Inquiry hears from lead pathologist who examined Russian’s body after his death from polonium-210 poisoning in 2006

The postmortem examination carried out on Alexander Litvinenko was “probably the most dangerous ever conducted in the western world”, and confirmed that Litvinenko was the victim of acute radiation poisoning, an inquiry into his death heard on Wednesday.

Dr Nathaniel Cary, the consultant forensic pathologist who examined Litvinenko’s body, said he and other officials examining the corpse wore not one but two protective suits, two pairs of gloves taped at the wrists and large battery-operated plastic hoods into which filtered air was piped.

Litvinenko died on 23 November 2006 in the intensive care ward at University College hospital, London. His body was so radioactive that staff left it in situ for two days, still attached to life-support machines and drips.

Cary said that when he arrived at the scene he carefully disconnected various tubes. He put Litvinenko’s corpse into two body bags. He took a sample of muscle from the right thigh, the inquiry heard, to test for radioactive polonium.

The pathologist said that after this “very hazardous” recovery operation he carried out a postmortem on 1 December at London’s Royal hospital. His team included a second pathologist, a detective constable and a photographer, all wearing full protective gear.

A special radioactive protection officer was also on hand to wipe away any specks of blood on clothing. Ambulance staff stood by in case anyone collapsed or fainted - a potential “disaster”, given the circumstances.

“It’s been described as the most dangerous postmortem undertaken … I think that’s probably right,” Cary said. He and his colleagues had never encountered anything like this, he said, adding that this was the first known case of acute polonium poisoning anywhere in the world.

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Litvinenko had met two Russian contacts, Andrei Lugovoi and Dmitry Kovtun, on 1 November 2006 in the Millennium hotel in central London. The two allegedly slipped polonium-210 into Litvinenko’s tea.

Speaking earlier, Ben Emmerson QC, acting for Litvinenko’s widow Marina, said there was no doubt Lugovoi and Kovtun were killers sent by Moscow, in an operation personally approved by Vladimir Putin.

The inquiry heard harrowing details of the poisoning’s aftermath. That evening Litvinenko began vomiting. He suffered from bloody diarrhoea. On 3 November he was admitted to Barnet and Chase hospital, north London.

Staff diagnosed gastroenteritis and gave him antibiotics. Over the next 10 days, however, Litvinenko’s condition worsened. Alarmingly, a biopsy revealed complete bone marrow failure – the result of alpha radiation infecting other cells, Cary said.

On 17 November Litvinenko was admitted to the haematology unit of University College hospital. By this point, Cary said, his white blood-cell levels had collapsed, his liver and kidney function had deteriorated and his hair had fallen out. Litvinenko’s throat and oesophagus were severely inflamed – all signs he had ingested poison.

He suffered cardio-respiratory failure twice, with doctors forced to resuscitate him. The third time, however, they were unable to save him and at 11pm on 23 November he died. Throughout his illness Litvinenko’s symptoms had confounded medical staff. They had quickly suspected radiation poisoning but tests for conventional gamma radiation had proved negative.

According to Emmerson, doctors then had an inspired hunch. On 21 November they brought in an atomic weapons expert who suggested testing for alpha radiation – much rarer, and emitted by virtually unknown polonium-210. Doctors took a urine and blood sample.

Confirmation that Litvinenko had swallowed fatal quantities of polonium, far in excess of known survivability limits, came just hours he died, the inquiry heard.

Facebook Twitter Pinterest Marina Litvinenko, the widow of Alexander Litvinenko, arrives at the inquiry into her husband’s death. Photograph: Alastair Grant/AP

Cary said his postmortem, carried out in sweltering protective suits, confirmed acute radiation poisoning. If doctors had not taken last-minute samples for alpha radiation testing the cause of death would have remained a mystery, he said.

Another forensic scientist, Dr Benjamin Swift, said the case was the UK’s only recorded incident of polonium poisoning. Emmerson asked Swift if Litvinenko’s assassins may had chosen this “vanishingly rare” type of poison because they assumed it wouldn’t necessarily be detected. Swift replied: “Potentially yes”.

The inquiry also heard anonymous evidence from a senior nuclear scientist who had carried out extensive tests on a range of sites contaminated with polonium-210. They included the Pine Bar – where Litvinenko met Lugovoi and Kovtun and drank the ill-fated cup of tea – as well as in various London hotel rooms used by the visiting Russians.

The inquiry was shown sophisticated three-dimensional images, colour-coded in green, yellow, red and purple, with purple indicating the highest levels of contamination. The scientist – identified as A1, and the head of nuclear forensics at the UK’s Atomic Weapons Establishment – said that less than a millionth of a gram of polonium would be enough to kill.

Huge amounts of contamination were found in an eighth-floor room of the Sheraton hotel, where Lugovoi stayed between 25 and 28 October 2006. The polonium traces found in the bin of his bathroom were “off the scale”, with high levels also found in the bath, basin and toilet seat, the inquiry was told.

The atomic scientists tested the teapot from the Millennium hotel – and found “full-scale deflection”, indicated by purple rectangles, in the middle and spout. There were further high readings on the chairs were Lugovoi and Kovtun had sat, especially on one right armrest.

The inquiry heard on Tuesday that Lugovoi and Kovtun first tried to poison Litvinenko during an earlier trip to London on 16 October. Their efforts were unsuccessful, as Litvinenko ingested a much smaller dose of polonium on this occasion and survived. Lugovoi made three dedicated trips to London around the time of the murder, and Kovtun two.

In an interview on Tuesday in Moscow, meanwhile, Lugovoi dismissed the inquiry as a “judicial farce” and said he would not be participating. He told the Echo of Moscow radio station there was “nothing” in the inquiry documents that proved his guilt. Emmerson said he still wanted Lugovoi and Kovtun to give evidence by video link.

The inquiry chairman, Sir Robert Owen, agreed but said: “I was careful to express the hope rather than the expectation”.

The inquiry continues next Monday.