The scenes-of-crime officer or the police might have given their own opinion that the deceased (found at a crime scene) was poisoned — but as the pathologist, standing tall in your morgue (it’s like your second home, right?) and ready to go, it’s up to you to read what a person’s organs and tissues spell, examine them closely, and write up your findings as an official cause of death. It’s time to pick up your scalpel, pull down your face mask, and do that last minute of rigorous hand-washing — because we’re about ready to take you back to the cold, hard slab and we’ll need your results, Doctor.
Before we actually start cutting anything open, it’s important that you confirm any findings that have been related to you by examining the body externally. We’ve written up the method for this already, and you can find it here. If you’re prepared to move ahead, it’s time to make an incision and start getting up-close and personal with the decedent’s (a polite way to say dead person’s) inner contents.
1. Note any smell that hits you after you make the regular Y-shaped cuts.
If you’re not up to speed on the basics of autopsy, fear no more — we’ve got you covered here. Feeling confident? Try noting any particular smell that hits you. This smell, for obvious reasons, will be strongest in the stomach. You might be able to smell something like camphor or phosphorus which might point to the particular agents utilised in the poisoning. Try compressing the chest and inahle near the person’s nose to see if anything is noticeable.
2. Check the digestive system and respiratory tracts for any hints.
It’s clear that staining or inflammation might be around the mouth and throat — but you can also peer at the oesophagus to see if a substance has damaged any of the membranes in this organ. As the muscly tube that attaches the throat to the stomach, it’s clearly a key part of the trip after any poison is gulped down. The mucousy membranes that line it might be softer and smoother after it’s been eroded by a harsh chemical.
You can also look for something called laryngeal oedema: this is just a fancy phrase for a lot of watery fluid collecting in the the larynx, or your voice box. It’s a sign that’s usually found in cases where alcohol or barbituate poisoning (barbituates, of course, being any sedative or sleep-inducing drug derived from barbituric acid) are the culprit.
3. The next important step: only if you can stomach it.
Taking things apart to get to the stomach is probably the most critical move you’ll make as a pathologist in cases of poisoning. You might find that there’s an excessive amount of blood in the vessels surrounding the stomach, which is caused by an irritant poison. The appearance is patchy and has a deep crimson colour when you’re examing it. As with the oesphogus, you’ll see that the mucous membranes of the stomach have also softened up, eroded or broken down.
In some cases, the stomach might even look blackish — this is if sulphuric acid poisoning is somehow involved. The tissues, in this situation, are easy to take apart and the edges are sort of sloughing off. Not a pretty picture to be sure, but still very telling and useful.
4. You’ve gotta be kid-ney. And examining the liver too.
Examining the colour of the liver is pretty telling: arsenic, phosphorus and rarely ferrous sulphate produce a fatty, yellowish liver. Arsephenamine, chloroform, carbonate-tetrachloride produces something called liver necrosis: a finicky phrase used to described toxic damage to the liver. Kidneys can also relate an awful lot: usually, you’d find “degenerative” changes in this organ, which means that certain fine structures of the kidney will be crumbling. Extensive decay like this might point to poisoning by mercury, phenol and carbontetrachloride.
If you’re ready to sew up and send back, don’t be quite so hasty. The brain might also show swelling, and other organs to examine include the bladder and the genitals. You’ll also have to take some tissue samples which will be sent to the toxicologist for further analysis (and confirmation of any findings you’ve made). After all this, it’s time to get your needle ready — and move onto the person in the next drawer.
Your Turn: Is there any organ or a slice of tissue that we’ve dared to miss? Think you could add an additional step that is absolutely critical in determining whether someone might’ve been poisoned? Let us know in the comments. We’d love to hear from you.