MEDIACL AUTOPSY

In medico-legal autopsies, often the clinical history is absent, sketchy, doubtful or misleading. In some
cases, identity may not be known. He has to determine time of death and age of injuries. If there are any
inconsistencies between the apparent death scene and his actual findings, he has to visit scene of crime.
He has to carry out careful external examination including clothing, in the determination of the pattern
of injuries and their relationship to the object or weapon causing them. He has also to determine the
manner and mechanism of death. It has evidentiary and confirmatory value for public interest.

Objectives of the Medico-legal Autopsy-

1. To find out the cause of death, whether natural or unnatural. This is done by detecting,
describing and recording any external or internal injuries, abnormalities and diseases.
2. To find out how the injuries occurred.
3. To find out the manner of death, whether accidental, suicidal or horrlicidal.
4. To find out the time since death.
5. To establish identity when not known.
6. To collect physical evidence in order to identify the object causing death and to identify the
criminal.
7. To retain relevant organs and tissues as evidence.
8. In newborn infants to determine the question of live birth and viability.

If autopsy is not done, the exact cause of death, the presence and extent of disease or injury, the
incapacitation produced by them, and whether there was any pain or suffering becomes only
speculation.

Rules for Medico-legal Autopsy-

1. The body should be labeled as soon as it arrives in the mortuary.
2. The autopsy should be conducted in a mortuary and never in a private room. However, it may
become necessary to do an autopsy at the site, when the body is in an advanced state of
putrefaction, and its transportation is difficult, and materials of evidential value may be lost in
transport and when immediate examination of the body without its removal to hospital is
essential due to any special reason.
3. It should be conducted only when there an official order authorizing the autopsy, from the
police or Magistrate.
4. It should be performed as soon as possible after receiving requisition, without undue delay.
5. The medical officer should first read the inquest report carefully and find out the apparent cause
of death, and obtain all the available details of the case from case sheet, accident register, etc.,
So that attention may be directed to the significant , points. While doing the postmortem
examination and to carry out appropriate investigations, e.g. toxicology, microbiology, virology,
radiology, etc. Lack of such information may result in loss of vital evidence.
 6. The examination should be conducted in daylight as far as possible because colour changes such
as jaundice, changes in bruises, changes in postmortem staining, etc. cannot be appreciated in
the artificial light. If the body is received late in the evening, a preliminary examination is done
to note the external appearances, the body temperature, extent of postmortem lividity and
rigor mortis, etc. The actual postmortem may be conducted on the next day as early as possible.
7. The body must be identified by the police constable who accompanies it. The names of those
who identify the body must be recorded. In unidentified bodies, the marks of identification,
photographs and fingerprints should be taken.
8. No unauthorized person should be present at the autopsy. The investigating police officer may
be present.
9. If there is discrepancy in the injuries noted in the inquest report and those found on the body,
the investigating officer should be shown the injuries, so that necessary corrections may be
made in the inquest report.
10. As the autopsy is conducted, details of examination should be noted verbatim by an assistant or
use a voice-activated tape recorder and sketches made of all the important injuries.
11. Nothing should be erased and all alterations should be initialed in the report.
12. Even if the body is decomposed, autopsy should be performed as certain important lesions may
still be found.
13. Both positive and negative findings should be recorded.
14. After completion of autopsy, the body is handed over to the police constable.
15. P.M. report should not be issued to the party.

PROCEDURE OF MEDICO-LEGAL AUTOPSY-

First the body is being identified by the escorting police officer and the relatives of the deceased and
then the dead body is taken over the autopsy table. All the external findings over the body are noted
first.

A. EXTERNAL EXAMINATION:
The body is first examined along with the wearing apparels. After noting down all the details of the
clothing, the garment should be taken down with very little disturbance to the body as well as to the
clothing and duly handed over to the escorting police officer.

