Autopsy

Department of forensic medicine,

Nowshera medical college,
Nowshera, KPK,
Pakistan.
Learning objectives
• Define Autopsy.
• Describe the modified continental system and compare it with other
medicolegal systems in the world.
• Classify types of Autopsy.
• Describe the role of Autopsy in Criminal offences.
• Describe section 174 and 176 of the Criminal Procedure Code (CrPC), 1973.
• Describe the components of modern autopsy suite.
• Describe the precautions taken while working in modern autopsy suites
• Explain the hazards encountered in modern autopsy suites.
• Describe pre-examination in Autopsy.
• Describe the protocol of examination of clothes, and external
examination in autopsy.
• Classify and describe different autopsy incisions.
• Describe internal examination in an autopsy.
• Describe the procedure to collect different autopsy samples.
• Describe the chain of custody.
• Describe the steps of writing an autopsy report.
• Describe autopsy procedure for death due to heat and cold.
 Autopsy
(Necropsy/ postmortem)
Autopsy (Greek autos: self, opis: view) —to see for oneself; also called
necropsy (Greek necros: dead, opis: view) or post-mortem examination (post:
after, mortem: death)

‘’Scientific examination of external surfaces and internal contents of a

dead body along with sample collection for medical, scientific and
legal purposes.’’
Medicolegal systems in the world
Describe the modified continental system and compare it with other medicolegal
systems in the world.
• Medicolegal system has the primary purpose of establishing the cause
and manner of death. Conventionally such an investigation was
initially associated with the detection of crime. But now these
investigations are also equally important for accidental deaths
whether on the road, in the industry or at home to recommend
proper preventive measures. Success of these investigations revolves
round the proper collection and preservation of physical evidences at
the scene and from dead body.
Necessary physical evidences
• Physical evidence associated with the crime scene.
• Medical evidence associated with the dead body.
• Anamnestic data (history) about the deceased.
• All these steps are inseparable and should be done by respective
agencies together for good results and the team should consist of
Forensic science expert, medical examiner and police. The
preservation of the scene in diagrams and photographs both in colour
and monochrome and of physical evidence present at the scene is the
duty of forensic science expert.
• Medical examiner makes the preliminary inspection of the dead body
at the scene and arranges its transfer to autopsy room.
• The corpse is fully wrapped in a clean plastic sheet and then sent
under police escort to the hospital.
• After the removal of dead body, he inspects the site and collects any
additional information, which may have been missed previously.
• Police maintains peace and order at the crime scene and collects the
details of circumstantial evidence including anamnestic data
pertaining to deceased.
• The person in charge of the investigation should be adequately
educated, experienced and employed exclusively for such purpose.
He should have proper authority over the dead body and others who
are connected with the investigation. He should be independent, free
from local and national politics. These points have been stressed by
various committees and have brought changes in medicolegal
systems.
 Committees recommending improvements in
medicolegal systems
• Coroners departmental committee (U.K)
• National municipal committee (U.S.A)
• National conference on uniform law (U.S.A)
• Broderick committee (U.K)
Medicolegal systems
• Coroner system.
• Medical examiner system.
• Continental system.
Coroner system
• Is a very ancient system.
• The original English coroner was the principal officer of the crown and
had extensive common law jurisdiction over the dead bodies within
his area of control to hold inquest.
• Recent developments have reduced his powers and now he can only
investigate sudden and unexplained deaths including deaths in police
custody.
• He can, however, still hold an inquest for this purpose. Under the new
rules, the qualification for appointment to the post of present day
coroner is either a medical or a legal degree with five years of
professional experience from the date of registration with the medical
council or admission to the bar.
Medical examiner system
• Has been developed in America for the investigation of cause of all
sudden and unexplained deaths. The executive authority is a
medically qualified officer enjoying almost the same powers as the
coroner, having achieved them by special legislation except the power
of inquest. He may, however, obtain all necessary information about
the circumstantial aspects of the case from the concerned persons in
private.
Continental system
• Makes no provision for the investigation of all sudden or unexplained
deaths. Only those deaths are subjected to investigation in which
suspicion of foul play exists. A system, which is not activated until
suspicion of crime is present, defeats its own purpose.
• There is no identifiable executive officer..
• In this system, criminal deaths are reported to the police who inform
the area judge through the public prosecutor. Both the public
prosecutor and the judge may be highly qualified officers but they are
only casually concerned with the investigation.
• The reputation of police fails to solicit wholehearted cooperation of
those having knowledge of the circumstances of the crime.
Modified continental system
• In Pakistan, a modified continental system is operative. All sudden
and unexplained deaths are not investigated. Section 174 of criminal
procedure code empowers the area police official to investigate
suicide, homicide and deaths due to accident or ones occurring in
other suspicious circumstances.
• From these, only those deaths undergo investigation which are
reported to police.
• The medico-legal system in Pakistan operates via a modified
continental framework, i.e., the initiation of investigations into death
is done primarily by the police, or by magistrates in cases of custodial
deaths. These investigations are ordered under section 174 of the
Criminal Procedure Code (CrPC) of Pakistan when the relevant
authority encounters sudden, suspicious or unexplained deaths, or
deaths due to criminal intent.
• Under the law, he informs about the crime to the area magistrate and
if thinks necessary may send the corpse of the above types to a
qualified medical man for autopsy provided he is in doubt regarding
the cause of death. He is all powerful to dispose of these cases
without autopsy. All reported cases are therefore not subjected to
autopsy.
• Autopsy rate is very low. Autopsy arrangements are almost non
existent.
Types of autopsy
Classify types of autopsy
Autopsies are of three types:
• Medical/clinical or pathological autopsy,
• Medicolegal autopsy.
• Academic/ anatomical autopsy.
Some special forms of autopsy:
• Psychological autopsy.
• Mini autopsy.
• Needle autopsy.
• Vitropsy.
• Negative autopsy
• Obscure autopsy.
Medicolegal autopsy
(role of autopsy in criminal offences)

• Performed in pursuance of law to establish the cause and manner of

death and also to establish or rule out foul play.
OR
‘’The scientific study i.e. external as well as internal examination of a
death body along with the collection of body tissues and fluids under
the law of state for protection of society and to administer justice.’’

• These autopsies comprise mainly of cases of death due to criminal assault, poisoning &
accidents on road, rail or industries.
• Consent is given by the state (permission from relatives not required.)
Objectives of medicolegal autopsy
• To determine cause of death for the legal system, and in criminal
deaths to collect trace evidence and other evidence in order to
provide information to reconstruct and to interpret a chain of events,
and in some cases to illustrate these findings in a court of law.
Other purposes include;
identification of an unidentified body, and documentation and
evaluation of suspected medical malpractice.
Cause of death.
Manner of death.
Fatal period (the period between injury and death).
Postmortem interval (time interval b/w death and autopsy examination).
Medical/Clinical/Pathological Autopsy
conducted for medical reasons to confirm or establish diagnosis in
cases where clinical investigations during life of the patient remained
futile in establishing it.
In this case, authority/consent is given by the relatives.

Academic/ anatomical Autopsy

To learn the normal structure of the human body by medical students.
It is usually done on an unclaimed dead body, handed over to anatomy department by municipal or
such other governmental authority.
It is also performed on the voluntarily donated dead body (after
relative’s consent). An anatomist performs this.
Objectives of medical autopsy.
• To study the course of disease.
• To study the effects of therapy.
• To correlate clinical diagnosis with autopsy findings.
• To understand the cause of death.
• For academic or research purposes.
Psychological autopsy
• Is undertaken for alleged cases of suicide to know about mental
status of the deceased at the time of death.
• Sources are family members, friends, colleagues, teachers etc. who
are willing to cooperate with medical people rather than the police.
• The police report is usually inadequate because they are not trained
to collect this form of technical data and are only interested whether
a homicide is committed.
• It should include the background of the person, his habits, mental
status, personality traits, character and relations with others etc.
• Important in life insurance claims that are void if death was suicidal.
 Mini autopsy- it is done on a part of the body.

 Vitropsy- Minimally invasive procedure to examine a body for cause of

death.
 Utilizes imaging techniques (CT and MRI) and 3-D optical measuring
techniques to get a reliable, accurate geometric presentation of all
findings (the body surface as well as the interior).

 Needle autopsy- it is done through a needle e.g. liver biopsy, CSF

aspiration etc.
 Describe section 174 and 176 of the
Criminal Procedure Code (CrPC), 1973.
Section 174-
Inquiry by Police into cause of death
 The officer in charge of a police-station or some other police-officer
specially empowered by the Provincial Government in that behalf, on
receiving information that a person:
(a) has committed suicide, or
has been killed by another, or by an animal, or by machinery, or by an
accident, or
has died under circumstances raising a reasonable suspicion that
some other person has committed an offence, . . (continued)
• ….shall immediately give intimation thereof to the nearest Magistrate
empowered to hold inquests, and, unless otherwise directed by any
rule prescribed by the Provincial Government, shall proceed to the
place where the body of such deceased person is, and there, in the
presence of two or more respectable inhabitants of the
neighbourhood, shall make an investigation, and draw up a report of
the apparent cause of death, describing such wounds, fractures,
bruises and other marks of injury as may be found on the body, and
stating in what manner, or by what weapons or instrument (if any),
such marks appear to have been inflicted. (continued.)
(b) The report shall be signed by such police officer and other persons, or
by so many of them as concur therein, and shall be forthwith forwarded to
the [concerned] Magistrate.
(c) When there is any doubt regarding the cause of death or when for any
other reason the police-officer considers it expedient so to do, he shall,
subject to such rules as the Provincial Government may prescribe in this
behalf, forward the body, with a view to its being examined, to the
nearest Civil Surgeon, or other qualified medical man appointed in this
behalf by the Provincial Government, if the state of the weather and the
distance admits of its being so forwarded without risk of such putrefaction
on the road as would render such examination useless.
Section 176
Inquiry by Magistrate into cause of death
When any person dies while in the custody of the police, the nearest
Magistrate empowered to hold inquests shall, and in any other case
mentioned in Section 174, clauses (a), (b) and (c) of sub-section (1), any
Magistrate so empowered may hold an inquiry into the cause of death
either instead of, or in addition to, the investigation held by the police-
officer, and if he does so, he shall have all the powers in conducting it
which he would have in holding an inquiry into an offence. The Magistrate
holding such an inquiry shall record the evidence taken by him in
connection therewith in any of the manners hereinafter prescribed
according to the circumstances of the case.
Power to disinter corpses: 'Whenever such Magistrate considers it
expedient to make an examination of the dead body of any person who has
been already interred, in order to discover the cause of his death, the
Magistrate may cause the body to be disinterred and examined.
Components of modern autopsy suite.
Learning objectives;
• Describe the components of modern autopsy suite.
• Describe the precautions taken while working in modern autopsy
suites.
• Explain the hazards encountered in modern autopsy suites.
Introduction
• Being in a developing country, mortuary building should become a
priority in a hospital building. Knowledge on how to design this is,
hence, necessary to ensure that the facilities comply with current
recommendations.
• In all, the concept is presented under three subheads viz;
(i) Building layout and needs.
(ii) Autopsy equipments.
(iii) Biosafety considerations.
BUILDING LAYOUT AND NEEDS
• A standard mortuary complex should be boarded in an area of
approximately 600 sq mt normally. It should have facilities for receiving
dead bodies from the hospital and from outside the hospital, for
embalming and performing autopsies, if necessary, and releasing the same
to the family members or undertakers.
• Facilities may be needed for relatives to view the deceased, when
preserved.
• Mortuary should have one entrance to the body storage area from the
hospital building directly and another entrance externally, both being
concealed from the public view if possible.
• There should be a transitional area between the body storage area and the
dissection area. This helps in keeping the body storage area clean from any
contamination, which occurs in the dissection area.
Thus, the essential areas required in an ideal mortuary include;
• mortuary office,
• changing rooms,
• cold chambers,
• strong room,
• autopsy room,
• autopsy viewing gallery and
• dead body viewing facilities for relatives and friends of the deceased.

