A medical examiner opens and analyzes the organs of three body cavities: skull, chest and abdomen, to discover the circumstances and causes of death.
Only three situations require this type of examination: 1) violent or suspicious death, when the body is taken to the Legal Medical Institute (IML); 2) natural death in which medical care was lacking or due to an unexplained illness, which is the responsibility of the Death Verification Service (SVO); 3) or when the disease is rare and needs to be studied, more common in academic hospitals.
CUT TO CUT
The procedures and work of coroners in a victim of violent death.
1. After the family is recognized, the body is identified with a number that refers to documents such as the RG and the Police Report. Clothes and projectiles are sent to the Institute of Criminalistics, of the Scientific Police, which performs forensics on “crime scenes” and objects. The cadaver is weighed and washed with soap and water.
two. In the necropsy room, the examination begins with the external analysis of the body. The doctor and assistant look for bullet holes, injuries and even signs that identify the dead person, such as a tattoo or a scar. All details are noted down and will form part of a document issued by the IML.
3. “The next step is the internal examination, by opening the corpse’s cavities and by meticulously examining its viscera”, says Roberto Souza Camargo, director of the IML in São Paulo. With a cut that runs from the neck to the pubis and which can be in the shape of a Y, T or I, the coroner has access to the rib cage and abdomen.
4. The injured organs that may help in discovering the cause of death are removed and examined – like a stabbed heart or the stomach, in the case of poisoning. Both general and microscopic analysis are performed and the results are combined in the final report.
5. After the organs in the chest, the doctor cuts through the scalp from one ear to the other to remove the brain. The skull cap is removed with an electric saw, but the brain can only be extracted if all the nerves that connect it to the body are cut – including the optic nerves, which connect to the eyes.
6. At the end of the analysis, the organs are reinserted and the body is closed. The small pieces used in exams are incinerated. The coroner uses a continuous seam, which has a starting point and runs from the beginning to the end of the cuts. Hair and clothing hide the sutures during burial.
7. The entire process, from arrival to release from the body, takes four to eight hours. The necropsy takes between two and three hours. At the end of the exam, the IML issues a Death Certificate, with the identification and reason for death. With this document, the family can withdraw the Death Certificate from a notary.
INDICATIONS OF DEATH
The appearance of an organ can indicate the causes of death.
Pus in the lung may indicate pneumonia – in a patient who has been hospitalized for a long time, the cause may be the intubation itself.
Swollen lungs, full of red spots and a purplish face indicate asphyxiation. In case of drowning, they are of course also filled with water.
Scattered brain mass is a sign of a skull fracture, which could be the result of some type of blow to the head, such as an axe.
Pale organs represent heavy blood loss due to hemorrhage. It could be the result of a gunshot wound to the heart, for example.
Although the process is popularly known as autopsy, the correct term is necropsy – since “auto” indicates that you would do the examination on yourself.
Oh, and it’s worth remembering: the IML doesn’t just deal with the dead. In São Paulo, a good part of the assistance (92%) is carried out with living people, such as victims of assaults, traffic and work accidents.
ILLUSTRATIONS Daniel Rosini
SOURCES: Roberto Souza Camargo, professor at the Faculty of Medicine at USP and director of the IML in São Paulo; Karla Campos, criminal expert, technical assistant to the superintendent of the Scientific Police of São Paulo; Flávio de Oliveira Lima, professor at the Faculty of Medicine of Unesp and responsible for the Death Verification Service at the Hospital das Clínicas of the Faculty of Medicine of Unesp; Ministry of Health; Handbook of Forensic Medicine by Delton Croce
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