1. Clothing’s:
Each and every wearing apparel should be examined separately and without missing any minute
detail. They have to be described as per the color of the apparel, the pattern of design present
over the apparel e.g., check print or floral design or vertical stripes etc, whether single colored
or multicolor, if multicolor, then as far as possible all the colors present in the apparel to be
properly described. The number of buttons, whether all the buttons present or not, the exact
location of the buttons over the apparel should be mentioned. Whether the apparel is intact or
it is torn or cut, has to be mentioned. If there is any cut or tear present over the apparel, then
total number of tears present has to be mentioned and it has to be properly measured and
located. Whether the tear corresponds to any underlying injury or not has to be mentioned. If
the apparel is wet, blood stained or mud stained or any such condition has to be mentioned. All
 such stains, if found should be cut along with the normal cloth, dried under room temperature,
sealed, labeled and then handed over to the IO for further chemical analysis.
It should be noted that, in case of such preservation, the pieces of clothing with suspected stain
should be preserved in a paper envelope (non-laminated) as the plastic coating of a laminated
envelope may hasten decomposition of the sample as it will not soak away any remaining
moisture present in the sample. The pockets of the garments should be properly checked to
look out for any pocket content and the same to be handed over to the IO.
After completion of the examination, the clothing should be taken off the body. It should be
noted that the clothing should not be torn while doing so and should be tried to be taken out
with minimal disturbance to both the apparel and the body. They are then dried (if needed) in
normal room temperature, sealed labeled and handed over to the escorting police officer.

After thoroughly examining the clothing, the body is then inspected under the following
headings-

2. Height: Height or more accurately length of the dead body is measured. Length is measured in
supine position itself and by using a measuring tape. Two cardboards are kept over both ends of
the body, one at the head end firmly attached to the parietal prominences and one firmly
attached to the heel. The measurements are then taken from one end of the board to other
end. This is done in order to avoid any misleading measurements.

3. Weight and built of the body: Whether the person is average built or obese built etc has to be
commented upon. The weight of the body is to be taken and the same to be noted down.

4. Body hair: The color, length, distribution pattern of the scalp hair, whether recently shaved,
beard and moustache present or not, whether any foreign body adhered or not, whether dyed
or not, singeing or any cuts present or not, has to be mentioned. These findings are of more
significance in case of unknown bodies and proper documentation may help in the identifying
the dead body.

5. Eyes and Ears: Whether eyes are open or closed or whether any significant findings present or
not, condition of cornea, presence of any sub conjunctival hemorrhage etc. to be noted down.

6. Body surface: The whole body surface should be properly inspected and any blood stain, color
change or injuries present to be duly noted down. If any stains or nail scrapings present, then
they should be duly collected. Stains can be collected in a swab and nail scrapings can be
collected in a piece of paper. They should be duly sealed, labeled and handed over to the
escorting police officer. The body should be inspected for-
a. Any bluish discoloration present over the tip of nose, ear lobules, finger nails etc.
b. Any postmortem color changes like, post mortem lividity present or not, if present then over
which part of the body it has developed and whether it is fixed or not. If possible the color
of the postmortem lividity to be commented upon.
c. Rigor mortis has to be noted down, whether fully developed or at a developing stage or
passed away.
d. Any decomposition change has developed or not. E.g. any greenish discoloration of the skin
whether started or not, if so, then the pattern of distribution of the same, peeling of cuticle
present or not, loosening of hair and teeth present or not, marbling present or not, maggots
and their eggs present or not. If maggots are seen crawling over the body, then the size of
the larvae to be mentioned, starting from the smallest size to the largest size. This helps in
understanding the time since death.
e. Natural orifices: All the natural orifices are to be properly inspected to look for the presence
of any injuries or any discharge. Froth coming out from mouth and nostrils to be mentioned
describing the nature of froth, whether copious, blood tinged, including the color of froth
etc. In case of suspected rape and murder cases, perineal region to be properly examined
for the presence of any associated injury or blood stain. Vaginal swab, normally two in
number, to be collected and duly preserved, sealed, labeled and handed over to the IO. Oral
swabs can also be preserved for the same purpose. In case of suspected sodomy cases,
separate anal swabs to be preserved. In male, penis and scrotum to be examined separately
and circumcision of penis to be looked for.
f. Female breasts to be inspected for any changes of pregnancy or presence of any injuries like
bite mark or nail scratches etc.
g. Any external injury present, including ligature mark or any blunt trauma or sharp force
impact etc, to be duly recorded. Each and every injury to be measured separately and
should be described in relation to their nature of injury, position, color of the injury, age of
the injury and their measurement. The position should always be described in relation to
two anatomical landmarks. While noting down injury, one should also try to note down the
possible weapon of offence, as well as the direction of force applied, as well.
h. Apart from all these, a good autopsy surgeon shall also look for any hesitation cuts,
concealed wounds, defense wounds, any needle prick marks or any fabricated wounds
present over the body. All these findings help in establishing the manner of death, whether
suicidal or accidental or homicidal.
B. INTERNAL EXAMINATION:
It is mandatory for all medical officers conducting a postmortem, to open all three body cavities
viz., cranial cavity, thoracic cavity and abdominal cavity and explore them. The cavities should be
opened using suitable incisions depending upon the case. It is been advisable that, the cavity
which is mainly involved should be opened last. E.g., in hanging, the neck dissection should be
done at the end. It is advisable to open the cranial cavity first so that all the neck vessels are
drained out of blood and a clear bloodless field can be provided for the neck dissection. This
minimizes the postmortem artifact. In case of suspected poisoning cases, cranial cavity should
be opened first so that the characteristic smell of the poison doesn’t get contaminated with
other body fluids. The incisions, which are commonly practiced, are discussed below:

