a pathologist or a forensic medicine expert.
 
TYPES OF AUTOPSIES
Autopsies are classified into two types. Medicolegal or forensic or coroner's autopsy is ordered by law whenever there is violent, suspicious, or sudden death which may be a criminal matter (see Chapter 7). On the other hand, clinical, medical, or pathological autopsies are performed to know the cause of death or for research purpose and are carried out with the consent of the family of deceased person.2
If the person does not have next of kin or legal heir to give consent, then information has to be given to nearest police station in whose jurisdiction the hospital is located and consent is obtained from the Investigating Officer (IO). Usually IO would conduct a police inquest. It is performed by the pathologist in tertiary care centers (ideal), but in most of the places in India, it is performed by medical officer, who may not always be a postgraduate in pathology. The aim of these autopsies is to determine, clarify, or confirm medical diagnosis that was not known prior to the death of the patient and to confirm a doubtful diagnosis. Clinical autopsies gain more insight into pathological process and determine factors that contributed to the patient's death and the extent of natural disease. It helps to identify the pathological changes that have taken place in different organs during disease processes and its progress or deterioration following treatment. It ensures the standard and care in hospital. Autopsy remains important for quality assurance of clinical work. It identifies medical error and also teaches how patient's death can be prevented in future. In autopsy, it is mandatory to carry out detailed examination of all the organs; this is called as complete autopsy. However, in reality a complete autopsy is not possible because examination of some organs/structures such as eyes, mouth, face, and the extremities are not permitted. In some cases, when the clinician is of the opinion that the patient has died due to localized disease involving one or two organs, there is a request for partial or restricted autopsy. In such situations, examination of the skull, thoracic, and/or abdominal cavities is performed. To perform partial autopsy, there is also a need of obtaining consent of the family of deceased person.
Anatomical dissection (considered by some as another type of autopsy) performed by medical students for understanding normal anatomy cannot be considered autopsy, as anatomical dissection is not carried out for knowing cause of death. Here, usually the unclaimed or unidentified dead bodies are dissected by the anatomist or the medical student to gather detail knowledge of the normal structures of different external and internal organs and structures of the human body. The consent for such autopsy is also given by the person when he was alive or his legal heir/next of kin after his death who have consented for body donation. No separate consent from any legal authority is required in such cases. Though consent is not required, permission ought to be taken from the government authority for such purpose when such donated bodies have to be transported from one place to the medical college where the body is required for dissection purpose by medical students. In some institutes, magnetic resonance imaging (MRI) and computed tomography (CT) scan of dead bodies are performed to determine lesions in various organs, a procedure termed as virtual autopsy.
 
HISTORY OF AUTOPSY
The beginning of autopsy was from anatomy; hence, initial history of autopsy is related to anatomical dissection. The first dissection was probably performed in ancient Babylon (Hillah-Iraq) around 3500 bc. In this time period, the organs of animals were examined to obtain messages from divine spirit. Another practice of hepatoscopy or haruspicy was also prevalent in ancient time. In this practice, 3examination of liver and intestine of sacrificed animals was carried out for foretelling the future. This practice has a religious background and had no relation for understanding of disease.
In the Egypt around 3000 bc, a technique of mummification was practiced, where the embalmers of ancient Egypt used to give incision on left hypochondrium and through this incision intestine, stomach, liver, spleen, pancreas, kidneys, and lungs were removed. The brain used to be removed through nostrils, but the heart used to be retained in the body. In this practice, even though organs were removed, their observations were never made and this dissection was not related for identification or understanding of any disease process. However, as time passed, the techniques of hepatoscopy or haruspicy and embalming played a major role in the progress of autopsy.
The Greek doctor, Galen of Pergamum (131–200 bc) dissected humans and animals to know pathology and he was the first to correlate the patients’ symptoms and signs on the basis of findings of diseased organs. His observations eventually led to autopsy and broke an ancient barrier for progress of medicine. Herophilus and Erasistratus of Chalcedon dissected bodies (3rd century bc) of live criminals to teach anatomy and pathology. In 44 bc, an official autopsy was carried out on Julius Caesar who was murdered by rival senator. By around 150 bc, ancient Roman legal practice had established parameters for autopsies. As early as 1200, the dissection of humans used to be performed with regularity to become skillful in dissection. In England, during the 13th century, dissection of dead bodies to determine the cause of death was largely unknown. By the mid-14th century, dissections had become part of the medical curriculum in many Italian Universities. Table 1.1 shows world leaders and their contribution in advancement in pathology through autopsy studies. Antonia Benivieni, a Florentine physician (1443–1502), used to obtain permission for postmortem from next of kin of deceased in interesting clinical cases. He performed autopsies, recorded their brief description, and correlated findings of autopsy with prior symptoms of the deceased. His autopsy records of 20 autopsies were published by his brother in 1507 as “The Hidden Causes of Disease,” one of the earliest publications of autopsy work.
