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Handbook of Autopsy Practice, 3rdEdition, Edited by Jurgen Ludwig. Hard Bound, 8.5" x 11".
Humana Press Inc., 999 Riverview Drive, Suite 208, Totowa, New Jersey 07512; Publication Date 10 July, 2002. 592 pages, ISBN 1-58829-169-3 (acid-free Paper). Price $149.50
Official Site:Click here to visit
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The second edition of this classic was published in 1979 under the title "Current methods of autopsy practice (W.B. Saunders company)". It has remained one of the most widely read and taught books on autopsy practice. It has, over the years, remained a standard reference text and a benchmark for forensic pathologists. The present edition has been brought out "to thoroughly update the material in a third edition by adding what we have learnt in the meantime (last twenty years) and eliminating text that has become obsolete." This itself is a refreshing concept. Many a time new editions are brought to add new knowledge without removing the older obsolete one, thereby making the books bulkier.
The present edition has been divided into three parts. Part One of the book deals with general autopsy techniques and other ancillary techniques that are done in an autopsy room. Part Two of the book is, according to the author, the most important part of the book. It lists various diseases and conditions in alphabetical order and the expected findings in them. Part Three deals with tabulations of weight, measurements and other statistical data.
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The author starts this section by describing the autopsy techniques. He appears to be overenthusiastic in making this chapter concise. He barely mentions the names of various techniques without elaborating on them. The detailed description of various autopsy procedures is one of the few things every forensic pathologist expects, rather demands, from a book of this magnitude. Although he has mentioned adequate references and also that the book is not meant for beginners, still the absence of detailed autopsy techniques is a glaring omission.
The second chapter deals with medico legal autopsies and toxicology. Here the author has done a good job by giving concise information. He has presented only the updated and relevant information and removed the outdated material. Table 2-1, about possible violent antecedents of some natural diseases, is very informative. It allows the reader to be over vigilant while dealing with cases of natural death lest he should miss out on some violent cause. It also gives him an idea of similar conditions at a glance without having to go through the pages of various textbooks. The section on toxicology describes the various methods of sample collection and analysis very briefly and precisely.
The next few chapters deal with what I may call as systemic autopsy. Here the author has described the methods of dissecting various organ systems in detail. The chapter on cardiovascular system deserves special mention, because in a bold attempt, the author has introduced several new methods of heart dissection, and at the same time retaining one or two older methods too.
Take for example the "unrolling method" (page 26). This method was first described in an old paper by Rodriguez and Reiner (Rodriguez FL, Reiner L. A new method of dissection of heart. Arch Pathol 1957;63:160-163). It is not used much now, but the author retains this method, so the newer generation can benefit from these older methods. The author is however careful to warn that "all unrolling techniques cause considerable mutilation of the heart and should be reserved for research studies". The author describes as many as eight other systems of cardiac dissection - a feature not to be found in any other post mortem techniques handbook available today. These methods (described from pages 21 till 26) are (i)inflow-outflow method of cardiac dissection (ii) Short axis method (iii) Four chamber method (iv) Long-axis method (v) Base of heart method (vi) window method (vii) partition method and (viii) injection corrosion method. Advantages and disadvantages of each method are described in detail. A series of photographs accompanies each method for better comprehension. For those wanting to have a look at these pictures can make use of the slide viewer on the right.
The various appendices given at the end of the chapter give a detailed list of various abbreviations, synonyms, eponyms etc used in relation to various heart diseases. It can be pretty handy during the autopsy especially when going through the medical records of the diseased. In other chapters, the methods of fixation and dissection have been dealt with adequately. The descriptions with photographs along with labeled diagrams leads to clarity and understanding of the subject. The addition of the section about postmortem angiography is in keeping abreast with the latest knowledge about post mortem investigations. The chapter on central nervous system has described the methods of fixation and dissection of the brain in great detail. One area the author has erred in is the anatomy of the brain. The complexity of the brain structures makes it imperative that its anatomy should be mentioned briefly so as to refresh our memory when required. The photographs present in the chapter on the eye are very detailed and informative.