A detailed description on how each of them should be is discussed below,

individually.
Mortuary Office
• Ideally situated between the entrance and storage area.
• Here, the mortuary clerks, technicians and police/public undertakers
dealing with all paperwork involved in the movement of bodies
should be present.
• The basic office facilities required are a desk, few chairs, filing
cabinets and a telephone. It may be convenient to have a direct
outside telephone line, which does not go through the hospital PBX,
since many calls will be between mortuary staff and the
public/undertakers police.
• An answering machine is useful when the mortuary staff is involved in
autopsies.
Changing Rooms
• In a mortuary complex, separate changing rooms for male and female
staff are essential.
• These rooms should have all the required protective clothing, toilets
and showering facilities.
• The changing rooms should be directly adjacent to the dissection
room without intervening corridors, but should have another
entrance also from a clean area. Signs or physical barriers should
mark the boundaries between clean and dirty areas.
• Sign boards carrying ‘No admission’/‘Restricted admission’, etc.,
should be kept in controlling the public entry.
Recommended clothing for an autopsy team are:
• A surgical cap or hood which completely covers the head
• Safety spectacles
• A surgical facemask
• A surgical gown / shirt and trousers (Plastic forearm protectors if the shirt is not
long sleeved)
• Waterproof gumboots
• Waterproof apron
• Latex gloves, possibly with a reinforced safety glove on the non-dominant hand.
• Each of these except the waterproof boots and safety spectacles can either be
disposable or be laundered after the autopsy examination. Especially when dealing
with HIV and hepatitis positive cases coxa, it is better to dispose.
• The waterproof boots should be kept at the entrance of the dissection room.
• They should be put in a disinfectant bath when removed after an autopsy.
Disposable bins and laundry bags can also be ideally placed at the same spot for
clothing to be discarded / laundry purposes after autopsies.
Cold Chamber
• Dead bodies whenever preserved in the mortuary for a few days will
have to be stored at temperature of 4°C.
• Deep-freeze facilities are essential when bodies are to be preserved
for a long period. The ideal or most convenient form of body storage
is a cabinet of fridges with doors at one end or both ends, with one
door opening onto the dissection area and the other onto the area
where bodies will be moved in and out of the mortuary complex.
• The bodies will be stored on stainless steel trays, which slide out of
the fridges onto trolleys.
Storage room
• This is a separate room used for preservation of viscera and body
fluids collected during an autopsy in a suspected case of poisoning till
dispatched to FSL for chemical analysis is another requirement in the
mortuary complex.
• Since specimen are also to be preserved in a fixative (formalin) for
histopathological purposes, continuously operating exhaust fan
ventilation system in this area is essential to help prevent high levels
of formalin vapour (2 parts per million).
Autopsy room
• The autopsy room/dissection area should have sufficient space with good cross
ventilation and exhaust system.
• The room should have a smooth nonporous surface especially the floor, allowing
easy cleaning and rapid drainage.
• The dissection tables should be placed with sufficient place in between enough to
move the trolleys containing body.
• The table should have smooth surface, preferably made up of stainless steel with
continuous flow of water from one end, allowing free drainage and easy cleaning.
• Attached to the main table an additional small dissection table should be
provided for the dissection of organs removed from the body. L-shaped tables are
available with long table for evisceration of organs and small table for dissection
of organs.
• The table should be provided with proper water supply for washing organs during
dissection.
• The autopsy room should have proper lighting facility. Lighting facility should be
provided for each dissection table.
• Bright ambient lighting with additional spot lights for particular areas
of interest for safety and detection of subtle lesions is necessary.
Incandescent light (100 watts × 2 + Tube light × 1) is to be made
available for the purpose of night autopsy giving natural day light
effect.
Autopsy Viewing Gallery
• Gallery is a must for all those medical staff, students, and nurses etc. who
attended the patient before death, for viewing the autopsy findings as part
of education.
• It must be remembered that these people will be coming to the mortuary
from the hospital wards in the clothing that they wear in those wards, so
the autopsy viewing area must be absolutely clean and access to it must be
through clean areas.
• The observation area should be divided from the dissection area by a
transparent glass window, which is high enough to prevent any risk of
contamination from the dissection area.
• The mortuary must be provided with facilities to enable audible
communication between the pathologist and observers.
Viewing facilities
• Viewing of the deceased for the relatives and friends should be
provided in a separate room so that viewers can enter from a
separate entrance without passing through any other part of the
mortuary.
• There should not be any possibility of seeing any other area of the
mortuary, such as the dissection area or the body storage area by
viewers.
• A waiting room with adjoining toilet and washbasin should be
provided.
• The viewing room should be furnished in a style which does not
offend any particular religious or cultural sensibilities.
Autopsy equipments
These comprise of;
• Instruments for dissection,
• Major equipments and
• Chemicals.
Autopsy instruments
Autopsy instruments will vary with individual preference but are likely to include basic requirements such as;
• Bernard’s saw 9” and 11”
• Basins
• Scissors—8”, 6” and 11” blunt and sharp ended
• Bone cutter—10” straight and angled
• Brain knife
• Cartilage knives of 4” and 5 ¼” blade
• Dissection forceps—Blunt and toothed-different sizes
• Electric autopsy saw with accessories
• Scissors-5” fine, pointed and dissecting
• Glass slides, bowls, sterilised swabs and test tubes.
• Gauge ¼” blade
• Half curved and double curved post-mortem suturing needles and twines.
• Hammer and chisel
• Hand lens
• Measuring and graduated glass/porcelain containers
• Metal/plastic measuring tape
• Organ knives of 6” to 10” blade
• Pointed probe
• Resection knife
• Rib shears—9½“
• Ruler with metric scale
• Scalpel of different sizes
• Sym’s speculum for examination of the female genitalia
• Sponges
• Thick PM gloves
• Trays
• Vials with stopper for collecting blood
• Wide mouthed glass bottles with stoppers of one liter capacity for viscera
Major equipments
Though these are expensive, it is preferable to be made available in the department and
they are:
• Cadaver weighing machine.
• Organ weighing machine.
• Embalming machine.
• Hot water geyser.
• Refrigerator.
• Dead body cold chamber.
• Portable X-ray machine.
• X-ray viewer.
• Camera with zoom lenses.
• Video camera.
Chemicals
Following chemicals are essential in a modern mortuary:
• Antiseptic lotions/soaps/disinfectants, sodium hypochlorite, sealing
wax, clothes, etc.
• Fixative like formalin 10%.
• Glycerine for preserving brain in suspected rabies case.
• Liquid paraffin for topping blood sample in cases of death due to
suspected irrespirable gas inhalation.
• Preservatives like common salt, rectified spirit.
Note: All stationaries required for documenting autopsy formalities
should be available in the mortuary office).
Biosafety considerations
• All bodies are potentially infective, but in some cases a pathogen will have
been known to be present before death.
• Suggestions by Kurk BN et al seem to be most suitable to be opted (Am J
Forensic Med Path 23(2) 2002;107-122).
• Accordingly, the autopsy dissectors are at the risk of being exposed to a
variety of infectious agents such as AIDS, hepatitis B, and C viruses, and
Mycobacterium tuberculosis.
• Transmission of infection may occur by cutaneous injury, which comes in
contact with infected blood or by aerosal exposure.
• In these cases, the autopsy workers should (wear PPEs- personal protective
equipments) protect the eyes, skin and mucous membranes by wearing a
surgical gown, mask and cap, goggles, shoe covers, and double surgical
gloves.
• Metal and synthetic mesh gloves if worn underneath surgical gloves
may reduce the risk of autopsy injuries from scalpels and other sharp
objects.
• When there is risk of aerosolised pathogen such as M. tuberculosis, it
is better to wear specialised face mask such as N-95 respirators,
which filters particles of 1 mm diameter.
• Instruments used for these autopsy procedures should be
decontaminated prior to cleaning by using 1:10 or 1:100 dilution of
bleach or by autoclaving. Autopsy surfaces should be decontaminated
with 1:10 (0.5%) bleach and agents such as phenolic compounds
(which is tuberculocidal).
Hazards of autopsy
Hazards of autopsy
1. Mechanical.
2. Sharp force injury.
3. Biological.
4. Chemical.
5. Electrical.
6. Radiation.
1.Mechanical hazards
• Injuries to limbs- by fall on wet slippery floor.
• Injuries to hands- cuts by sharp instruments during dissection, needle
prick, burns from boiling water/ hot instruments.
• Injuries to back- sprains from carrying of heavy corpse.
• Injuries to eyes- corneal ulcer via bone dust.
2.Sharp Force Injury
• Conscious awareness is the best prevention against inadvertent cuts
and punctures during an autopsy.
• Make habit of safe removal and disposal of “sharps” and avoidance of
sharp-pointed scissors whenever possible. In addition, one can wear
cut-resistant gloves on the nondominant hand, which will prevent
cuts but not needle punctures. Awareness also means knowing, at all
times, where the scalpel is, not where it isn’t. A missing scalpel or
scalpel blade (dislodged from the handle) requires suspension of the
autopsy procedure until the blade is found. A frequent cause of lost
scalpels is placing them on or in a body cavity. The habit of putting
scalpels on the table only should be developed.
• Trauma victims may pose additional hazards that could lead to a cut
or puncture.
• Comminuted rib fractures, for example, are often hidden by a
hemothorax, and the unwary prosector may readily impale a hand on
these jagged fractures.
• Stabbing victims may have a portion or entire blade of a knife
embedded in the body, and some bullets have jackets that may
produce sharp fragments or peel back to form very sharp and pointed
hooks. A preautopsy radiograph not only will localize foreign metallic
objects, but also may reveal a potential hazard to the prosector.
3.Biological hazards
Bacterial infections
• From septicemic/ pyemic dead bodies.
• Purulent fluid from cavities, viscera, abscess.
• From specific infection (typhoid, tuberculosis, leprosy, anthrax)
Viral infections- hepatitis/ AIDS.
Fungal infections.
4.Chemical hazards
Antiseptics and disinfectants:
concentration for inanimate bodies like instruments, autopsy table etc.
is high and may burn skin on contact.
• Iodine
• Phenol fluids
• Dettol.
Fixatives like formaline (living skin also gets fixed if it stays in contact
for >15mins)
5. Electrical hazards
• Electrical burns due to faulty appliances, metallic autopsy table and
wet floors.

6. Radiation
• Electromagnetic radiation/ ionizing radiation from therapeutic
radioactive isotopes.
Autopsy (medicolegal) guidelines
Legal formalities
Legal formalities in taking up a case for medicolegal autopsy are:

 Authorisation order.
 Identification of the deceased.
 Facts about the case.
 Place of performing autopsy.
 Qualifications.
 Authorisation order
Authorisation order is usually in the form of requisition letter, which
must be received by the doctor prior to autopsy and it depends on type
of the case.
Body for medicolegal autopsy should be accompanied by a
dead body challan and an inquest report.

However, never perform an autopsy without an authorisation order.

A dead body challan is a requisition submitted to doctor by
investigating officer and contains name, age, gender, address along
with probable date and time of death.
An inquest report is preliminary investigation to ascertain the matter
of fact, the details of body, presence of any injury etc.
Preferable for the doctor performing autopsy to visit crime
scene.
Identification of the deceased
A dead body is better identified prior to autopsy. If the deceased is a
known person it is mandatory to get it identified.

Known body
Confirm identity by the police officer or constable or the relatives or
legal heirs. Always take the signature of the person identifying.
If police constable is identifying the deceased, note down his or her
PC No, name and name of the police station he or she belongs to, etc.
on the post-mortem report form itself.
Unknown body:
If the deceased is unknown, efforts are made in noticing the factors
which could help in establishing the identity later.
Ask police for taking the photograph, fingerprint, details on the
particulars of the dress worn with the tailor’s label if any, etc.
Doctors should also make note of all available factors
(external/internal) of establishing identity.
Facts about the case.
For better autopsy results always try to study all available facts about
the case prior to autopsy and it includes:
Inquest report—issued by police
Hospital records (if any) such as wound certificate, case file/sheet,
etc.
Preferable for the doctor performing autopsy to visit crime scene.

Note: Confirm HIV and HBV status of the deceased whenever facilities
available, as to take proper self-care and care of the other mortuary staff.
Place of performing autopsy.
The medico-legal autopsy should be conducted in an authorized
centre. Preferably done in an equipped mortuary.
Autopsy is also done at site of recovery of the cadaver in cases of
exhumation and putrefied body.
Qualifications
• Minimum qualifications render a doctor qualified for this work is that he or
she should have MBBS degree and that he or she must be a registered
medical practitioner.

