To uncover the truth through an autopsy

There is a controversy involving autopsies related to the Dengvaxia issue, and I doubt that the general public is truly aware of what an autopsy is. I speak from my experience as a pathology resident, whose first year was spent conducting at least 10 autopsies under the guidance of consultants, after which the cases were discussed at length in Monday conferences.

But first, it should be clarified that an external examination of the body is just part of an autopsy, and not the procedure in itself.

Of the classic autopsy techniques identified by the College of American Pathologists, four are most often used: Virchow, Rokitansky, Ghon and Letulle. In our institution, we are trained on the Letulle technique in which, after an adequate Y-shaped primary incision on the anterior thorax to the abdomen, the cervical, thoracic, abdominal, and pelvic organs are removed as one block. Body fluids are collected and noted, and, when necessary, postmortem laboratory examinations are also done. The organs are individually weighed, photographed, serially sectioned, and sampled for histologic examination (i.e., tissues suspicious for pathologic changes are examined under the microscope).

Another important step is gathering all the patient’s records, history, and clinical course and correlating these with all clinical laboratory exams, imaging, and gross and microscopic findings to arrive at a provisional anatomic diagnosis. Residents then present their cases in an autopsy conference to consultants, who mostly include a forensic pathologist; rotators from different departments such as Neurosurgery,
Obstetrics and Gynecology; coresidents; and interns and clerks. Revisions are made on the provisional diagnosis, and a microscopic examination of tissues is done with the primary consultant before arriving at the final diagnosis.

Suffice it to say that a huge amount of work is done in one autopsy. This does not include brain cuttings, which are done live during a conference with the Neurosciences department.

Different autopsies are done for adults and for children. Most important, a medical autopsy is different from a medico-legal autopsy, which is far more delicate as it generates evidentiary documents for criminal and civil lawsuits. As stated very plainly in Jurgen Ludwig’s Handbook of Autopsy Practice, “ideally, medico-legal autopsies should be carried out by trained forensic pathologists.”

A pathologist is a licensed physician who has undergone the four-year residency training in anatomic and clinical pathology and passed the diplomate exams administered by the Philippine Society of Pathologists. Subspecialists, like forensic pathologists, undergo further training in their field of expertise for at least a year, usually overseas because fellowship training for subspecialties is still lacking in the country.

An autopsy is conducted to uncover the truth. What was the immediate, antecedent and underlying cause of death? Was the manner of death natural or accidental? Was it suicide or homicide? As pathologists, we strive to elucidate on these matters using all the information gathered from the clinical data and the gross and microscopic findings to arrive at a conclusion with a reasonable degree of certainty. I fervently hope that the general public will be able to discern truthful information from mere speculation or hype, and that we will arrive at a resolution to this controversy that upholds the common good.

Thaddeus C. Hinunangan is a pathology resident at the Philippine General Hospital.