Autopsy

Written by Dr. D. Rao

The medico-legal autopsy is an examination performed under the law for the protection of its citizens.


Objectives:

  1. To find out the cause of death, whether natural or unnatural.
  2. To find out the manner of death, whether accidental, suicidal or homicidal
  3. To find out the time since death.
  4. To establish identity when not known.
  5. To identify, collect, and preserve evidentiary material (physical evidence) in order to identify the object causing death and identify the criminal.
  6. To provide factual, objective information to law enforcement agencies, etc.
  7. To provide interpretation of facts and circumstances related to death.
  8. To protect the innocent by separating death due to disease from death due to external causes.
  9. In new born infants to determine the question of live birth and viability.
  10. To maintain the cosmetic integrity of the dead.

Requirements:

  1. Complete autopsy in every case.
  2. Personally perform the examination and observe all findings.
  3. Thorough examinations; overlook nothing.
  4. Preserve all information by written and photographic records.
  5. Factual, objective written report without bias.

Rules:

  1. It should be conducted only when there is an official order authorizing the autopsy from the police, Magistrate or Coroner.
  2. It should be done without undue delay.
  3. It should be conducted in day light as far as possible, because colour changes cannot be appreciated in artificial light. Note that there is no law which prevents autopsy during night.
  4. The body must be identified by the police constable who accompanies it. In unidentified bodies, the marks of identification, photographs and finger prints should be taken.
  5. No unauthorized person should be present at the autopsy.
  6. As the autopsy is proceeded with, details of examination should be taken down verbatum by an assistant, and sketches made of all the important injuries.
  7. Nothing should be erased and all alterations should be initialed in the report.

Preliminary Procedures: (1) Each item of clothing should be listed, labeled and examined and described with regard to its nature and condition, tears, loss of buttons or disarrangement indicating a struggle, as each item is removed from the body. Cuts, holes, burns or blackening from fire arm discharges should be noted and compared with the injuries on the body. Blood stains, etc. should be described. Stains due to poison, vomit, or faecal matter should be noted. The clothing may be removed by unbuttoning, unzippering, or unhooking if possible. If they cannot be removed intact, they should be cut along the seams. If the clothing is wet or bloody, it should be hung up to dry in the air to prevent putrefaction but should not be heat dried. Preserve with proper identification for subsequent examination. (2) Note general condition of the body. (3) The time since death should be noted from rectal temperature, rigor mortis, post mortem lividity, putrefaction, etc.


AUTOPSY PROCEDURE:

  1. Note date, time and place of autopsy.
  2. Describe physical characteristics: Sex, age, colour, height and weight, state of nutrition, scars, tattoos, colour of eyes and hair, teeth, pupils abnormalities, deformities, evidence of fracture, old or recent.
  3. External wounds should be systematically examined taking up each part of the body in turn. The description should include nature, site, length, breadth, depth, direction, position, margins, base and extremities. The condition of their edges, presence of foreign matter, coagulated blood and evidence of bleeding into nearby tissues noted. Determine whether they were caused before or after death and their time of infliction. Describe the course, direction and depth of injuries and enumerate structures involved by the injury.
  4. Identify and label any foreign object, etc., bullets, fragments of knives, etc. and specify its relation to a given injury.
  5. Photograph injuries to document their location. Include a scale to show their size. Photographs can be used to demonstrate and correlate external injuries with internal injuries.
  6. X-ray examination can be used to locate bullets or other radio-opaque objects, to identify victim, and to document fractures,

Internal Examination: There are different methods and Techniques adopted in different countries to examine the internal organs. The common incisions followed world wide is the Y-shaped incision; this helps to have a good view of the neck structures without disturbing the underlying tissues and also helps to maintain the cosmetic integrity of the dead. The Author also advices Enmasse removal of the organs by adopting Modified Rokitansky’s method of dissection and Histopathological examinations of all the organs including the Endocrines irrespective of the cause and manner of death, beside other special examination as per the case requirement like toxicological, serological, microbiological..Etc.