About Pathology

So what does a pathologist do? Everyone has an idea in their heads, but it’s only 10% right; the truth is both a lot more mundane and a lot more interesting.

To be boring and didactic, pathology literally means the study of disease. Over the centuries, it has actually become super-subspecialised; technically speaking, haematologists, medical microbiologists, chemical pathologists and immunologists are all ‘pathologists’.
What most people know as pathologists, though, are histopathologists. The ‘histo’ bit means ‘tissue’, which means they look at the cells, tissues and organs. They do so with the naked eye but, more importantly, they do so with a microscope. And, contrary to popular opinion (fed by ill-informed crime literature and ignorant journalists), the vast majority of pathologists spend most of their time nowhere near dead people.

I am a full-time histopathologist and I spend less than 10% of my working life performing autopsy examinations; the rest of the time I examine and report on tissue biopsies of living human beings. Anything from minute skin biopsies or tissue samples taken via an endoscope to entire organs surgically removed (the whole large intestine, a kidney, or a lung for instance) come to someone like me.

What I say determines precisely what treatment the patient will receive. Pathologists are of far more importance to the living than the dead.

What happens in an Autopsy?

In the UK, there are about 200,000 autopsies per year, in England and Wales mostly done under the authority of the Coroner, whereas in Scotland they are under the authority of the procurator fiscal. What, though, does that actually mean? What happens in an autopsy? I could at this point go into the details of formal identification and external examination, but I think what is important to the relatives of the deceased who undergo post mortem examination is what actually is done to the body. That is what this page is about.

Only two incisions are made when an autopsy is performed; if the brain does not need to be examined, then only one is necessary. Forget, therefore, the images of horror films in which corpses are hacked about, and blood flies everywhere. The main incision is made in the midline and extends from the top of the throat to the pubic area; through this incision, all the organs, save the brain, can be removed and, quite astonishingly, they can be removed in one, cohesive ‘block’; with a bit of fiddly knife work, even the tongue can be removed from the mouth.

It is the job of the pathologist, to assess all the organs and tissues that have now been removed. To examine the heart, both the lungs, the tongue (which, surprisingly, can sometimes be important), the airways, the major blood vessels, the kidneys, the liver, the pancreas, the gullet, stomach and intestines, the bladder, the genital systems, the spleen, the adrenals and the thyroid.

Each of these has to be dissected in a particular way.

If the brain is to be examined, a second incision is required but, do not worry, the relatives will not see it unless they look hard. It is made around the back of the scalp, from ear to ear. This allows the scalp to be pulled forward, exposing the skull. A wedge is cut into the vault of the skull and the brain removed. It, too, is examined by a specialised dissection technique. After it is over, what then? That, perhaps, is the one thing that might dismay you. There is certainly no time to for anything other than putting everything back in the body cavity; the brain is not put back into the skull, but mixed up with everything else. The skull is replaced and the scalp sown back over nothing more than cotton wool. Rest assured, during this whole process, the mortuary technicians will have treated the deceased with due reverence. After it is over, the body will be washed down and dressed in a shroud; if reconstruction is necessary, the mortuary technicians will use great skill to achieve it. Even if the deceased has badly disfigured at the time death, I have seen miracles worked by these unsung heroes. It is highly likely that when the bereaved view their relative, they will see little sign that an autopsy has been performed and what they see will have been reverentially and skillfully handled.