Specialist qualifications vary and include any one of the following

qualification:
• MD (forensic medicine)
• FCPS (forensic medicine)
• DNB—forensic medicine (diplomat of national board—forensic medicine)
• DFM (diploma in forensic medicine)
• DMJ (diploma in medical jurisprudence) from UK.
Other specialist qualifications
• MD (pathology)
• MS (anatomy/surgery)
• Any other specialists may also be allowed to do the autopsy in
Pakistan on account of shortage of subject specialists.
Autopsy (medicolegal) guidelines
Avoid unnecessary delay in performing autopsy.

Do not allow unauthorised person into the mortuary. (If allowed record a
statement from him or her giving reasons for his or her presence and signature
for being present during the autopsy). The investigating officer (IO) may be
allowed, if desires.

An autopsy is better done in the daylight (dawn to dusk) since it is said that
colour changes, such as jaundice, changes in bruises and PM staining cannot be
appreciated in the artificial light.

However, medicolegal autopsy may also be conducted even after dusk or in the
night, with proper artificial light having day light (incandescent light) effect.
A preliminary examination is done to note external appearances,
body (rectal) temperature, extent of PM staining and rigor mortis. The
actual post-mortem is conducted on the next day.
Both positive and negative findings should be recorded.
Prepare the PM notes during autopsy or arrange to tape record the
dictation.
Prepare the PM report immediately and sign it duly.
Handover this report and viscera (if preserved for chemical analysis)
only to an authorised police officer/constable maintaining the
‘Chain of custody’.
 Chain of evidence/custody

• To preserve chain of custody-proper reception and handling over of

medicolegal case is absolutely essential.

• Chain of evidence/custody requires that from the moment the

evidence is collected, every transfer of evidence from person to
person be documented and be provable that nobody else could have
accessed or tampered that evidence which can compromise the case
of the prosecution.
Autopsy- guidelines
(medicolegal autopsy)
Obtaining the authority.
Identifying the case (via systemic examination or 3rd party)
Cloth’s examination.
External and internal examination.
Collection and preservation of body fluids (sealing, labeling, packing,
storage and transport to laboratory.
Handling them over to the authorities, receiving proper receipt from police
and from chemical examiner-to preserve chain of custody.
If sample is sent through parcel, receipt should be obtained from post
office (receipt from different people- avoid substitution and missing of
sample)
The whole process is called chain of custody/ chain of evidence.
Autopsy- guidelines
(medicolegal autopsy)
A list is made of all the articles removed from the body, e.g. clothes,
jewellery, bullets, etc. They are labelled, sealed, mentioned in the report
and handed over to the police constable after obtaining a receipt.
Prepare the post-mortem notes during autopsy.
Prepare the autopsy report immediately and sign it duly.
After completion of autopsy, the body is stitched, washed and restored to
the best possible cosmetic appearance, and then handed over to the
police.
A doctor should better not take up the autopsy, which he does not feel
competent to carry out.
Autopsies and cause of death investigations are performed under the
Section 174 and Section 176 of Criminal Procedure Code (CrPC) Pakistan.
 Autopsy protocol
‘’The autopsy protocol is the written record of the objective observations
made during the examinations conducted by the pathologist.’’
Autopsy protocol
These are the signed documents containing details about autopsy,
presented to the court as a proof.
• Protocol of medicolegal autopsy is specific and very important
because of legal implications.
• Before the start, medical examiner should satisfy himself that he has
valid written authority addressed to him for the job. It comes either
from police/ court in the form of written reference.
• Before starting he should go through all the relevant documents
keeping in mind the recommended working protocol and specific
objectives of medicolegal autopsy.
Precautions to autopsy.
Authority.
Identification (3rd party)
Care and skill.
Collect too much of evidence.
List of people during autopsy.
Never voice your opinion (public/colleagues).
Mouth shut, eye and ears open.
If untrained don’t be proud/ ashamed in learning from trained personnel.
Trained assistant.
Optimum conditions (protection from hazards, PPEs, room disinfected).
Photography (before, during and after procedure, MLC- wounds
photographs).
• Deaths during surgery/ anesthesia- surgeon/ anesthetist should be
present with his notes. Death (in case there is interval b/w death and
violence) hospital charts review is must.
• Day light/ nights (ice blue or incandescent light).
• Autopsy report- priority basis- to avoid delay in justice.
• Relevant info from police/ relatives- may help in opinion.
• Proper container with appropriate preservatives (body tissues/ fluids).
• Death due to firearm/ blunt weapon (battered baby syndrome) always
take x-rays before autopsy to locate foreign body/ fractures if any.
Autopsy- procedure
- Procedures vary and depend on the skill and experience of forensic
expert.
- A checklist for post-mortem examination can be given under the
following headings in general;
Preliminaries.
External Examination.
Internal examination.
Sample collection.
Opinion, signature and designation.
Preliminaries
it includes;
Crime scene inspection. (cause/manner of death can be established at scene in 60-70%).
Dead body’s transportation to the mortuary. (under police and MO’s supervision).
Registration at mortuary.
Storage of dead body.
 -short term storage (deep freezer @ 4oC).
 -long term (deep freezer @ minus20oC).
Authority. (Dr. must be authorized + authority by state/police ASI).
Detailed study of documents. (police, hospital documents/ death certificate).
Bio data (known(3rd part)/unknown body (subjective/objective method), name, father’s name, age, gender,
cast, occupation, address).
History (info by police/ relatives before and after death).
Autopsy number. (given to the body, brought by whom, date/ time/ place of examination noted).
External examination
Most important part- can help a lot in solving the most mysterious deaths. This
includes examination of:
Clothes
Stains of mud, blood, urine, stool, etc.
Identity
Body orifices
Finger/toe-nails
Injuries/surgical intervention Examination of body
Rigor mortis.
Post-mortem staining
Decomposition/other changes
External injuries.
Clothes examination
They are listed and their number, labels and laundry marks, design, stains, tears,
loss of buttons, cuts, holes or blackening from firearm discharges with their
dimensions should be noted.
Trace evidence like hair, fibres, insects, glass fragments etc. are collected and
labelled.
Jewellery, medicines or drugs of abuse and personal papers in the pockets may
help in identification.
The clothes should be removed carefully without tearing them, to avoid
confusion of signs of struggle. If they cannot be removed intact, they should be
cut in an area away from any bullet hole or cuts, along the seam of the garment.
Examination of clothes is done on the body and off the body.
After autopsy, wet clothing (decomposes evidence) should be air-dried, packed,
sealed in paper bags and handed over to the police.
Examination of body.
Whole surface of the body should be carefully examined before and after
washing from head to foot, and back and front, and the details noted
General description: deformities, scalp hair, beard, scars, tattoo marks,
moles, skin disease, circumcision, amputations, surgery marks etc.
Time since death: Rectal temperature, rigor mortis, postmortem staining,
putrefaction, maggots, stomach contents, etc.
Skin including scalp: General condition - rash, petechiae, colour etc. The
presence of stains from blood, mud, vomit, faeces, corrosive or other
poisons, or gunpowder is noted.
Face: Cyanosis, petechial hemorrhages, pallor, protrusion or biting of the
tongue, state of lips, gums, teeth, marks of corrosion or injuries inside the
lips and cheeks.
 Eyes: Condition of the eyelids, conjunctivae, softening of the eyeball, colour of
sclera, state and colour of pupils, contact lenses, petechiae, opacity of the cornea
and lens
 Nose (bleed/ fracture), Ears (bleeding ~middle cranial fossa fracture)
 Natural orifices: nose, mouth, ears, urethra, vagina and anus should be observed
for any discharges, injuries and foreign body. Samples of leakage of blood or CSF
from ears, mouth or nostrils is collected on swabs
 Neck: Bruises, fingernail abrasions, ligature marks etc.
 Thorax: Symmetry, general outline, and injuries if any
 Abdomen: Presence or absence of distension , striae gravidarum
 Back: Bedsores, spinal deformity, or injuries
 External genitalia: General development, oedema, local infection, and position of
testes.
 Hands: Injuries, defence wounds, electric marks, and in clenched hands if
anything is grasped.
 Fingernails: Presence of tissue, blood, dust or other foreign matter
may be indicative of struggle
 Limbs and other parts: Fracture and dislocation, shortening- lateral
rotation.

Indications of radiological examination

 Examination of external injuries
The final stage of external examination is the documentation of injuries.
Each injury is characterized by its:
 Type/nature of injury/ number of wounds.
 Size (length, breadth and depth).
 Shape.
 Site (in relation to two external anatomical landmarks).
 Direction of application of the force.
 Margins/edges and base.
 Distance of the wound from the heel.
 Time of infliction of the injury should be studied from inflammatory and colour changes.
 Foreign materials, e.g. hair, grass, fibres, etc.
 If the injuries are obscured by hair, it should be shaved.
 Deep or penetrating wounds should not be probed until the body is
opened.
 In burns, their character, position, body surface area involved, and
degree should be mentioned.
 The position of the injuries should be pictographically depicted on the
diagrams.
 Photographic documentation of major injuries is now considered as
standard practice.
 Identifying markers bearing the unique autopsy number, with a
measurement scale should be included to ensure that the photos
correspond to the specific case.
Note PM changes which are;
Rigor mortis.
PM lividity.
Cooling of the body.
Putrefaction.
Internal examination
Basics of internal examination
a) General rules.
b) Skin incisions.
c) Evisceration/ Autopsy techniques.
Examination proper
a) Dissecting Cranial cavity.
b) Dissecting Spinal cord.
c) Dissecting Neck.
d) Dissecting Thoracic cavity.
e) Dissecting Abdominal and Pelvic cavity.
 Basics of internal examination
a) General rules.
b) Skin incisions.
c) Evisceration/ Autopsy techniques.
a) General rules;
Dissection and examination of all three major cavities of the body i-e Cranial,
Thoracic and Abdominal cavities, and their contents should be carried out.
Spinal cord is routinely not opened.
The choice as to which part of body is to be opened first — skull or the body
cavities is left to the dissector.

However, some surgeons suggest to start autopsy by opening the cavity least
affected so as to create a blood-less field in the affected area e.g. in case of
strangulation, cranium and chest cavity to be opened first so that the excess of
blood is drained out from the neck.
b) Skin incisions
Major skin incisions used to open the cranial, thoracic and abdominal
cavities are:
For cranial cavity:
 Intermastoid Inverted U-Shaped incision.
For thoracic and abdominal cavities:
 I-Shaped incision.
 Y-Shaped incision.
 Modified Y-Shaped incision.
For back:
 Elongated X-Shaped incision.
Intermastoid inverted U-shaped incision
Incision starts behind one ear (at mastoid process) passes across the
scalp just behind the vertex and ending behind the other ear (at
mastoid process).
Only common incision used to open skull.
Indication: Opening of cranial cavity.
Green : I shaped incision Red : T shaped incision
Brown : Y shaped incision Blue : modified Y shaped incision
I-shaped incision
Straight incision is made from the chin (symphysis mentis) to pubis (symphysis
pubis), avoiding umbilicus (because the dense fibrous tissue is difficult to
penetrate with a needle, when the body is stitched after autopsy)
Indication: Most common type of incision
Advantage: Simple and convenient
Y-shaped incision
Straight incision from suprasternal notch to pubis is made, avoiding umbilicus.
Now this incision is extended from suprasternal notch to the mid-point of clavicle
and then upwards towards the neck behind ear. Similar incision is made on
opposite side
Indication: When a detailed study of neck structures is required, e.g. strangulation
Advantage: Better exposure and allows study of neck structures
Modified Y-shaped/ Continental incision
It begins at a point close to acromial process and extends down below
the breast and then medially across the xiphoid process. A similar
incision is made at opposite side of the body and from xiphoid process
the incision is carried downwards in a straight line to the pubis
Indication: Preferred in females
Advantage: Prevents cutting of the chest skin in midline and also
allows detailed study of neck structures.
Elongated X-shaped incision
Special incision used to dissect out subcutaneous
structures in the back to identify and evaluate the
extent of blunt injuries, which are usually missed
where superficial imprints are faint, particularly
when present on skin not overlying bone
Indication: Practiced in custodial deaths
c)Evisceration/ Autopsy techniques
Four different techniques are used to remove contents of the body
during autopsy:
i. Technique of Virchow / Individual organ removal and dissection.
ii. Technique of Rokitansky / In situ dissection.
iii. Technique of Ghon / En bloc removal and dissection.
iv. Technique of Letulle / En mass removal and dissection.
Ludwig principal
According to Ludwig principal autopsy techniques are described and they are:
1. Technique of R Virchow: organs are removed one by one.
Here the cranial cavity is opened first, then spinal cord, followed by thoracic,
cervical and abdominal organs in that order.
Removal of individual organs one by one with subsequent dissection of that
isolated organ.
Quick and effective method, if the pathological interest is in a single organ.

