Postmortem Examination

Regardless of the suspected cause of death, a medical examiner or coroner's postmortem examination should always be thorough and comprehensive, for deaths which come under the jurisdiction of this office are often extremely complex, dealing as they do mostly with instances of sudden and unexpected demise. The postmortem examination should be approached with a certain degree of suspicion of ot.her possible but hidden etiological factors. The true cause of death may be masked by the obvious findings. In the simpler ca.ses, the specific cause of death may be accurately determined by any competent pathologist and even by an alert non pathologist physician. In more complex cases, however, those without the trained or ingrained sense of suspicion of a forensic pathologist may be misled by the apparent and may seek no further information beyond the obvious. The average physician is often either unaware of or has a rather lax attitUde toward the potential medicolegal ramifications and significance of the autopsy report in coroner's cases. As an example, a history of heart attack should not automatically lead to the conclusion that a sudden death was due to heart disease. Drug abuse or misuse may be highly unlikely, but adverse reaction to therapeutic drugs is a possibility which should not be overlooked, especially in persons under intensive drug treatment of medical conditions. A nUlnbel' of deaths due to drugs have probably been missed because of bias induced by the medical history of the deceased. Deaths involving psychoactive drugs may be divided into three categories, each of which calls for a thorough postmortem investigation: 1. Death due to the direct toxic effect of a drug. 2. Death as a result of secondary complica-