1. “I” Shaped incision:

“I” shaped incision is the most common incision practiced all over the world. The body is placed
in a supine position and a wooden block is kept beneath the shoulder blades. One clean and
straight incision is made extending from the symphysis menti to the symphysis pubis, with
deviation at the umbilicus, preferably towards the left. The skin flaps, along with the
subcutaneous fat and muscle layer are reflected to expose the underlying structures.
This is the most convenient method of autopsy and gives a thorough exposure to the thoracic
and abdominal cavity. Though the neck structure exposure becomes bit limited towards the
lateral end and there is no exposure to the back of the body, so exploration of the structures at
the back of the trunk is a bit cumbersome.

A typical ‘I’ shaped incision, extending from symphysis menti to symphysis pubis

2. “Y” shaped incision:

 The body is kept in supine position with a wooden block placed under the shoulder blades.
Incision is made starting from the tip of the acromion processes, bilaterally, passing below the
breasts upto the xiphoid process. From there, the incision passes upto the symphysis pubis with
deviation near the umbilicus. The upper section of the incision is reflected upwards and the
lower section of the incision is reflected separately and laterally to expose the deeper cavities.
This is mainly used for cosmetic purpose as the incision is not visible in the front of the neck. The
disadvantage of this incision is that it doesn’t give exposure to structures in the front of the
neck.

‘Y’ Shaped Incision in Male and Female

3. Modified “Y” shaped incision:

The incision extends from the mastoid processes bilaterally, upto the mid-clavicular point, and
then continued over the clavicle upto the suprasternal notch. From the supra sternal notch, a
straight incision is made downwards upto the symphysis pubis with deviation at the umbilicus.
The flaps of the skins are reflected upwards and lower flaps are reflected laterally. This incision
is mainly preferred for neck dissection in cases of hanging or any violent asphyxial deaths.
Opening of the thoracic cavity:
The thoracic cavity is opened after separating the sternum by cutting the costochondral joints
first and then the sternoclavicular joint. Cutting through the 2nd costochondral joint and
working way down through the consecutive costochondral joints are not much of a problem. But
cutting through the first costochondral junction between the first rib and the sternum needs
manipulation as the joint is an inverted C shaped joint. This has to be done along with cutting of
the sternoclavicular joint. First the sternoclavicular joint is felt by motioning the consecutive side
arm. After locating the junction, they are being cut and subsequently in the same motion, the
first costochondral joint to be cut by manipulating the scalpel in an inverted C shaped as per the
shape of the joint.

Image of an opened Thoracic and Abdominal cavity during an autopsy

Opening the abdominal cavity:

The peritoneum is first lifted up and a nick is made in it near to the xiphoid process. The
peritoneal cavity is then opened without disturbing the underlying structures, by making an
incision by an enterotome or blunt scissors, with index and middle fingers using as guard, upto
the symphysis pubis.

Opening of the cranium:

The incision over the scalp is made in coronal plane extending from one mastoid process to
other, through the vertex and the flaps are reflected to expose the skull. The vault of the skull is
removed in a circular motion by using autopsy saw and chisel.
Removal of the Viscera:

There are four basic techniques of removal of the viscera.

1. R.Virchow’s technique: In this technique, after opening the body cavity, the organs are
removed one by one. This method is widely and most commonly employed.
2. C.Rockitansky technique: This technique portrays in situ dissection of the organs and
removal of organs as required.
3. A.Ghon’s technique: Also known as en-bloc removal of the organs. The thoracic, abdominal
organs, urogenital systems are all removed system wise.
4. M.Letulle’s technique: Also known as en masse removal of the organs. The thoracic,
cervical, abdominal and pelvic organs are removed as one block and subsequently dissected
into organ blocks.