An autopsy examination is a scientific and systematic study of a dead body. Although it provides valuable information as regards the exact aetiology, pathogenesis, and diagnosis of diseases, and cause and manner of death, time since death, etc, very little attention is usually paid in the design and construction of an autopsy section. This is partly because the importance of the information obtained from an autopsy examination is not properly appreciated, and partly because of paucity of funds in developing countries where most of the available funds are of necessity utilised for important and pressing needs of a living patient.
India consists mostly of villages which are served by Taluka or District Hospitals. Cities with big Hospitals and attached Medical Colleges are comparatively few in number. The requirements of an autopsy section at a Taluka or District Hospital naturally differ from those of a bigger Hospital, especially the one to which a medical college is attached. In Talukaor District Hospitals medico-legal autopsies constitute the major bulk of autopsy work and the routine medical autopsies are indeed very few, if any. Autopsies are performed by medical officers mainly occupied in patient care. Most of them have very little or no experience or training for this purpose. In bigger Hospitals and especially those attached to the medical colleges, both types of autopsies are performed. A certain number of Medical Officers are reserved for medico-legal autopsies and they can always have guidance from senior pathologists and forensic experts, when required.
REQUIREMENTS OF A LARGE HOSPITAL
The autopsy section should be located a little away from the main Hospital and should have its own entry exit to facilitate movements of the mourners, transport of the cadaver and proper handing over the body after autopsy to the relatives for further disposal. The autopsy section should provide the following:
a) Office for the Medical Officer
b) Units/ rooms for performing autopsies
d) A room for delivering the dead body
e) A servants’ room
f) A room for special procedures on the Dead
g) Rooms for laboratory and radiological procedures, storage, maintenance of records, etc.
h) Shade/ waiting room for the relatives
i) Adequate sanitary facilities
a) OFFICE FOR THE MEDICAL OFFICER
Here the Medical Officer can study the relevant documents, such as case papers, dead body challan, inquest report, etc., and can view the x-rays. He can also obtain additional information either from the police or from the relatives accompanying the dead body. Depending upon the suspected cause of death, he can plan out the procedures to be adopted at the time of performing the Autopsy; further, yeah can refresh his memory (quickly) by referring to standard textbooks, to avoid any omissions while conducting the autopsy; further, he can refresh his memory (quickly) by referring to standard textbooks, to avoid any omissions while conducting the autopsy. He can have the autopsy reports typed. He can contact the police or the relatives after the autopsy is over. Both internal and external telephones should be available in this office.
b) UNITS/ ROOMS FOR PERFORMING AUTOPSIES
There should be provision of three units/ rooms for performing autopsies-
· One for, medical autopsy,
· Another for, medico-legal autopsies,
· And the third one as a spare unit.
The first two units should have a gallery type or a stepwise arrangement to accommodate 25- 30 students at a time. The third unit need not have such an arrangement. The floor and the walls of the autopsy units should be lined by glazed tiles.
In each autopsy unit there should be two tables-
· One, standard autopsy table
· And another table with a marble top for carrying out further separation of the viscera, or dissection of individual systems or organs.
There should be arrangements for adequate water supply at each of these tables, and for the proper drainage of water, and blood stained and other discharges from the centre of each of these tables. Each autopsy unit should have two sinks (one each for dirty and clean work) and one wash basin.
Each unit should have ample natural light; however there should be provision for adequate artificial light, which may be supplemented by adjustable lights for a proper view. There should be adequate ventilation, and sufficient number of exhaust fans. Alternatively, these units should be air-conditioned. Facilities for closed circuit television system should be provided at suitable places in the autopsy room and at some places in the Hospital for teaching purposes.
Each unit should display charts to show the average weights of organs of the body. There should be x-ray viewing boxes and black boards in each of these units.
This is a place where the dead bodies are kept till they are ultimately handed over to the relatives or others for further disposal. The mortuary should have refrigerated boxes to keep the bodies cool; otherwise the latter would emanate foul smell due to decomposition. In a 1000 bed Hospital, there should be provision normally to keep 16- 20 dead bodies. However, it is advisable to have 28- 32 compartments to meet additional requirements following a major disaster.
