The term autopsy derives from a classical Greek word compound that means 'seeing for oneself' (auto + psy). It refers to an external and internal medical examination that is performed on a dead body by a medical examiner, pathologist, or other trained person for the purpose of determining or confirming cause of death. As such, it is a favored, if generally misrepresented, scene in fictional police procedurals.
The post mortem examination can be ordered by the government (i.e., the Coroner) when there is concern for criminal activities or public health. Autopsy may also be requested by the attending physician or by a family member. Privately ordered autopsies may cost between $1500.00 and $3,000.00 or more in the US.
Generally, an autopsy will include gross examination (well-named) and microscopic examination, and may also include laboratory work on body tissues or fluids. Gross examination (well-named!) is done with the unaided eye, with observations recorded by microphone or by writing. Microscopic examination is done afterwards on prepared slides of tissue sections made from samples collected during the autopsy. Laboratory tests may be ordered to find evidence of disease or drugs.
First, the exterior of the body is examined for abnormalities and findings are noted by voice, on charts or by written description.
The internal examination usually includes the vital organs: the brain and the organs of the neck, thorax and abdomen.
To remove the brain, a deep incision is made down to bone with a scalpel from the bony bump behind one ear, across the crown, and down to the same place behind the other ear. The top flap of the scalp is pulled forward and down over the face and the bottom flap is pulled down to the neck, exposing most of the skull. A bone saw is then used to cut through the skull in two intersecting arcs. That is done so the cut off part won't slide around when it is later replaced. The brain is severed from the spinal cord, which is pretty much all that holds it in. It is then carefully lifted out and placed in a jar of formalin solution, suspended by a string. The brain is very soft, and so must be 'cured' for a week or more in formalin before it can be manipulated.
Next, the internal organs and glands from the neck down to the pelvis are removed. There are a number of techniques for doing that, ranging from removing them item by item to cutting out the whole kit in one piece from top, above the larynx to the bottom, at the pelvis. (This is called the Rokitansky method.) It all begins with the 'Y' incision made with a large scalpel and now universally known from TV and movies. First a' V' cut is made from each shoulder down to the bottom of the sternum. This cut detours below the breasts if the subject is female. The chest flap is cut away from bone and underlying tissues and then pulled up over the subject's head. A straight cut is made downwards from the sternum to the pubis, cutting through the abdominal wall but avoiding the belly button, and the side flaps are laid back. Then, the ribs are detached from the sternum with an bone cutter (a large frightening thing with curved blade that you may have seen in a horror movie or two) or an electric bone saw. (The Stryker autopsy bone saw, by the way, is not at all as intimidating as it looks and sounds when turned on. Its serrated cutting edge vibrates rather than rotates, so it cuts bones neatly but does not easily damage soft tissues.) The sternum is lifted out, and the ribs are pulled back, exposing the lungs and pericardial sac.
The organs are moved to a dissection table, which is often placed above the legs of the body. There, the organs are sliced open to reveal the internal structure, and are examined for abnormalities or disease. The esophagus, stomach and major blood vessels and ducts are also cut open and examined. Samples are taken and placed in formalin. The last and least pleasant job is 'running the gut'. The intestines are taken to a sink with lots of running water and cut open for internal examination. This job may fall to a lower ranking assistant.
After curing, the brain is also sliced and examined.
After examination, the brain is usually incinerated. The remnants of other dissected organs are either sloshed back into the body cavity or incinerated. The skull and sternum are returned to their original positions and the incisions are sewn up with coarse thread, usually with the same kind of stitch used on baseballs.
As with many old crafts, there is a separation between the older purists and the impatient youngsters. The purist works with scalpels and a large, long knife, known as the 'bread knife', which takes skill and produces elegant, clean cuts. Many younger prosectors prefer scissors where expedient.
The decision on cause of death is the job of the pathologist. If the pathologist was not the prosector, which is what the person who does the autopsy is called, then the judgment is made on the basis of the prosector's notes, photographs, direct microscopic examination, and lab results. The final result is a report signed by the pathologist.
If you want to try your hand at a pathologist's job of determining cause of death, try this Virtual Autopsy