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I performed an autopsy on the body of ANILINE, CAROLINE L. at the Hospital for Tropical Diseases

In London, England on the date of October 31, 2009 @1430 HOURS.

From the anatomic findings and pertinent medical history I ascribe death to:




Anatomical Summary:

I. Pulmonary edema

II. Anorexia Nervosa (clinical).

III. Cachexia

IV. Distended abdomen

V. Dehydration

VI. Liver necrosis and enlargement

VII. Leukopenia (found on microscopic analysis of bone marrow)

VIII. Distention of intestines


External Description:

The body is unclothed and un-embalmed and is that of a well-developed, frail 20 year old pale white female which measures 5 feet 11 inches in length and weighs 95 pounds. The body is at room temperature. Rigor mortis is not present. Liver mortis is in the dependent portions and is unfixed, blanching with pressure. The hair is dark black. The pupils are widely dilated and are round, regular and equal. They measure 0.6cm in diameter. The eye-colour is green. The nasal cavity is clear. The mouth is clear. No abnormalities are seen. The teeth are natural. The ear canals are clear. No injuries are seen of the neck. A small superficial abrasion measuring 1/4 inch is seen over the left breast. The abdomen is extremely distended. The female genitalia reveal no evidence of injury or disease. Multiple needle puncture marks are seen on the thighs bilaterally. The legs show no evidence of injury. The toe nails are unpainted. The arms are thin. An intravenous needle is present on the left arm. Fresh needle marks are seen in both wrists and on the back of the right hand. A superficial abrasion measuring ~1/8 inch is present on the back of the left hand. The finger nails are long and are painted black. The right hand shows minor desquamination.

Internal Examination:


The scalp and pericanial tissue reveal no evidence of injury or disease. The skull is intact and shows no
fractures. The dura is intact and shows no hemorrhages, either extradurally or subdurally. The arachnoid is thin and transparent. The cerebrospinal fluid is clear. The arteries of the circle of Willis have their normal anatomic distribution and reveal no arteriosclerosis. The brain weighs 1100 grams and shows no focal alterations of the surface layers. On multiple sections no abnormalities are seen throughout the cortex, white matter, basal ganglia, thalami, midbrain, pons, cerebellum or brainstem.


Pink foamy material is present in the airway to the level of the larynx. No obstruction is seen. No gastric contents are present. No injuries or abnormalities are seen of the tongue. The larynx, trachea and large bronchi show no abnormalities. The soft tissue of the neck reveal no evidence of injury or disease.

Body Cavities:

The pleural and peritoneal cavities are free of fluid and the surfaces are smooth and glistening. The pericardial cavity is clear of any fluid.


The heart weighs 154 grams and is small but of normal shape and configuration. The epicardial surface is smooth. The myocardium is red-brown and firm and shows no focal ulcerations. The endocardial surface and valves are grossly normal. The coronary arteries reveal no arteriosclerosis and no congenital abnormalies. The aorta reveals minimal wall thickening and plaque formation. The pulmonary arteries and great veins are grossly normal.

Respiratory System:

The lungs weigh 450 grams each The surfaces are redish-pink and moist. The consistency is soft and doughy. The cut surface is dark red in the lower lobes and pale grayish-pink in the upper lobes. Frothy pink fluid is present on the cut surfaces. No focal alterations are seen and no evidence of aspiration, pneumonia or tumor is seen grossly.


The liver weighs 1820 grams. The capsule is reddish-brown and smooth. The liver is massively enlarged. Slices of the liver have a uniform reddish-brown appearance and show signs of necrosis. The gallbladder contains an estimated 20 ml of green viscous bile. No stones or abnormalities are seen. The bile ducts are normal. The hepatic lymph nodes are enlarged to about the size of a pea. GCMS preformed on gallbladder bile for alpha-amanitin and paracetamol was NEGATIVE


The spleen weighs 300 grams and is enlarged. The capsule is grayish-purple, smooth and tense. The consistency is firm. Cross sections are dark red and show focal necrosis.


The pancreas is grossly normal.

Gastrointestinal Tract:

The esophagus is dilated and contains gastric content to the level of midesophagus. The upper portions of the esophagus are grossly normal. The stomach contains an estimated 200 grams of a dark green, dry and crumbly material which has the consistency of ground coffee. The stomach contains no indefinable food or medications. The mucosa is grossly normal and reveals no ulcerations or other abnormalities. The duodenum is dilated and full of a soft yellowish-green material. The mucosa is intact. The small bowel is also distended and full of a yellowish-green semisolid syrupy material. The appendix is normal. The colon is also distended and dilated with a greenish-brown dehydrated material to the level of the terminal sigmoid. The rectum is empty and shows no abnormalities.

Genitourinary System:

The right and left kidneys weigh 130 grams each. The capsules strip with ease revealing a smooth reddish-purple surface. The cut surface reveals good corticomdullary distinction. The cortices and medullae are grossly normal. The ureters are unremarkable. The bladder is normal and contains 20 ml of clear cloudy urine. The vagina is clear, the mucosa is intact. The cervix is smooth and small. The uterus is of normal size, shape and configuration. The myometrium is firm. The endometrium is thick and mucoid. The fallopian tubes are grossly normal. The right and left ovaries are unremarkable.

Endocrine System:

The pituitary, thyroid and adrenal glands are grossly normal.

Bone Marrow:

Microscopic analysis of bone marrow appears consistent with leukopenia. An Antibody assay for trichothecene mycotoxins was NEGATIVE

Signed by: Simon H. Posford, D.O


Autopsy On:

October 31, 2009

Time 2:30pm


Report released Nov 1, 2009

Death was caused by:

Immediate cause:


Due to:



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