The next few chapters deal with post mortem investigations techniques. They describe the various microbiological, chemical and radiological techniques utilized in post mortem investigations and the method of using them properly. The forensic pathologist is the person who has to take the various samples, preserve them under proper conditions and send them to the concerned laboratory for processing, so he has to be well versed in the method of drawing the samples and their preservation and transportation. Thus these chapters are of immense practical utility to the forensic pathologist. Tables 11.1 and 11.2, which describe post mortem chemical changes, are very useful and obviate the need of referring to the textbooks repeatedly. The chapter on autopsy roentgenology is a very welcome addition. Since post mortem imaging is a fast improving branch of forensic pathology every forensic pathologist should be well versed with various modalities available.
 ...The author describes as many as eight other systems of cardiac dissection - a feature not to be found in any other post mortem techniques handbook available today. These methods (described from pages 21 till 26) are (i)inflow-outflow method of cardiac dissection (ii) Short axis method (iii) Four chamber method (iv) Long-axis method (v) Base of heart method (vi) window method (vii) partition method and (viii) injection corrosion method. Advantages and disadvantages of each method are described in detail. A series of photographs accompanies each method for better comprehension...
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What surprised us most was the absence of any mention of DNA profiling. Although DNA profiling is done by forensic scientists, a forensic pathologist must have some basic idea about it. This is because many a time a forensic pathologist is asked to supply the relevant samples for DNA profiling especially when the services of forensic scientists cannot be availed of easily. In such cases the forensic pathologist has to take the sample, preserve it and send it to the laboratory properly. The unfamiliarity with the technique can be a big hindrance in doing the job properly. So we would suggest DNA fingerprinting be described in the next edition of this book.
We would club these chapters together under the sub heading "miscellaneous topics". They range from fixation and staining techniques to autopsy photography to maintenance of registers etc. These chapters are very helpful in a mortuary. The chapter on fixation and staining techniques explains various methods usually employed by a forensic pathologist in daily practice. They provide immense practical knowledge, which is to be utilized in immediate post autopsy period to make tissue sections for histopathology. Interviews with the next of kin are one of the most difficult aspects of forensic practice. Its inclusion gives the pathologist some idea as to how he has to deal with this problem.
To the best of our knowledge, it is the first time such a useful topic has been included in a book on autopsy techniques. It is an extremely important section in this book. This section mentions various diseases in an alphabetical order. Along with every disease the author mentions various synonyms of that disease, materials that are to be collected, the methods of dissection of various organs and the expected findings one can encounter in these cases. This tells the forensic pathologist how a particular case has to be dealt with. It gives all relevant knowledge and requirement at one place. So one is not required to go through different books to see the findings in various disease conditions. The book can kept handy in a mortuary for reference at short notice. The presence of a note for each disease provides useful information about disease. The various medico legal topics such as homicide, sexual assault, infanticide etc. have been given special emphasis. The method of homicide investigation has been dealt very effectively. The chart to note down the various details in a case of homicide is exhaustive. The references given after every disease can be utilized the details of any of. We are of the opinion that this book is a necessity for every forensic pathologist. The amount of new knowledge imparted by this book is relevant for today.
This is basically a statistical section, and gives us a number of useful statistics such as body weight and length in relation to age, body surface area from age, weights of various organs and other measurements in stillborn infants, organ weights in normal people of various age groups and of both sexes, brain weight as a function of age in children and adolescents, and so on. This is a section most of us would turn to, when checking up if our measurements are in accordance with the normal accepted figures.
Overall, an extremely useful book. This book should be present in each and every mortuary where autopsies are performed. The best place for this book is near the autopsy table from it can be referred to while performing autopsies.
-Puneet Setia and Avneesh Gupta
Department of Forensic Medicine and Toxicology,
Maulana Azad Medical College,
New Delhi, India
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-Anil Aggrawal
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