Table Of ContentPost Mortem Technique Handbook
Second Edition
Post Mortem
Technique Handbook
Second Edition
Michael T. Sheaff, BSc, MB BS, FRCPath
Department of Morbid Anatomy and Histopathology,
Royal London Hospital,Whitechapel,London,UK
Deborah J. Hopster, BSc, MBChB, MRCPath
Department of Histopathology,Whittington Hospital,London,UK
With 128 Illustrations
With Forewords by John H.Sinard and Professor Sir Colin Berry
Michael T.Sheaff,BSc,MB BS, Deborah J.Hopster,BSc,MBChB,
FRCPath MRCPath
Department of Morbid Anatomy and Department of Histopathology
Histopathology Whittington Hospital
Royal London Hospital London,UK
Whitechapel
London,UK
British Library Cataloguing in Publication Data
Sheaff,Michael T.,1965–
Post mortem technique handbook.—2nd ed.
1. Autopsy—Handbooks,manuals,etc.
I. Title II. Hopster,D.J.,1966–
616¢.0759
ISBN 185233813X
Library of Congress Cataloging-in-Publication Data
Sheaff,Michael T.,1965–
Post mortem technique handbook/Michael T.Sheaff,Deborah J.Hopster.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-85233-813-X (hc :alk.paper)
1. Autopsy–Handbooks,manuals,etc. I. Hopster,D.J.,1966– II. Title.
[DNLM: 1. Autopsy–methods–Handbooks. 2. Pathology–Handbooks.
3. Postmortem Changes–Handbooks.QZ 35 S539p 2004]
RB57.S43 2004
616.07¢59—dc22 2004049160
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ISBN 1-85233-813-X
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Once again my appreciation and love to Sue,Tim,Emma
and my late father Peter,
But especially mum,
Who sadly died during the preparation of this second edition.
MTS
To Andrew,
for his love and support,
in addition to all his help
in writing this second edition.
DJH
Foreword I
Forces are at work which may be changing the way the general public thinks
about the autopsy. The past few decades have seen a consistent, almost
depressing drop in autopsy rates across the world. Once considered the
foundation of medical science,the autopsy has fallen into relative disfavor.
As the authors of this book discuss,the overall autopsy rate in England has
dropped to approximately 25%,with 22% representing coroner mandated
cases and only 3% attributable to hospital/academic cases.The situation in
the United States is similar, with an estimated overall autopsy rate of
just under 10%,half of those attributable to hospital/academic cases.But
this may be changing.At least at my own institution, autopsy rates have
plateaued over the last few years,and this past year may even be showing
a slow increase.As much as I would like to think this is due to internal
efforts to increase the value of the autopsy,it is more likely that three rel-
atively recent trends are altering the public’s perception of this medical
procedure,and that this change in perception is largely responsible for the
possible reversal of the autopsy rate decline.The first is the general public’s
increased awareness of and involvement in their own medical care.Once
available to only those select few who chose to enter the medical profes-
sion, knowledge of medical procedures, and medicine in general, is now
widely available to anyone with a library card or an internet connection.
Secondly,increased media focus on medical errors and/or mishaps has led
to greater demands for accountability and assurances that accurate diag-
noses have been made and appropriately treated.Finally,the popularity of
a number of recent television series have made words like “autopsy”and
“forensics”and “medical investigation”household words.The net result of
these trends is a change in the public perception of post-mortem examina-
tion from a macabre procedure performed by hump-backed technicians in
a dimly-lit basement to one of a modern,perhaps even high-tech medical
procedure performed to answer very real and important questions. Even
outside of the medical-legal environment, families simply want to know
what happened,and recognize the autopsy as a way to answer many of their
unanswered questions.With the world potentially poised for a resurgence
vii
viii Foreword I
in the demand for autopsies, are pathologists ready to take on this chal-
lenge? Unfortunately,the past few decades of autopsy decline have resulted
in a number of pathologists entering practice having performed fewer than
forty or fifty autopsies, and as a result their knowledge of autopsy tech-
niques is limited.This book is targeted at addressing that deficit. Nearly
50% longer than the first edition,this new edition contains updated text,
many additional photographs,and a greater use of tables and lists.It is quite
simply among the best detailed descriptions of post-mortem examination
techniques that I have read. Comprehensive in scope, it includes both
routine and specialized dissection techniques.Perfect for general study and
as an ongoing reference for pathologists in training and in practice,it will
undoubtedly be a valuable tool as the field of pathology faces the challenges
of the future.
John H.Sinard,MD,PhD
Director,Autopsy Pathology
Yale-New Haven Hospital
Associate Professor of Pathology
Yale University School of Medicine
Foreword II
The relentless decline in the hospital based autopsy has been documented
elsewhere in detail and has been generally deplored as a loss of an impor-
tant method of “quality control”at a time when the practise of Medicine is
closely scrutinised.This is not the place to revisit these well-rehearsed argu-
ments but the change itself provides a powerful justification for the pro-
duction of this book.
The decrease in clinically requested autopsies in hospitals leaves a large
and increasing number of Coronial autopsies to be done;many of these in
circumstances of discontent with some aspect of the medical or other man-
agement of the events which ultimately lead to death.The pathologists now
performing these autopsies will not have had the amount of experience that
was commonplace among their predecessors;an experience of carrying out
procedures which, although devised for different purposes, can provide a
more complete examination of the whole body than often appears neces-
sary in straightforward deaths in the community. In my first two years in
Pathology I performed 200 autopsies;most of my contemporaries will have
had a similar grounding—it would not be possible to provide this experi-
ence for staff in training now, except in some parts of the European
mainland.
So there is a need to provide a written but practical account of the
autopsy which will help those who may find themselves in unfamiliar terri-
tory. A “fixed” technique will not do for all cases (this is perhaps most
evident in infancy and childhood) and a number of procedures are pre-
sented with this in mind.Readers will find tables of weights,dimensions and
diagrams,which will help in description or illustration in reports and save
searches of now unfamiliar anatomy texts.Although much has been written
about the investigation of suspicious or unnatural death in recent years,it
is difficult to find help with the more prosaic work and Ross’s “Post Mortem
Appearances” is more than 30 years old. This text addresses questions
which will present themselves to Pathologists in conventional hospital prac-
tice who have to provide clear accounts of processes and descriptions of
findings for discussions with colleagues and relatives,hospital case confer-
ences,Coroners courts or legal reports.
Professor Sir Colin Berry
ix
Acknowledgements
Many thanks again to our patient colleagues,particularly Mr Dean Jansen
at the Whittington Hospital who kindly helped with photography.Grateful
thanks also to all at Springer,especially Melissa Morton and Eva Senior,
who encouraged us through the preparation of this second edition.
MTS
DJH
xi
Contents
Foreword I by John H.Sinard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword II by Professor Sir Colin Berry . . . . . . . . . . . . . . . . . . . . ix
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1. Before the Post Mortem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. General Inspection and Initial Stages of Evisceration . . . . . . . . 56
3. Evisceration Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
4. Block Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
5. The Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
6. The Respiratory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
7. The Gastrointestinal System . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
8. The Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
9. The Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
10. The Haematopoietic and Lymphoreticular Systems . . . . . . . . . 249
11. The Musculoskeletal System . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
12. The Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
xiii