Andreas Vesalius (1514–1564) used to do anatomical dissection meticulously and skillfully. He moved in Padua in 1537 where he made interesting observations, therefore, understanding of anatomy became easier. His observations described in De humani corporis fabrica (1543) made it possible to distinguish pathologic anatomy of aortic aneurysm from the normal aorta.
Giovanni Battista Morgagni (1682–1771), a keen academician, a physician, and professor at the University of Padua, was trained under Antonio Valsalva. The autopsy examination in its modern form began in Padua with his work. He meticulously performed and described findings in 700 autopsies and produced the first exhaustive work on pathology “The Seats and Causes of Disease Investigated by Anatomy” in 1761. He was the first to correlate clinical symptoms with pathologic lesions and with him, the science of pathology reached new heights.
He convinced the physicians that if they want progress of medicine, then autopsies should be performed and clinicopathological correlation should be achieved. Morgagni is truly a “Founder of Pathologic Anatomy.”4
TABLE 1.1   Contributions of world leaders in autopsy.
Name
Period
Place and country
Significant contribution
Antonio Benivieni
1443 to 1502
Florentine (Italy)
Correlated clinical symptoms with autopsy findings; Publication of autopsy records in 1507—“The Hidden Causes of Diseases”
Giovanni Battista Morgagni
1682 to 1771
Padua (Italy)
Performed and described 700 autopsies and produced the first exhaustive work on pathology in 1761—“The Seats and Causes of Disease Investigated by Anatomy”;
“Founder of Pathologic Anatomy”
Marie Xavier Bichat
1771 to 1802
Paris (France)
Identified 21 types of tissue with the help of physical and chemical tests and without the help of microscope; wrote monograms and books which describe his experiences with tuberculosis, pneumonia, typhoid, and gastroenteritis; “Father of Histology”
Carl von Rokitansky
1804 to 1878
Vienna (Austria)
Performed 30,000 autopsies and supervised 70,000 autopsies; described autopsy technique based on the in situ examination of viscera; Publications: “Handbook of Pathological Anatomy” and “Defects in the septa of the heart; “Father of Modern Autopsy”
Rudolf Ludwig Carl Virchow
1821 to 1902
Berlin (Germany)
Developed simple autopsy technique and published as “Method of Performing Post-Mortem Examinations in the Dead House”; Through the use of microscopic examination and demonstrated that the cellular pathology is the basis of disease; published a book “Cellular Pathology”; first to give names to diseases such as leukemia, embolism, thrombosis, ochronosis, etc. terms named after him: Virchow's node, Virchow–Robin space, Virchow–Seckel syndrome, and Virchow triad; “Father of Modern Pathology”
William Osler
1849 to 1919
Montreal (Canada)
A giant of clinical medicine and pathology; Brought autopsy at the center of medical education; first to note that aneurysm of aorta was a complication of syphilis; on the basis of his autopsy data published in a book “The Principles and Practice of Medicine”
Marie Xavier Bichat (1771–1802), an anatomist and leading physician of Paris, had a great interest in autopsy. In the year he died, he allegedly performed 600 autopsies. He was analytical, and in addition to dissecting the organs he used to carry out physical and chemical tests on the organs. With the help of these tests, he identified 21 types of tissues and this was done without using microscope. He strongly argued that tissues are damaged in diseases. His observations were important milestones in the history of medicine. Bichat wrote monograms and books which describe his experiences with tuberculosis, pneumonia, typhoid, and gastroenteritis.5
Carl von Rokitansky (1804–1878) was a great physician of Vienna and is considered as the father of modern autopsy. He was of the opinion that the autopsy will be of great help for physicians. In earlier time when autopsy examination of only diseased organs was performed, Rokitansky described a technique of systematic examination of organs. He not only examined the diseased organ meticulously but also paid attention toward examination of all organs one-by-one systematically. In a span of 45 years of his career, he himself performed 30,000 autopsies and supervised 70,000 autopsies. He had collection of tens of thousands of pathologic specimens. Rokitansky described entities such as acute yellow atrophy of liver to massive hepatic necrosis. His notable contributions are congenital heart disease, bacterial endocarditis, lobar and lobular pneumonia, and pulmonary complications of typhoid. Vienna school of medicine was worldwide recognized because of scientific contributions of Rokitansky; his contribution was published as “Handbook of Pathological Anatomy and Defects in the Septa of the Heart.”
Rudolf Ludwig Carl Virchow (1821–1902) was a great pathologist of Berlin (Germany), biologist, prolific writer, an editor, and is known as “The Father of Modern Pathology.” When he was appointed as assistant to prosector in the Chariate Hospital, Berlin, he noticed that the working in the autopsy room was disordered. No systematic method for performing autopsy was available. Young untrained surgeons used to perform autopsy and they were not making notes during autopsy. Therefore, for the benefits of beginner in autopsy, Virchow developed simple autopsy technique which was subsequently published in 1876. He studied diseased tissue by microscopic examination and demonstrated that cellular changes are responsible for the development of disease and cellular pathology is the basis of disease. Through microscopy, he made significant contribution for the development of pathology and brought autopsy and pathology to recognizable state. His most important work in the “Cellular Pathology,” published in 1858 as a collection of lectures, is regarded as the root of modern pathology. A number of terms are named after him, Virchow's node, Virchow–Robin space, Virchow–Seckel syndrome also known as “bird-headed dwarfism”, and Virchow triad. He was first to describe and give names to diseases such as leukemia, embolism, thrombosis, and ochronosis.