The importance of preserving the dead body at refrigerator temperature cannot be overemphasized in a tropical Country.
d) A ROOM FOR DELIVERING THE DEAD BODY
The dead body is brought in this room after it has been washed well in the autopsy room. The body is placed over a table. The relatives are called to identify the body, which is then dressed according to the religious customs. Minor traditional and religious rights can be performed at this place. It is necessary that the medical officer should be present while handing over the autopsied body either to the police or to the relatives.
In case of medico-legal autopsies, it is necessary, though not always practiced, to hand over the body to the police and not to the relatives. In case of medical autopsies, the body can be handed over to the relatives. In either case a receipt for having delivered the body should be taken and the same preserved.
e) A SERVANTS’ ROOM
A separate room should be available for servants who are on 24 hours duty either for autopsy work or for receiving the dead bodies.
f) A ROOM FOR SPECIAL PROCEDURES ON THE DEAD
Here cornea from a dead body or other organs may be removed for transplantation purposes. A refrigerator should be provided to preserve the organs removed for transplantation. This room should be preferably air conditioned.
g) ROOMS FOR LABORATORY AND RADIOLOGICAL PROCEDURES, STORAGE, MAINTENANCE OF RECORDS, ETC.
Although these rooms should be of small size, they should be separate as they serve a definite purpose.
One room is used for storing the various organs removed at the autopsy, till they are despatched to the respective departments for further investigation. There should be adequate number of buckets/ trays and big sized glass jars to preserve the autopsy organs.
One room should house a side laboratory, where minor laboratory tests such as staining by Gram’s Method, or Ziehl-Neelsen’s method, examination of urine for sugar, simple tests for detection of poisons, etc, can be performed. Further, a freezing microtome or a cryostat can be installed in this room, and histological sections can be prepared, stained and examined.
All the stores of the autopsy section can be placed in one room. The stores include miscellaneous items such as test-tubes, glass jars, enamel buckets and trays, linen inclusive of gowns and masks, rubber gloves, cotton, formalin solution, first-aid equipment, new and discarded instruments, etc.
There should be one room for maintaining the medico-legal records, such as police inquests, autopsy reports, etc.
One room is provided for preserving material to be sent to the chemical examiner.
In one room, a suitable x-ray machine should be installed to facilitate taking of radiological plates of dead body, before, after, or during autopsy. A side room attached to this room should be used for developing an x-ray plate. The side room can also be used for developing and preparing photographs of the medical and medico-legal importance.
Gas connection should be provided in the autopsy units, room for special procedures and in the laboratory.
REGISTERS TO BE MAINTAINED IN THE AUTOPSY SECTION
It is advisable to maintain five types of registers in the autopsy section-
· Two general registers medical and medico-legal Autopsies,
· Two report registers for medical and medico-legal autopsies, and
· One mortuary register.
Entries in all the five registers should be made in the autopsy section only, and these registers should not be removed from this section under any circumstances.
h) A SHADE/ WAITING ROOM FOR THE RELATIVES
This area is meant for the relatives who are required to wait till the autopsy is over and the dead body is handed over to them. This place should be a little away from the main autopsy section/ complex and the relatives should not have easy access either to the mortuary or to the autopsy units. After the body has been autopsied and brought to the room meant for delivering the dead body, a few of the relatives should be called to this room and body is handed over.
i) ADEQUATE SANITARY FACILITIES
Adequate sanitary facilities should be provided to the Medical Officers, servants and to the relatives at respective places.
REQUIREMENTS OF A SMALL HOSPITAL
In a small Hospital, where the number of autopsies performed per year does not exceed 20-25, the requirements of the autopsy section cannot be as stringent as those in a larger Hospital. Nevertheless, the basic needs of the autopsy section must be fulfilled adequately. Thus, there must be one room for performing an autopsy (one unit), one room to function as a mortuary, and one room for delivering the dead body to the relatives. The other functions of the autopsy section can conveniently be carried out in the main Hospital premises.
Navin Kumar Jaggi