2. Technique of C Rokitansky: This is characterised by ‘in situ’ dissection, in part,

combined with removal of organ blocks.
Rarely performed, involves dissecting the organs in situ with little actual
evisceration being performed prior to dissection.
Method of choice in patients with highly transmissible diseases.
3.Technique of A Ghon: Thoracic and cervical organs, abdominal organs, and
the urogenital systems are removed as organ block (‘en bloc’ removal).

4. Technique of M Letulle: Cervical, thoracic, abdominal and pelvic organs

are removed as one organ mass (‘en masse’removal) and subsequently
dissected into organ blocks.
Cervical, thoracic, abdominal and pelvic organs are removed En-masse and
subsequently dissected into organ blocks.
Rapid technique for removing the organs from the body although the
ensuing dissection is the lengthiest. It has the advantage of leaving all
attachments intact.
 Note: While undertaking a medicolegal autopsy following points may
also be remembered:
• Depending on type of a case, any of the body cavity can be opened
first. Table (next slide) provides an idea as to open which cavity first,
depending on type of a case.
• Spinal cord is routinely not opened.
• Arrange for histopathological examination, chemical analysis, etc. as
needed, especially when cause of death is not clear.
 2. Examination proper
a) Dissecting Cranial cavity.
b) Dissecting Spinal cord.
c) Dissecting Neck.
d) Dissecting Thoracic cavity.
e) Dissecting Abdominal and pelvic cavity.
a.Dissecting cranial cavity
Dissection of cranial cavity includes five steps;
1. Scalp incision
Intermastoid inverted U-Shaped incision.
Bring the anterior flap up to superciliary ridge and posterior flap up to
occipital protuberance.
2. Removing the skull cap
Incise the temporalis muscle and cut it along its origin and reflect down on
both sides.
Saw the skull bone a little above superciliary ridges in front and occipital
protuberance behind.
Now, let both lines meet at an angle of 120° above mastoid process and
then remove the skull cap using chisel, exposing dura mater.
3. Opening the dura mater
− Using sharp pair of scissors it is cut along the line of detached skull cap and
pulled gently from front to back while cutting falx cerebri, and examined
for subdural and subarachnoid hemorrhages.
4. Removing the brain
− Insert four fingers of left hand between frontal lobes and skull.
− Draw the lobes backwards gently and cut optic nerve and then other
nerves and vessels with right hand as they emerge out from the skull.
− Cut the tentorium cerebelli along its attachments in posterior cranial fossa.
− Cut spinal cord, first cervical nerves and vertebral arteries as low as
possible through foramen magnum.
− Support the brain in left hand and remove with the cerebellum.
5. Dissection of brain and its parts.
− The brain is weighed (normally 1.3 to 1.4 Kg) and then examined for any
swelling, softening, shrinkage or herniation, upper and lateral surfaces of
the brain for asymmetry or flattening of the convolutions. The cerebral
vessels is looked at for arteriosclerosis, embolism and aneurysms.
− Brain is dissected by two methods:
Dry dissection: Less common; Dipped in 10% formalin which makes the tissue firmer
without altering its histological characteristics.
 Wet dissection: More common; Fresh brain dissection without using any fixative.
− The brain is placed on a board with frontal pole away from dissector.
− Cut the brain in serial coronal sections at regular intervals (about 1cm
apart) from front to back or cut obliquely at the intracerebral fissures
exposing basal ganglia, lateral ventricles and white matter.
Features to look for:

The cortical ribbon, white matter, basal ganglia and lateral ventricle should
be examined for any asymmetry or brain shift that would indicate space
occupying lesion—abscess, large hemorrhage, recent infarction or either
metastatic or primary tumors.
Dilatation of lateral ventricle may indicate atrophy
Shrinkage of cerebral cortex (grey matter) is common in chronic alcoholics
Petechial hemorrhages in the white matter are commonly found in death
from anaphylactic shock.
In head injury, edema is seen in the white matter around or deep to
contusions, lacerations or ischemic lesions.
If there is any injury to the brain, successive sections parallel to the
wounded surfaces should be made till the whole depth of the wound is
revealed.
 b.Dissecting Spinal cord
The spinal cord can be removed from an anterior or posterior
approach
If there is no indication, the spinal cord need not be exposed
1. Anterior approach
All the organs of abdomen and thorax are removed first
Spinal cord is then exposed by cutting the vertebral bodies from
anterior
The anterior approach is more difficult but has the advantages of not
requiring the body to be turned and allowing the nerve roots and
dorsal ganglia to be dissected
2.Posterior approach
The posterior approach is both quicker and easier, but best performed
before the full postmortem, to avoid the mess.
In this approach, a midline incision is given, extending from base of the
head to the sacrum dissecting away soft tissue from the spines and arches
of spinal cord.
With the help of saw and chisel, cut through and remove lamina and spinal
processes to expose dura mater.
Examine the dura for any pathological condition, such as inflammation,
haemorrhage, crushing, infection, etc.
Separate the cord at the foramen magnum, carefully lift it from vertebral
column, and place it on table for examination.
The dura is then opened with the help of forceps and scissors to examine
the cord itself.
Samples may be taken for histology, if needed.
 c. Dissecting neck
• The neck structures are examined before removal of the thoracic organs so that
the tongue, larynx, trachea and esophagus can be taken out along with the
lungs.
• For exposing the structures of the neck, ordinarily, the I-shaped incision is used;
however, when wider view is necessary, neck structures should better be
exposed by a Y-shaped incision.
• In case of death due to alleged constriction of the neck, there may be fracture of
hyoid bone or thyroid cartilage with extravasation of blood into the tissues, and
injury to carotid arteries, sternomastoid muscles or platysma.
• Compression of the neck with hard materials may cause injury to the cervical
vertebrae and the corresponding part of the spinal cord.
• Neck when dissected is also checked for presence of any foreign body.
 d.Dissecting thoracic cavity
Chest is opened by midline incision.
The skin, subcutaneous and soft tissues in the neck and chest are then reflected
sideward.
Now cut along the costochondral junction, and reflect the chest plate.
Introduce the hands into pleural cavities and explore and look for blood/fluid
collection.
Disarticulate the sternoclavicular joints on either side, cut the cartilage of first rib
and separate the chest plate and remove it.
In situ inspection is done before removal of thoracic organs which includes
observation of the atrium and ventricle for air embolism, distension or collapse
of lungs, the chest cavity for fluid, hemorrhage or pus, pleural adhesions, injuries
including fracture of ribs.
Demonstration of Air embolism:
Usual indications for air embolism are
Suspected criminal abortion
Open wound of the neck, central venous catheterization etc.
Principle: To demonstrate air in the vascular system, i.e. heart.

Procedure:
Heart is exposed by routine autopsy incisions and sternal plate is removed with ribs up
to the costochondral junction. The pericardial sac is now incised anteriorly, and the
edges are grasped with haemostats on either side and held firmly. Now fill the sac with
water till the heart is submerged. Invert water filled measuring glass cylinder (300 ml)
over the heart, with the mouth of cylinder under pericardial water column. The right
side of the heart is then punctured with a scalpel under the water level. The gas will
escape from heart into the cylinder, displacing the water in it
Another method is by inserting a water-filled syringe (minus plunger) connected to a
needle into the right ventricle, the syringe chamber observed for the presence of
bubbles
Demonstration of Pneumothorax :
− Pure form of pneumothorax is rare. It is usually associated with injury to
lung, resulting in blood in the pleural cavity or haemopneumothorax. Thus
every case of chest injury is an indication for checking for the presence of
air or pneumothorax .
Principle: To demonstrate air in the pleural cavity.
Procedure:
Incision of the body as in any routine medicolegal autopsy examination and
the skin and muscles on the injured side are reflected and dissected to form
a pocket. This pocket is then filled with water. Invert now water filled
measuring glass cylinder over the pocket, with the mouth of cylinder under
water in the pocket. A scalpel is then introduced under water level into the
costodiaphragmatic sinus through an intercostal space. If air is present in
the pleura, bubbles will come out from the wound and get collected into
the glass cylinder and directly measure the amount of air in the pleural
cavity.
Another method is possible before any incision is made. This involves
introducing a wide bore needle attached to a 50 ml syringe into the
subcutaneous tissue over an intercostal space into the pleural space.
The plunger should be removed previously and the syringe filled with
water. The water is observed for the presence of any bubbles. A
similar procedure is then followed on the other side.
A third method involves postmortem chest X-ray, and assessment in a
manner similar to detection of a pneumothorax in the living patient.
Examination of Heart :
− The heart is held at the apex, lifted upwards and separated from other thoracic
organs by cutting the vessels entering and leaving it (inferior and superior vena
cava, pulmonary vessels, and ascending aorta) as far away as possible from the
base of the heart
− The size and weight of the heart is noted. Adult heart weighs about 250–300 g
− The myocardium is examined for fibrosis or recent infarct. If an infarct is
identified, sections from its central and peripheral zones are useful in dating
the onset of ischemic damage and determining any recent extension.
− The extramural coronary arteries are examined by making serial cross-
sectional incisions about 3–5 mm apart, in order to evaluate for atherosclerotic
narrowing, the common site being 1 cm away from the origin of the left
coronary artery
− The extent of coronary artery atherosclerosis is categorized based on the
approximate percentage stenosis, caused by the plaque. Anything < 50% is
considered mild, while 50–75% is considered moderate and > 75% is severe.
Pulmonary embolism may be detected by opening pulmonary
artery before any other part of the heart is opened.
• It is important to differentiate between antemortem embolus, that
originates from deep veins of the leg, from postmortem clots that are
formed in stagnant blood
• An embolus is firm, has transverse ridges, often coiled upon itself and
generally of the size of femoral vein. Postmortem clots, which form
after death in stagnant blood, are soft, smooth, shiny and purplish or
yellowish
• For confirmation of antemortem embolus, deep veins in the calf
muscles can be incised which will reveal firm solidly structured thrombi
which pops out as sausages when the vein is transacted.
Postmortem clots
Two types are seen:
1) When blood clots rapidly, a soft, lumpy, uniformly dark-red, slippery,
moist clot is produced ("red currant jelly").
2) When red cells sediment before blood coagulates, the red cells produce a
clot similar to the first type. Above this, a pale or bright-yellow layer of
serum and fibrin is seen ("chicken-fat").
• The fibrin clot may be soft or jelly-like, but is elastic, when the amount of
fibrin is greater. Usually, a mixture of the two types of clot is seen.
• PM clots are moist, smooth, shiny, rubbery, homogeneous, loosely or not
at all attached to the underlying wall, and there are no fine white lines of
fibrin (striae of Zahn).
• PM fibrinous clots in heart are known as cardiac polyps.
AGONAL THROMBI
• Person dying slowly with circulatory failure, a firm, stringy, tough,
pale-yellow thrombus forms in the cavities, usually on the right side
of the heart. The process may begin in the atrial appendage, in the
apex of the ventricle or in the angles of the ventricular surfaces of
tricuspid valve.
• It extends and fills the right auricle and ventricle and spreads into the
pulmonary artery and its branches like a tree-like cast. In the left
ventricle, agonal thrombi are not so big.
Heart is dissected by Inflow - outflow method or following the direction of
blood flow --- right atrium, right ventricle, pulmonary arteries, pulmonary
veins, left atrium, left ventricle, and aorta.
First, the right atrium is opened, followed by the tricuspid valve, and then the
pulmonic valve.
Next, the left atrium is opened, followed by the mitral valve and the aortic
valve.
During opening, the valves should be examined before being cut and valve
orifice measured (The circumference of mitral valve is 8–10.5 cm (mean 10
cm) and admits two fingers; tricuspid valve is 10–12.5 cm (12 cm) and admits
three fingers; aortic valve is 6–8 cm (7.5 cm) and pulmonary valve is 7–9 cm
(8.5 cm). The decrease in circumference is suggestive of stenosis whereas
increased circumference could be due to regurgitation or incompetent valves).
Special sections can be taken at this point to evaluate the conduction
(electrical) system of the heart.
Examination of Lungs :
− Normal lungs weigh 250–400 g each in an adult, but may weigh > 1 kg in
cases of severe cardiac failure or diffuse alveolar damage.
− The condition of pleura, any sign of pleuritis, petechial hemorrhages,
injury, effusion, hemothorax, pneumothorax or pyothorax is noted.
− It is conventional to cut open from large to small airways, from medial to
lateral to include all lobes and segments opening along the branches as
they are encountered.
− Impression of the parenchymal appearance and texture is noted. The
parenchyma is squeezed and any pus or fluid expressed is noted.
− It is preferable to make large horizontal slices through the whole lung
rather than opening the airways and vessels in cases of large mass lesion
(e.g. carcinoma).
e.Dissecting abdominal and pelvic cavity
Abdomen is usually opened by a midline I - shaped incision.
Care being taken not to injure the intestines underneath. To
accomplish this, a small puncture may be made in the peritoneum
and a finger inserted to lift it away from the intestines.
The knife then may be directed outwards cutting along the length of
abdomen and preventing penetration into the intestines.
The cavity as such should be examined for any pus, blood, exudation,
etc. Then the individual organ should be examined as described in
next.
Stomach:
− Two ligatures are applied at the cardiac end of the esophagus and
two ligatures below the pyloric end of the stomach. The stomach is
removed by cutting between the double ligatures at both ends, and is
opened along the greater curvature.
− The mucous membrane is examined for the presence of any stain,
congestion, hemorrhage, desquamation, ulceration, or perforation.
− The content of the stomach is noted in respect to quantity, nature of
material/food, state of digestion, colour and smell.
Intestine:
− Dissected in its entire length. Any injury or reactions due to poison or
presence of foreign body, e.g. a bullet, is noted.
− Ulcerative colitis like lesions is noticed in case of poisoning with
mercuric chloride.
Liver:
− Removed along with gall bladder and its weight, size, colour,
consistency and presence of any pathology or injury is noted.
− Normal liver weighs about 1300–1550 g in an adult.
− Inflammatory or neoplastic processes often cause
hepatomegaly, but fibrotic conditions such as cirrhosis will
cause a shrunken organ.
− For macroscopic examination of the liver, multiple transverse
sections at 1–2 cm apart are given from one side to the other.
− The gallbladder should be opened, and the presence or
absence of bile stones and the character and quantity of the
bile should be noted.
− In some cases, bile may be required for analysis as in
morphine or chlorpromazine poisoning.
Spleen:
− The spleen is removed by cutting through its pedicle; its size, weight
(130-170g), consistency and condition of capsule, and rupture,
injuries or disease is noted. Hilum should be inspected for
splenunculi before dissecting the spleen.
− In case of septicemia, the spleen will often be soft and liquefied, and
slicing may be impossible.