Sir William Osler (1849–1919), the giant of clinical medicine, was initially trained for 3 months in Berlin under Virchow and for 5 months in Vienna with Rokitansky. In his era, pathology and autopsy attained the highest position. He performed 800 autopsies, and published papers on autopsy. At McGill University, Montreal, he curated and mounted museum specimens and used this data while writing his textbook “The Principles and Practice of Medicine.” He highlighted the importance of pathology for better understanding of medicine. He was among the first to note that aneurysm of aorta was a complication of syphilis. He was among the earliest to show micrococci in the etiology of endocarditis; he also contributed significantly to our understanding of cardiac pathology.
 
HISTORY OF AUTOPSY IN INDIA
The first medicolegal autopsy in Indian empire was performed on 28th August, 1693, when Mr James Wheeler (Member of Council, Sea Customer and Chief Justice 6of Choultry) died in Chennai. The progress of pathology in India during British Era began much earlier in preindependence era. The first Bengal medical school was established in 1822 in Calcutta (now renamed as Kolkata) which was converted into a Bengal Medical College (now renamed as Kolkata Medical College) in 1835. In Bengal Medical College, records of creation of the “Pathology Museum” in early 1840 are available. Dr Allen Webb, Professor of Descriptive and Surgical Anatomy, was the main person behind the creation of museum. In those days civilian medical students and medical students of army who passed as graduates, used to perform autopsies and collect specimens of diseased organs. The specimens were collected from the West, the East, from Aden and Singapore, from Moulmein and Lahore, and from the southern confines of the Madras Residency to the Himalayan range. The British Government provided the preservation facility and transportation facility to bring the specimens to Kolkata Medical College to create a pathology museum in 1840. This museum is the central depot of pathological contributions from every part of the British Empire. The descriptions of the specimen are written by Dr Allan Webb, after exposition of parts in the dissecting room, and by the civilian and army doctors. The vast collection of morbid anatomy specimens in the museum, thoroughness of the study and recorded descriptions are simply fascinating. This pathology museum during that time was known to be “one of the finest pathology museums” in the world. Professor Allen Webb subsequently published a book Pathologia Indica: “Anatomy of Indian Diseases” in 1848 (Fig. 1.1A). This book contains autopsy notes with short clinical details and treatment prescribed and also has comments on historical and pathophysiological aspects of diseases of different systems of the body.
The review of first edition of the book on the subject of diseased heart and arteries among the native, Parsees, and Hindus, mentions that aneurysm appears to be, if not altogether unknown, a disease of rare occurrence. Hence, remarks as “Are natives of India exempt from aneurysm”? In Southern part of India, Madras Medical College was established in 1835, while in the West, the Grant Medical College was established in Bombay (now renamed as Mumbai) in 1845. The Coroner's act was implemented in Mumbai on January 27, 1871. In the Coroner's system, autopsies were performed 24 hours a day, after obtaining permission from the Coroner's office. The Coroners Act did not apply to the cases in which the death had been caused by cholera or other epidemic diseases. The first clinical postmortem was conducted in the Grant Medical College, Mumbai in January, 1872. Dr Gharpure has published several articles on the autopsy material of GMC and JJH, Mumbai. Dr Gharpure's papers described the incidence of primary carcinoma in India from postmortem records between 1877 and 1926, and also described analysis of postmortem findings of human amebiasis in 426 cases. Currently, The Grant Medical College has preserved autopsy records of 18,578 autopsies from 1884 to 1966. These records are handwritten, contains meticulous descriptions and hand drawings of the pathologic lesions.
Dr MN De, from Kolkata Medical College, studied and published autopsy findings describing pathogenesis of commoner types of splenomegaly met within India” (1938) (Fig. 1.1B) and pathologic aspects of “Epidemic Dropsy.” In postindependence period (1947–2000), clinical autopsies were performed in all the government run medical colleges and postgraduate institutes. Significant pathological data of nervous system and cardiovascular diseases was published.7
zoom view
FIGS. 1.1A AND B: (A) Pathologia Indica: Anatomy of Indian Diseases; (B) Publications of Dr MN De.
Recently, Dr Lanjewar et al. described the largest autopsy report in India from the Department of Pathology, Grant Medical College, and Sir JJ Hospital, Mumbai, wherein autopsy findings of 13,024 adults are described. Currently, 529 medical colleges are providing undergraduate and postgraduate training to several thousand medical students in India. Only 10 out of 529 medical colleges perform clinical autopsies, due to nonperformance of clinical autopsies in many institutes, valuable information is lost; hence, there is a need of reviving clinical autopsy program in India.
FURTHER READING
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