Post Mortem Technique Handbook Second Edition

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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

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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

Apart from any fair dealing for the purposes of research or private study, or criticism, or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.

ISBN 1-85233-813-X

Springer Science+Business Media springeronline.com

The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of a speciﬁc statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.

Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

Printed in the United States of America. (BS/MV) Printed on acid-free paper SPIN 10911587

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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

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Foreword I

vii 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 examination 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

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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 techniques 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

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Foreword II

ix The relentless decline in the hospital based autopsy has been documented elsewhere in detail and has been generally deplored as a loss of an important 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 experience 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 practice 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

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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

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Post Mortem Technique Handbook Second Edition

Post Mortem

Technique Handbook

Foreword I

Foreword II

Acknowledgements

Contents