Pancreas:
− The pancreas is removed along with the stomach and
duodenum. It is sliced by multiple sections at right
angles to the long axis to expose the ductal system.
Kidneys:
− Removed along with adrenal glands after tying the ureters along with the vessels at least
1 inch away from the hilum.
− The surface of the kidneys along with the covering capsules should be examined for
texture, congestion, hemorrhage and injury.
− An adult kidney weighs about 150 g.
− The kidney is sectioned longitudinally through the convex border into the hilum. The
pelvis is examined for calculi and inflammation.
− With chronic renal parenchymal disease such as nephrosclerosis, ischemia or infection
there may be fine or coarse scars.
− Renal infarcts are pyramidal or wedge-shaped lesions with the base at the cortical
surface and the apex pointing to the medullary origin of the arterial supply.
Urinary bladder:
− Examined in situ for any pathology, hemorrhage, congestion or injury
− If bladder contains urine, it is syringed out before opening to avoid any chances of contamination
by blood or any other material.
− Both the ureters should be opened along their long axes.
Female genitalia:
− The uterus and its appendages should first be examined in situ and then removed en- masse
along with the vagina.
− The uterus is examined and its dimensions, weight, whether gravid, parous or nulliparous, or any
pathology present is noted.
− It should be opened longitudinally, and mucous membrane and walls should be examined.
− In old age, it becomes atrophied, and paler and denser in texture. If the uterus contains a fetus,
the age of its intrauterine life should be determined.
− The ovaries and fallopian tubes should also be examined. The vaginal canal should be opened
from below upwards and examined for the presence of a foreign body or marks of injury. The
condition of the cervix and any marks from instruments should be noted.
Prostate and Testes:
− These should also be sectioned and examined wherever necessary.
− Prostate is examined for enlargement or malignancy. In prostatitis, it
is firm and in carcinoma, it is hard and granular.
PARKMAN-WEBSTER CASE
• Dr. Parkman who had loaned money to Professor Webster was lured
into the chemistry laboratory of Dr. Webster on 2-11-1949, where he
was killed with a knife. The body was mutilated, then destroyed in a
furnace and by chemical agents. A week later, an entire trunk of a
human body with left thigh and some artificial teeth were recovered
from Webster's laboratory. The age, sex and stature tallied with those
of Dr. Parkman. The dentist, Mr. Keep, who had attended Dr.
Parkman, identified the blocks of mineral teeth recovered from the
furnace. He demonstrated that mandibular mineral blocks fitted the
original plaster model which he had preserved. Webster was tried
and convicted.
THE RUXTON CASE
• Two women, Mrs. Isabella Ruxton, wife of Dr. Ruxton, aged 35 years and Mary
Rogerson, their maid, aged 20 years, disappeared from the house of Dr. Ruxton in
Lancaster on 15-9-1935. A quantity of human remains (70 portions) were found in
a ravine near Moffat, about 107 miles from Lancaster. The remains consisted
chiefly of two heads, thorax, pelvis, segments of the upper and lower limbs, three
breasts, portions of female external genitals, and the uterus and its appendages.
The disarticulation had been carried out without damage 1mggesting the
anatomical knowledge of the person. Both bodies had been mutilated to remove
all evidence of identity and sex. All the remains were assembled and found to
represent two female bodies, aged about 35 to 45 years and 18 to 22 years,
respectively. Casts of the left feet of the two women fitted perfectly shoes
belonging to Mrs. Ruxton and her maid. Superimposition of photographs of the
skull on life-size photographs of the heads of two women were found to tally in
every respect. The fingernails of the younger were scratched and her finger prints
tallied with prints found on many articles in the house of Dr. Ruxton.
• The newspapers and certain garments found with the bodies were
useful in identification. The parts assigned to Mrs. Ruxton showed
signs of asphyxia and fracture of the hyoid bone, suggesting
strangulation. In the body assigned to Mary Rogerson, there was a
fracture on the top of skull. A number of human blood stains were
found in the bathroom and on the stair carpets and pads, in the
house of the accused. Fragments of human tissue were found in the
drain traps and a suit of clothes of the accused was contaminated
with blood. Dr. Ruxton was found guilty of murder and sentenced to
death.
 4. Sample Collection and
Preservation
a. Collection of Samples and Viscera.
b. Preservation of Samples.
c. Samples for Lab Investigations.
a.Collection of Samples and Viscera
Blood: Before autopsy, 10–20 ml of blood can be drawn from the femoral
(best sample), jugular or subclavian vein by a syringe. Due to loss of
cellular barrier after death, samples of blood collected from other places
will lead to erroneous results.
CSF: May be collected by lumbar puncture or by direct aspiration from the
lateral or third ventricle after removal of the brain.
Vitreous Humor: 1–2 ml of crystal clear fluid from each eye is aspirated by
a hypodermic needle (20 gauge) inserted through the outer canthus into
the posterior chamber of the eye.
Water/saline is re-introduced through the needle to restore the tension in
the globe for cosmetic reasons.
Urine: Collected in a suitable sterile or non-sterile ‘universal container’ for either
microbiological or toxicological analysis by suprapubic puncture or when the
bladder is opened.
Before dissection, urine can be collected via catheter
Bone: About 200 g is collected. It is convenient to remove about 10–15 cm of the
shaft of the femur.
Hair: Sample of head and pubic hair should be removed by plucking along with
roots, and not by cutting, and preserved in separate containers (0.5 g for DNA
analysis, up to 10 g for analysis of heavy metals).
Maggots: Dropped alive into boiling absolute alcohol or 10% hot formalin
which kills them in an extended condition (to disclose the internal structure of
the larvae).
If time of death is an issue, some larvae/maggots should be preserved alive for
examination by an entomologist. Maggots may reveal the presence of
drugs/poisons in decomposed bodies.
Nails: All the nails (fingers and/or toes) should be removed in their
entirety and collected in separate envelopes.
Skin: If there is needle puncture, the whole needle track and
surrounding tissue should be excised. Control specimens should be
taken from same area on the opposite side of the body and preserved
in a separate container.
In firearm cases, a portion of skin around the entrance and exit
wounds should be preserved.
PRESERVATION OF VISCERA
IN CASES OF SUSPECTED POISONING viscera should be preserved;
1) If death is suspected to be due to poisoning either by the police or the
doctor.
2) Deceased was intoxicated or used to drugs.
3) Cause of death not found after autopsy.
4) In cases where an unusual smell, colour or an unidentifiable material is
detected in stomach contents.
5) Anaphylactic deaths.
6) Death due to burns (if needed).
7) Advanced decomposition. (When the body is too decomposed to collect any fluids, collect
at least 100 g of muscle from thigh, liver, brain, fat and kidneys).
8) Accidental death involving driver of a vehicle or machine operator.
9) Any case, if requested by the Magistrate.
The following must be preserved in all fatal cases of suspected
poisoning.
1) Stomach and its contents. If the stomach is empty, the wall should
be preserved.
2) The upper part of small intestine (about 30 cm length) and its
contents.
3) Liver 200 to 300 gm.
4) Kidney half of each. as one kidney may be dysfunctional.
5) Blood 30 mls. Minimum 10 mls.
6) Urine 30 mls.
• As most poisons are taken orally, the poison is most likely to be
present in the stomach and intestinal contents and in their wall.
• After absorption all poisons pass through the liver, which is the major
detoxicating organ and has the power of concentrating many poisons
making them identifiable when the blood and urine concentrations
may have declined to very low levels.
• The kidney being the organ of excretion contains large amounts of
poison, which is excreted into the urine.
• Levels of drugs in the muscle more accurately reflect blood levels
than the liver or kidney.
Some practical points to remember:
− Blood is the most useful sample because toxins present in this can be best related to a
physiological effect, and can be used to assess the likelihood of recent exposure to
poisons/drugs.
− Urine is the second most important specimen collected. However, the disadvantages are:
it is unavailable in half the cases (since it is voided after dying) or poison may be already
metabolized by the body.
− Vitreous Humor is the preferred specimen for postmortem confirmation of alcohol
ingestion, since postmortem formation of ethanol does not occur to significant extent in
vitreous, and hence useful even in decomposing bodies. It is recommended that this
specimen is included routinely in sudden death investigations.
− Whole stomach is preserved since it allows the analyst to dissolve any poison adhering to
the sides of the walls.
− Specimen from liver is taken from its right lobe. Liver is quite important due to high
concentration of toxins, and availability of large database of liver drug concentrations.
However, majority of drugs are detected readily in the blood, and it is not necessary to
rely on the liver nowadays. Also, lives decomposes faster as compared to blood.
− Bile has been collected historically, but its usefulness is limited. It may be show
the presence of number of drugs including morphine/heroin, benzodiazepine,
cocaine, methadone, glutathione, many antibiotics and tranquillizers and heavy
metals (in chronic poisoning)
− Brain, kidney and spleen are used to determine and interpret the concentration
of toxins, i.e. overall assessment of the body burden of a toxin.
− Spleen is useful as a specimen for toxins, such as carbon monoxide (CO) and
cyanide that binds to hemoglobin. If septicemia is suspected and the cause of it
is not obvious, spleen should be cultured.
− The viscera should be refrigerated at about 4°C, if not sent to the laboratory.
They can be destroyed either after getting the permission from the Magistrate or
when the IO (investigation officer) informs that the case has been closed.
b.Preservation of samples
The ideal samples are the ones in which no preservative has been added and sent
to Forensic Science Lab within few hours.
The specimen is preserved at 4°C until they are analysed. For long-term storage,
it has to be kept in freezer (–10°C).
In order that putrefaction may not set in and render chemical analysis difficult,
certain preservatives are used.
1.Viscera
− Most commonly used preservative is saturated solution of Common Salt.
− The best preservative for preservation of viscera is rectified spirit. However, it is
not used in cases of suspected poisoning with: ---- Alcohol --- Chloroform ----
Kerosene ---- Ether ---- Phosphorus --- Formaldehyde ----- Paraldehyde
---- Acetic acid.
2- Blood
− Blood for toxicological analysis is preserved in sodium or potassium
fluoride at the concentration of 10 mg/ml of blood and anticoagulant
potassium oxalate, 30 mg/10 ml of blood.
− Heparin and EDTA should not be used as anticoagulants, since they
interfere with detection of methanol.
− If blood is required only for grouping, no preservative is necessary.
− In case of suspected CO poisoning, a layer of 1–2 cm of liquid paraffin is
added immediately over the blood sample to avoid exposure to
atmospheric oxygen.
− If solvent abuse and anesthetic death is suspected, the glass container
should have a foil-lined lid to prevent gas from escaping (as gas can
permeate rubber) and the container is completely filled to prevent gas
from escaping in ‘dead’ air space.
3. Urine
− Urine is persevered by adding small amount of phenyl mercuric
nitrate or thymol.
− Fluoride should be added to urine if alcohol, cyanide or cocaine is
suspected in the sample.
4. Vitreous humor is preserved using sodium fluoride (10 mg/ml).
5. For bones, hair and nails, preservative is not required. It has to be
dried in normal temperature and sealed in plastic bag.
6. Bone marrow is preserved in a test tube containing 4–5 ml of 5%
albumin-normal saline solution and stored at 4°C.
Procedure of Preservation;
− For preservation of viscera, a clean, transparent and preferably sterile
glass jar (one litre capacity) with a wide mouth and stoppers should be
used. The size of the jar should be such, that at least 1/3rd of the
container remains empty after being filled with the preservative to allow
for accommodation of the gas which will evolve out of the organs
preserved. However, the preservative should completely immerse the
viscera after the contents are well shaken.
− The stomach, small intestine and its contents are preserved in one bottle,
part of liver along with gallbladder, spleen and kidneys in another bottle
and urine in the third bottle. The stomach and intestines are opened
before they are preserved. The liver and kidneys are cut into small pieces
to ensure penetration of the preservative. Blood should be sent in a vial(s).
− A sample of the preservative used (sodium chloride or rectified spirit) is
separately preserved and sent for analysis to rule out any poison being
present as a contaminant.
− The stoppers of the bottles should be well fitting, covered with a piece of
cloth and tied by tape or string, and the ends sealed using a departmental
seal. Each bottle should be suitably labelled with the autopsy number,
name of the deceased, name of the organ, date, time and place of autopsy,
followed by signature of the doctor who performed the autopsy.
− The sealed bottles are then put in a viscera box which is sealed. The viscera
box along with a specimen of the seal used (put in a separate envelope and
sealed) is handed over to the police constable, in return for a receipt. All
these precautions are necessary to maintain the chain of evidence.
Along with the viscera box, the following documents are also sent:
I. Copy of the inquest papers, brief facts of the case and the case sheet.
II. Copy of autopsy report.
III. Letter requesting the chemical examiner to examine the viscera and
inform the medical officer of its findings.
c. Samples for Lab Investigations
Histopathological examination: Sections of various internal organs
(1.5 × 1.0 × 1.0 cm) in case of suspected abnormality are preserved in 10%
formalin or 95% alcohol.
Bacteriological/serological examination: Blood should be kept in
sterile container using sterile syringe from the right ventricle of the heart
or from some large vessel, such as femoral vein or artery. It may also be
used for biochemical examination.
Virological examination: A piece of tissue is collected and preserved in
50% sterile glycerine.
Enzymatic studies: Small pieces of tissues are collected into a thermos
containing liquid nitrogen.
Opinion, signature and designation
(autopsy report)
In opinion, following information is given:
A. Cause of death.
B. Causative agent of death.
C. Time b/w injuries and death (fatal period)
D. Postmortem interval.
After report completion, it should be signed by the performing doctor
(signature, designation, name) and hand to over to the police.
Exhumation
Learning objectives;
• Define exhumation.
• Describe authorisation of autopsy surgeon for exhumation.
• Describe protocol of exhumation.
• Describe time limit for exhumation.
• Describe the precautions for exhumations.
• Describe the procedure to collect samples.
• Describe the limitations of exhumations
• Describe the scope of exhumation.
 Exhumation
(‘Ex’ means ‘Out’, ‘Hume’ means ‘’Earth’)
‘’Lawful digging out of an already buried body from the grave for
postmortem examination.’’
Usually, it, involves a body (of any age group) that was not originally
autopsied but which, for some reason, must be exhumed in order for
an autopsy to be performed
Authorization: The body is exhumed only when, there is a written
order from the Magistrate and is done under CrPC Section 176,
Subsection 2.
Reasons/ objectives of exhumation;
1. Criminal cases
− Establishing the cause and manner of death in suspected homicide
disguised as suicide.
− Death as a result of criminal abortion and criminal negligence
− Retrieving some vital object which may throw light on the case, e.g. bullet
from the dead body, if the person was killed by a firearm
2. Civil cases
− Identification of the deceased for accidental death claim, insurance,
inheritance claims, disputed identity, and burial of the wrong body
inadvertently or by fraud.
• In case of unnatural death / relatives have buried the deceased
without autopsy.
• Autopsy with or without chemical examination of viscera.
• in case of deaths, in which foul play is suspected.
• Second autopsy, when the first autopsy report is ambiguous.For
permanent burial.
• Recovering papers/ documents which have been buried.
Precautions
• Written order of magistrate (police cannot request for exhumation).
• Proper identification of graveyard, grave and deceased- autopsy is
performed on the spot/ nearby morgue.
• Early hours of the day/ forenoon. (privacy reasons)
• All authorized persons (Dr.s, magistrate, investigation officer, police, radiographic
technician, portable x-ray, trace evidence expert and photographer must be present)
• Perfect/ complete equipment (container of variable sizes, gloves, mask, cap, boots,
overall).
• List of people on the spot.
• Collect earth surrounding the grave.
• Open coffin with care (gases). Always stand on windward side to avoid
inhalation of gases.
• Exhumation of the body must be thorough and utmost care should be
offered.
• Take as many photographs as possible.
• X-ray before starting- locating bullets, pieces of knife etc.
• Before examination all relevant info from police and relatives to make the
case easy.
• Report of first PM must be available if it’s a second postmortem.
• Before closing make sure max. evidence has been collection (difficult to
exhume again and again.)
• Never voice your opinion in public.
• Complete your report as soon as possible and hand it over to law enforcing
agencies.
Procedure/ protocol
− Exhumation should be done and completed in broad daylight.
− The body is exhumed under the supervision of a medical officer and
Magistrate, in the presence of a police officer.
− Before opening the grave, it should be positively identified through
relatives and from headstone and grave markers.
− Soil from above, below and two sides of the body or the coffin should be
preserved in separate glass jars to rule out postmortem imbibition.
− Disinfectants should not be sprinkled on the body as it might interfere
later with the determination of poison in the body.
− The doctor should note the position and appearance of the body inside
the grave or the coffin. A drawing of the grave and body or skeleton
should be made, noting all the details.
− The grave or the coffin with the body should be photographed.
− If decomposition is not advanced, a plank or a plastic sheet should then
be lowered to the level of the earth on which the body rests.
− After this, the body is lifted and sent for postmortem examination, along
with a requisition and a preliminary investigation report. In the mortuary,
postmortem examination on the body is performed as in all other cases.
Sampling
In highly putrefied bodies, an attempt should be made to establish the
identity. Viscera should be preserved for chemical analysis. If the body
is reduced to skeleton, the bones should be examined.
Following viscera and materials are sent for chemical analysis:
• About 500 gm of soil from above, below and in actual contact with
the body.
• Hairs from head and pubic region.
• Nails, teeth and bones.
• Viscera such as liver, stomach and intestines.
Procedure
• Identification (family/relatives/friends/ neighbors/ police graveyard’s care
taker/ people at the time of burial)
• Digging of the grave after erecting a screen around. Coffin
identification. Open slowly- gases of putrefaction and should be
wearing protective clothing masks/ gloves etc.
• If exhumation for identification purpose- call relatives and magistrate
for identification and close back and rebury.
• If for medicolegal autopsy- transfer to mortuary if nearby other wise
autopsy on spot.
• All precautions/ procedure is same as that of normal autopsy but with
extra skill and care.
• Max. info from relatives/police/ hospital record/ previous autopsy if
any/ preliminaries and external examination.
• If less time has been passed- external features/ skin intact- wound
inspect and describe.
• If more time (putrefactive changes) then focus attention to certain
points i.e.
• 1-Violence (if neck preserved- ligature marks, open mouth-?forigen material, if peace of
weapon on x-ray collect that, if soft tissues gone look for fractures. In females always examine
external genitalia, uterus, conception products, attempted abortion. Collect and preserve.)
2-Pathology: collect body tissues/ fluids (as applicable) for
histopathological and chemical analysis.
3-Poisons: in case of chronic poisoning, poison may be accumulated
in bones, nails, hairs teeth etc. collect these for chemical analysis.
Closure of the body: before closure make sure you have fulfilled the
needs. Stich the body and hand over to relatives for burial.
Also collect earth from above and below and sides of the box, pieces of
wood, shroud or water if the area is water logged.
Scope/ limitations of exhumation
• In cultures/ religions where body is burnt- exhumation cannot be
performed.
• If performed early- results will have more value. Limited results in
delayed cases bcz of body changes.
• Social problems- people are very much reluctant.
Time limit for exhumation
• In Pakistan, India and England, there is no time limit but in countries like
France, Scotland and Germany, etc. 10, 20, 30 years respectively are the
time limits for exhumation.

