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The pathologist first examines the outside of the body. A great deal can be learned in this way. Many pathologists use scalpels with rulers marked on their blades.
The body is opened using a Y-shaped incision from shoulders to mid-chest and down to the pubic region. If the head is to be opened, the pathologist makes a second incision across the head, joining the bony prominences just below and behind the ears. When this is sewed back up, it will be concealed by the pillow on which the dead person's head rests.
The pathologist uses a scalpel for these incisions. There is almost no bleeding, since a dead body has no blood pressure except that produced by gravity.
The incisions are carried down to the skull, the rib cage and breastbone, and the cavity which contains the organs of the abdomen. The scalp and the soft tissues in front of the chest are then reflected back. Again, the pathologist looks around for any abnormalities.
Here, one pathologist is preparing to open the skull, using a special vibrating saw that cuts bone but not soft tissue. This is an important safety feature.
Another pathologist is cutting the cartilages that join the ribs to the breastbone, in order to be able to enter the chest cavity. This can be done using a scalpel, a saw, or a special knife, depending on the pathologist's preferences and whether the cartilages have begun to turn into bone, as they often do in older folks.
The third pathologist is exploring the abdominal cavity. The first dissection in the abdomen is usually freeing up the large intestine. Some pathologists do this with a scalpel, while others use scissors.
The skull vault is opened using two saw cuts, one in front, and one in back. These will not show through the scalp when it is sewed back together.
When the breastbone and attached rib cartilages are removed, they are examined. Often they are fractured during cardiopulmonary resuscitation.
Freeing up the intestine takes some time. The pathologist in this picture is cutting along the attachment using a scalpel.
The top of the skull is removed, and the brain is very carefully cut free of its attachments from inside the skull.
The chest organs, including the heart and lungs, are inspected. Sometimes the pathologist takes blood from the heart to check for bacteria in the blood. For this, he uses a very large hypodermic needle and syringe. He may also find something else that will need to be sent to the microbiology lab to search for infection. Sometimes the pathologist will send blood, urine, bile, or even the fluid of the eye for chemical study and to look for medicine, street drugs, alcohols, and/or poisons.
Then the pathologist must decide in what order to perform the rest of the autopsy. The choice will be based on a variety of considerations. This team will use the method of Virchow, removing organs individually. After the intestines are mobilized, they are opened using special scissors.
Inspecting the brain often reveals surprises. A good pathologist takes some time to do this.
The pathologist examines the heart, and generally the first step following its removal is sectioning the coronary arteries that supply the heart with blood. There is often disease here, even in people who believed their hearts were normal.
After any organ is removed, the pathologist will save a section in preservative solution. Of course, if something looks abnormal, the pathologist will probably save more. The rest of the organ goes into a biohazard bag, which is supported by a large plastic container.
The pathologist weighs the major solid organs (heart, lung, brain, kidney, liver, spleen, sometimes others) on a grocer's scale. The smaller organs (thyroid, adrenals) get weighed on a chemist's triple-beam balance.
The next step in this abdominal dissection will be exploring the bile ducts and then freeing up the liver. Again, this pathologist has decided to use a scalpel.
After weighing the heart, the pathologist completes the dissection. There are a variety of ways of doing this, and the choice will depend on the case. If the pathologist suspects a heart attack, a long knife may be the best choice.
The liver has been removed. The pathologist has found something important. It appears that this man had a fatty liver. It is too light, too orange, and a bit too big. Perhaps this man had been drinking heavily for a while.
The pathologist has decided to remove the neck organs, large airways, and lungs in one piece. This requires careful dissection. The pathologist always examines the neck very carefully.
The liver in this case weighs much more than the normal 1400 gm.
The lungs are almost never normal at autopsy. These lungs are pink, because the dead man was a non-smoker. The pathologist will inspect and feel them for areas of pneumonia and other abnormalities.
The liver is cut at intervals of about a centimeter, using a long knife. This enables the pathologist to examine its inner structure.
The pathologist weighs both lungs together, then each one separately. Afterwards, the lungs may get inflated with fixative.
The rest of the team is continuing with the removal of the other organs. They have decided to take the urinary system as one piece, and the digestive system down to the small intestine as another single piece. This will require careful dissection.