Postmortem imbibition:
• Process by which poisons or metals percolate into body from surrounding
medium through passive diffusion after death
• For example, if Arsenic is found in dead body, it may be due to poisoning
or postmortem imbibition from surrounding soil. To confirm this,
surrounding soil is collected and checked for presence of Arsenic.
Autopsy of a skeletonized body
Learning objectives;
• Describe the steps of examination of a skeletonized body to assess its
race, age, sex and stature.
• Describe the protocol for autopsy of a skeletonized body
• Describe cause of death in such cases.
• Describe nature of injury and type of weapon used in such cases.
• Describe time since death in such cases.
• At times some skeletal remains may be recovered from an open land, ditches,
rubbish dumps etc., or a skeleton may exhumed from a temporary grave, a
burial ground, or even while new constructions.
• The bones should be listed and the photographs are preferably taken. The
bones should be arranged in an anatomical position of articulation.
• If some earth, sand, dust etc. is sticking to the bones, it is to be cleaned by
brushing.
 General Examination of Bones
• The bones are thoroughly examined as to whether the bones are dry, clean,
brittle and whitish in colour with cartilages attached or whether they are moist
and humid, yellowish or yellowish brown, with soft tissues still attached and
cartilages adhering. The stage of putrefaction of soft tissues should also be
noted.
• Cleaning the Bones: The soft tissues can be separated by boiling in water
containing sodium bicarbonate for about 6-12 hours and then brushing gently.
 Examination Proper
Whenever a skeletal remains or a single bone is brought for examination to the forensic
expert, the following questions need to be answered:
1.Whether they are actually bones:
• Sometimes pieces of stones may be mistaken by the Police officer for bones. For this,
proper examination, looking for the protuberances, surfaces, borders etc. is necessary.
2. Whether the bones are human or animal?
• Human skull is commonly mistaken for that of the Chimpanzee, Gorilla or Monkey. The
bones can be differentiated from that of an animal from the anatomical configurations.
• In an animal skull, glabella is more prominent, nasion is deeper, jaw is protruded and the
cranium is small in size. In Human pelvis, iliac crest and upper border of symphysis pubis
lie in the same plane whereas in animals they lie in different planes due to different
postures while walking. Precipitin test being species specific would be helpful when the
remnants of blood are still attached to the surface of bones.
3.Whether they belong to one or more than individuals:
• The bones are arranged in anatomical position and if all the bones fit properly and
anatomically and there being no disparity between the bones of contralateral side or
duplication and all bones belong to same age and sex it suggests that the bones are
of same individual.
4. The race of the person to whom the bones belong?
• Race of the individual can be known from cephalic index that is
• 70-75 when the skull is dolicocephalic in pure Aryans,
• 76-79 in mesaticephalic skull of Europeans and
• 80-84 in brachycephalic skull of mongoloids.
• The other indices used to determine race are:
• (i) Brachial Index (ii) Crural Index (iii) Humero-femoral Index.
5. The sexing of bones- only after puberty.
• The sex of the person can be determined from the subjective and objective
parameters.
• The subjective parameters include the examination of different bones determining
the gender such as the pelvis, skull, long bones, mandible, sacrum, sternum, clavicle
etc.
• Rough surface, marked muscular marking and well marked prominences and
tubercles they belong to males.
• The average weight of Indian male skeleton is about 4.5kg and in an average Indian
female it is about 2.5kg.
• The pelvis is the best bone used for the purposes of sexing; the accuracy for sexing
from different bones according to Krogman is from pelvis (95-96%), skull (90- 92%),
skull and pelvis (98-99%), long bones (80%).
• The objective indices for determining sex include:
(i) Sciatic notch index (ii) Ischium pubic index (iii) Pelvic index (iv) Kell index
6. The age of the person to whom it belongs?
• The age of the person can be determined from the ossification and union of the
bones state of dentition, closing of sutures, state of calcification of laryngeal
cartilages, sternum and hyoid bone, condition of the symphyseal surfaces of the
pubic bone, changes in the sacrum and mandible, extent of wear and tear in both the
jaws with ageing and changes like bony lipping, osteoporotic and osteoarthritic
changes.
• Epiphyseal union is about two years earlier in females compared to males. The age
changes after 25 years and in old age can be ascertained from the changes in the
mandible, vertebra, pubic symphysis and internal bone structure.
7. The stature of the individual:
• The stature is determined fairly accurately using the long bones such as femur, tibia,
humerus or radius.
• The tibia being the best bone used for the purpose.
8. Identifying features:
• The person identity can be established from the teeth, any congenital peculiarities, any
bony disease or deformities such as caries, osteoarthritis, mal-united fracture, spinal
deformities, supernumerary ribs and cervical ribs etc.
• Skull-available, the superimposition technique can be used.
9. Nature of injury:
• The bones should be examined as to whether there are any sharp cuts, or any fractures
implying use of blunt weapon or from a vehicle or sometimes they are gnawed by animals
when the soft tissues are attached.
• The charred and blackened bones are suggestive of burns. But in case of intense heat of
fires, the bones turn to ashes and are so brittle as to turn to powder when touched.
• Superficial bones when burnt will show evidence of heat fractures, charring, and cracking,
splintering and calcining whereas bones lying embedded amidst thick soft tissues will show
molten or guttered condition.
• A bone when burnt in open fire will become white but when burnt in close fire is black or
ash-grey.
10.Time since death:
• The nature and circumstances of burial of the body modifies the rate of decaying of
the bone.
• If the bones are wet and humid, and have an offensive odour, they are recent.
• Bodies when exposed to open air gets skeletanised within seven to fourteen days.
But when the bones loose their soft tissues, the decaying odour will be lost. Because
of ground water seepage, the buried bones may show increase in decrease of
mineral contents e.g. calcium phosphate, calcium carbonate etc. depending upon
mineral rich content of soil.
• X-ray defraction studies may give an idea about the mineral content of the bone.
• Following putrefaction, the bones loose their organic constituents and thus become
light and brittle, dark or dark brown in colour, such changes depend upon manner of
burial (with or without coffin), the nature of soil of the grave, age of the individual etc.;
usually the time taken for these to occur varies between 3 to 10 years.
• In case of burial in mass graves of in shallow graves without any coffin,
putrefaction will occur very rapidly.
• Long buried bones may have chalky texture.
• Bone marrow and periosteum may persist in the bones for several months
often after burial.
• Superficially buried bones may expand or crack within few years by repeated
freezing or thawing.
• When burial is old, the cancellous bone at the metaphysis and epiphysis may
get eroded by effects of weather.
• In case of fracture, the time may be judged with some accuracy by examining
the callus by cutting it longitudinally.
• As globulin disappears rapidly, precipitin tests on 10 years old samples
become negative.
The Dating of Human Bones:
• Examination of the bones rarely, if ever, permits a precise estimate of the time
interval since deposition in the ground. At the same time it is possible and
important to decide whether they are ‘ancient’ or ‘modern’ bones that the
interval is greater or lesser than 50 years. In recent years, a considerable
amount of research has been carried out in an attempt to increase the
accuracy of dating skeletal remains.
• Some of these depend on sophisticated laboratory techniques, such as
radiocarbon analysis, which are difficult and expensive to perform. Radio-
carbon is essentially a tool for archeologists and its forensic use is limited
because of the insignificant fall in the C-14 content of bones during the first
century after death. This is the stumbling block for many physical and
chemical methods for bone dating, as although old samples (in excess of 100-
200years) can fairly readily be differentiated from recent bones.
• The environmental conditions are more potent than age in causing progressive
degeneration of the bone; even different parts of the same skeleton (and even
opposite ends of the same long bone) may be quite different in their chemical and
physical properties, if local changes in inhumation such as drainage, are marked.
• Bones in wet peaty soil may be decalcified and crumble within two decades, yet
bones in dry gravel or sand may remain almost pristine for millennia.
• Naked eye appearances are very deceptive, but bones with remnants of
periosteum, tags of ligament or soft tissue other than adipocere are likely to be less
than 5 years old, unless kept in a dry protected place. A ‘soapy’ texture of the
surface, from residualm fat, also indicates a date of less than a few decades.
i. Nitrogen content: New bones contain 4.0-4.5 gm% of nitrogen, derived
mostly from the collagenous stroma. After a variable interval following death,
usually longer than 60-100 years, this declines. A value of 2.5gm% usually
indicates an age of at least 350 years.
ii. Amino-acid content: Amino acid content is estimated by autoanalyser
after acid hydrolysis of the residual protein. Up to 20 acids may be found in
bones less than a century old. They then decline in number and concentration.
iii. Blood pigments: Blood remnants may be found up to a century using the
most sensitive, though non-specific tests. As benzidine have carcinogenic
activity, other tests such as phenolphthalein and leucomalachite green can
detect blood only up to 5-10 years, using either bone dust or the periosteal
surface as the test area.
iv. Fluorescence: Fluorescence can be seen across the whole freshly sawn
surface of a long bone under ultra-violet light for more than a century, but
beyond this time, declining fluorescence is seen advancing from both the outer
surface and the marrow cavity. The ‘sandwich’ of fluorescence progressively
narrows during the first 50 years and may vanish with 300-500 years.
v. Immunological activity: Eluted extracts of bone when tested against
animal antihuman serum gives a visible antibody antigen reaction, either in
cross-over electrophoresis or by passing diffusion in gel. Recent studies/
repetition of the tests indicated that it ceases within months of death Early work
5-10years).
11. Cause of death: Presence of depressed comminuted fracture, cut injury
or bullet wounds in the skull, facture-dislocation of the vertebral column, facture
of ribs, hyoid or any other limb bones etc. will be informative, pointing towards
the cause and nature of death.
• Metallic poisons like Arsenic, Lead, Antimony, Mercury etc. can be detected in
the bones long after death. Arsenic can be recovered even from examination
of charred bony fragments. From the type and depth of cut in the bone the
nature of the offending weapon can be made out.
Negative versus obscure autopsy
Learning objectives;
• Define negative autopsy.
• Describe causes of the negative autopsy.
• Describe concealed trauma.
Negative autopsy
 ‘’The type of autopsy in which the cause of death remains unknown, even
after all laboratory examinations including biochemical, microbiological,
virological, microscopic and toxicological examination.’’
 Occurs in 2-5% cases.
 Reasons :
• Inadequate history especially in cases of death due to vagal inhibition,
hypersensitivity, etc.
• Inadequate external examination and internal examination.
• Insufficient laboratory examination.
• Lack of toxicological analysis.
• Lack of training of the doctor.
Obscure autopsy
• ‘’An autopsy done meticulously, properly and perfectly, but may present
with no clear-cut findings as to give a definite cause of death.’’
• Occurs in almost 20% cases.
• Causes :
• Natural diseases: Epilepsy, paroxysmal fibrillation.
• Concealed trauma: Concussion, reflex vagal inhibition.
• Poisoning: Anaesthetic overdose, narcotic, neurotoxic poisoning.
• Biochemical disturbances: Uremia, diabetes.
• Endocrinal disturbances: Adrenal insufficiency, thyrotoxicosis.
• Miscellaneous: Allergy etc.
Obscure autopsy
This type of autopsy creates a lot of confusion to the forensic experts.
The causes of obscure autopsy are:

1. Concealed trauma: in cerebral concussion there is a state of transient

unconsciousness as a result of blunt force injury to head followed by
amnesia and spontaneous recovery.
• Autopsy may not show any change, but in some cases petechial
haemorrhages are found. Even microscopic examination does not reveal
any axonal injury up to 12 hours.
• Injury to the cervical spine causing fracture dislocation and injury to the
spinal cord can cause instantaneous death without any obvious external
injuries.
2. Cardiac lesions
a) In blunt force injury to heart it may stop functioning without any
visible signs.
b) Cardiac arrest can occur during or immediately following heavy
exercise--increase in heart rate and systolic pressure with
progressive ischemia and cardiac arrest.
c) Cardiac arrythmias which, may be precipitated by emotional
excitement can cause physiological asystole and may lead to death.
3. Reflex vagal inhibition:
which can be due to pressure on neck following blows on the larynx,
chest, abdomen and genital organs.
When death is due to reflex vagal inhibition, there is hardly any
findings at autopsy.
It may occur during drowning, when the body is subjected to very
cold temperature.
Any manipulation of external auditory meatus.
Such cases include deaths precipitated by:
Functional inhibition of the vagus nerve or excessive sympathetic
discharge.
Endocrine disturbances e.g. diabetes and adrenal insufficiency.
Iatrogenic disorders like sudden withdrawal of steroids or beta
blockers.
Trauma such as concussion, self induced neck injury, concealed
puncture wounds which escaped detection at autopsy.
Other conditions like idiopathic epilepsy, chronic asthma,
convalescence from recent infection especially in athletes, SIDS and
probably some obscure poison.
In these cases medical officer should frankly admit that the cause of
death cannot be determined.
The investigating officer may still proceed with the case, if he so
desires, depending on circumstantial evidence.
Postmortem Artefacts
Learning objectives;
• Describe autopsy artefacts.
• Describe the importance of forensic artefacts.
• Describe effect of artefacts on the opinion of post-mortem report.
 Postmortem Artefacts
(Latin arte: art, factum: something made)

‘’Postmortem artefact is any change or new feature introduced into the

body after death, and such feature or change posses’ difficulty in
interpreting the autopsy findings.’’
or
‘’Artificial product or feature that is not real but has been added to the
original picture by processing/ handling.’’
Importance
• Necessary to avoid misinterpretation of medically significant
antemortem changes.
• Lacks vital reaction of living tissue and can easily be recognized by
trained eyes.

Causes:
• PM changes, PM handling, insects, rodents etc.
Classification
PM artefacts can be classified into:
1. Artefacts due to PM changes/ during PM interval.
2. Artifacts introduced during systemic death.
3. Artifacts introduced during autopsy.
4. Third party artefacts.
5. Environmental artefacts.
6. Other artefacts.
1.Artefacts due to Postmortem Changes
Rigor Mortis: Existing rigor mortis may be broken down while
removing the body from the scene of crime to the mortuary which
may cause error in interpretation of time since death.
Postmortem Lividity: Isolated patches of postmortem lividity may be
mistaken for bruises. Such patches on the front and sides of the neck
may be mistaken for bruising due to throttling. Lividity of the internal
organs may be mistaken for congestion due to disease.
• Autolysis: Autolysis leads to discoloration of skin and viscera, like
gallbladder, pancreas, liver, kidney, and brain, where it may simulate
injury or disease. Pancreas is one of the first organs to undergo
autolysis because of proteolytic enzymes within it, which can be
mistaken for acute haemorrhagic pancreatitis. Perforation of the
stomach due to autolysis have to be distinguished from that due to
corrosive acid or peptic ulceration.
• Putrefaction: Postmortem bloating due to putrefaction may give false impression
of antemortem obesity.
− Escape of sanguineous fluid from the mouth and nose in case of pulmonary
edema may give impression of hemorrhage.
− False strangulation groove (deep groove simulating ligature mark of
strangulation) may appear on the neck if the deceased was wearing tight collar
shirt or some other beaded threads or ornaments around the neck.
− The bulging of eyes, protrusion of tongue and discharge of red stained froth
from mouth and nose may be mistaken for signs of throttling.
− Putrefactive blisters may be confused with blisters from burns.
− Splitting of skin may give a false impression of antemortem lacerations or
incised wounds.
− Gas bubbles in the blood and air in the right side of the heart may be mistaken
for air embolism.
2.Third Party Artefacts
Artefacts due to Animal and Insect Activity: Rats and rodents gnaw
away the tissue over localized areas mimicking incised or lacerated
wounds.
Bodies recovered from water may show gnawing by fish, crabs and
other aquatic animals, giving false impression of lacerated wounds.
Flies, maggots and larvae may alter the wounds.
• Therapeutic Artefacts: External cardiac massage, especially in
elderly patients is associated with the fracture of ribs (3rd-5th) and
sometime fracture of the sternum which can create an impression of
antemortem violence.
− Regurgitation and aspiration of gastric content into the air passages
may give a false impression of choking.
− Investigative procedures, like carotid angiography may result in
bruising of the neck muscles giving a false impression of constriction
of the neck.
Autopsy induced artefacts
 During the opening of the skull by forceful sawing or by using a
chisel and a hammer, an existing fracture of the skull may become
extensive or fresh fractures may be caused.
 During pulling of the dura, air may enter the blood vessels. This may
lead to an erroneous diagnosis of air embolism.
 The handling of organs and the incision of the vessels may result in
extravasation of blood into the tissues.
 The removal of the neck structures en-block as in routine autopsies
may produce artefacts in the neck tissues which resemble bruises (as
seen in throttling)
 While removing neck structures, the hyoid bone and thyroid
cartilage may be fractured, especially in old persons which may be
mistaken for being antemortem in origin.
 Collection of the viscera in a single bottle or use of contaminated
bottles/ instruments/ preservatives may result in wrong analysis of
poisons.
4. Environmental artefacts
Heat Effects: Heat applied to the skin of a dead body may loosen the
epidermis from the dermis and produce a PM blister.
An unburnt groove around the neck due to a tight collar may
resemble a ligature mark.
Heat ruptures may resemble lacerated or incised wounds.
• Postmortem Corrosion:
Dead bodies exposed or lying in kerosene, water or gasoline show
chemical injuries. The epithelium detaches while handling the body,
and then the underlying dermis turns yellow to brown which may be
misinterpreted as antemortem chemical injury or abrasion or burns.
Other artefacts
Artefacts due to Refrigeration: Pink PM staining is seen in bodies
kept in cold storage. If the bodies are kept in a cold storage
immediately after death, goose skin may develop.
Artefacts due to Mishandling of the Body: During the process of
transfer of the body from the scene of crime to the mortuary,
abrasions may be produced over the back or bony prominences,
clothes may get bloodstained or torn.
− Fractures of the ribs or long bones or cervical spine may occur by
rough handling of the bodies, especially in the elderly or debilitated,
during attempts to straighten limbs which are contracted due to rigor
mortis.
− Contusion may occur over occiput due to bumping of the head on
hard surface. Undertaker’s fracture may be seen which is a
subluxation of the lower cervical spine due to tearing of the
intervertebral disc at about C6-C7.
Effect of artifacts on the opinion of PM report.
Ignorance and misinterpretation of such PM artefacts leads to:
Wrong cause/ manner of death.
Undue suspicion of criminal offence.
A halt in the investigation of criminal death.
Unnecessary wastage of time and effort, as a result of misleading
findings.
Miscarriage of justice.
Infanticide
Learning objectives;
• Describe infanticide and its related law.
• Describe the Age of viability and its medico legal significance.
• Describe the concept of live birth and separate existence.
• Describe the Hydrostatic test and its importance.
• Explain Cause of death, i.e. acts of commission and acts of omission.
• Describe sudden infant death syndrome (SIDS).
Infanticide
‘’Infanticide is defined as the deliberate, unlawful, destruction of
a child under the age of one year, by act of omission or act
of commission.’’
 “Hence ,it is obvious that in a case of
infanticide the matters to be proved are”
• Whether it was viable when born?
• Whether the foetus was born alive, stillborn or dead born?
• Whether it had separated existence for sometimes?
• That the cause of death was neither natural nor accidental but was due to
some deliberate act of commission or omission?
• That the dead infant examined, belonged to the woman charged for
commission of the offence of infanticide?
 Whether the Child is Viable or Not?
• Viable child is a foetus, which has completed of 210 days (7 months) of
intrauterine life (IUL) and capable of leading a separate existence after birth.

• Further questions like live birth, duration of survival and cause of death etc.
arise only if it is above the age of viability.
 Haase's rule/formula:
• Up to 5 months, age of the foetus = Square root of length of foetus (in
months).
• > 5 months = length of the foetus (in cm)/5 = (age in months).
Medicolegal Importance
 If on autopsy, the child or newborn is found to be not viable then the charge
of infanticide stands withdrawn.
 Thus, every doctor examining a case of infanticide must establish whether
the child or fetus examined is viable or not.
 LIVE BORN, STILLBORN AND DEAD BORN
CHILD
Live Born Child
• A child is considered live born, if any of its part is out of mother's reproductive
passage, though it has not breathed or completely born.
Stillborn Child
• A stillborn is one who is born after 28 weeks (IU age) of pregnancy, and it did
not show any signs of life, at any time after being completely born. In this the
foetus was alive in uterus but dies in the birth canal ( Vagitus vaginalis or
Vagitus uterinus) after the birth process has initiated.
• MLI (medicolegal importance)- charge of infanticide will not stand in still
birth cases.
Dead Born Child
• A dead born child is one which had died in uterus before the birth process has
started and shows rigor mortis, maceration or mummification at birth.
• Overlapping of skull bones (Spalding sign).
• Soft tissue oedema >5mm.
• Gas shadow in foetal heart& vessels(Robert's sign)
Concept of live birth and separate existence
• According to Knight, “separate existence” refers to signs of life in an infant
completely expelled from the maternal passages (independent of the
placenta), whilst “live birth” refers to signs of life in an infant regardless of
whether they have been completely expelled from the maternal passages.
 Establishing Whether Live Born?
In civil cases: Following are considered signs of live birth:
• Baby's cry (vagitus vaginalis/vaginus, vagitus uteralis/uterinus, i.e. baby's cry inside
the vagina or uterus respectively during delivery).
• Muscle twitching/movements of limbs, etc.
• Sneezing and yawning.
• Heart beat.

In criminal cases: Signs of live birth have to be demonstrated by autopsy

examination of the newborn as usually law presumes that “Found dead is born dead”.
Sign of live birth
(As Recognised By Criminal Law)

External Signs :
1.Shape of chest and its measurements:
increase AP diameter and circumference.
2.Changes in skin
• Colour -bright red at birth.
Brick red- 2nd to 3rd day.
Yellowish -3rd to 6th day.
Normal-7th to 10th day.
• Desquamation of skin -begins over abdomen by 2nd day and is completed by 3rd to
4th day.
• Vernix caseosa.
3. Caput succedaneum.
4. Cephalhaematoma.
5.Change in the Umbilical cord;
Cut margin dries up by about 2 hrs.
The cord dries up about 24 hrs.
Red ring appears around umbilicus on the 2nd day.
Cord falls off by 4th -5th day and complete healing of the surface occurs.
 Sign of live birth and separate existence in
dead infants
Internal Examination
1.Position of highest point of diaphragm goes down from 3rd- 4th ribs to 6th / 7th
ribs.
2. Examination of lungs;
• Ploucquet’s test.
• Hydrostatic test.
• Histological examination of the lungs.
Confirmatory Tests for Respiration in Lungs
• Plaquet's test
• Hydrostatic test (floatation test)
• Histological examination of lung.

Plaquet's Test
• In this test, weight of the lung and body weight are compared. Normally the
ratio of lung: body weight is 1:35. In unrespired lung this ratio cannot be
maintained.
Hydrostatic Test (Floatation Test)
• Salmon-pink spongy lungs that floats in water, is diagnostic of an infant who
has breathed provided there is absence history of resuscitation and no
putrefaction commenced.
Principle:
• Air that has entered into lung tissue during respiration makes it lighter and
floats in water. It is also a fact that specific gravity of the lung before
respiration is 1040-1050, which becomes 0.940 to 0.950 which is less than
that of water, after respiration, and makes the respired lung float.
Procedure
• Dissect out the fetal lungs.
• Put both the lungs into a trough of water and observe.

Inference
• If they sink—unrespired lung.
• If they float—remove them form water, cut into small pieces and then squeeze or press
firmly between sponges, again put into the water column.
• If they sink—unrespired lung.
• If they float—respired lung.

• The floatation observed in the test above for the second time is mainly because of the
"residual air" that remains in the lungs, which cannot be squeezed out by pressing, if the
child has breathed after birth.
Fallacies
A false-positive test of floatation of lung pieces may be observed in
conditions such as:
• Accumulation of putrefying gases
• Air pushed into lung by artificial respirators, etc.

A false-negative test of sinking of lung pieces can be observed in

conditions such as:
• Atelectasis
• Pneumonic consolidation, etc.
Histology of Lung
• Unrespired lung looks like section of parotid
gland mainly because the alveoli with lining
epithelium which is cubodial, while on entry of air
into it, the cells get flattened with dilatation-
pavement epithelium.
3.Findings in the stomach and intestine:
• Breaslau’s second life test.
• Demonstration of air in x ray.
• Presence of milk / honey in stomach.

4.Meconium - large intestine is completely free of meconium within 24 hours

after birth.

5.Change in the heart:

closure of foramen ovale occurs within 3 months after birth.
6.Change in blood vessels-
• Umbilical arteries – start contracting within 10 hrs after birth and obliteration
completed by 3rd day.
• Umbilical vein -start contracting by 2nd to 3rd day after birth and completely
obliterate by 4th to 6th day.
• Ductus arteriosus starts to obliterate by 2nd to 3rd day after birth and
completed by 7 to 10 days.
• Ductus venosus- starts to obliterate by 3rd to 4th day after birth and
completed by 10 days.
7.Incremental line in the enamel of the teeth-one of the surest sign of
live birth.
8. Air in the middle ear.
9. Presence of some ossification centres e.g. at the lower end of radius,
heads of humerus and femur and capitulum of humerus.
10.Changes in the blood-
• Nucleated RBC is absent in peripheral circulation with in 24 hrs.
• Foetal haemoglobin 55 % to 60 % at birth.
11. Closure of fontanelle.
Cause of Infant death
A-Natural

B-Accidental

C-Criminal
 Natural causes;
• Prematurity.
• Asphyxia.
• Birth trauma.
• Congenital malformation.
• Haemolytic disease.
• Neonatal infection.
• Early separation of placenta.
• Pre - eclamptic toxaemia in mother.
• Infective condition during infancy.
• Sudden infant death syndrome.
Accidental causes during birth
• Injury to mother on her abdomen.
• Prolapse of cord.
• Prolonged labour.
• Twisting of cord around neck.
• Premature separation of placenta.
• Mother’s death.
Accidental causes after birth;
• Non rupture of membrane.
• Cord around neck
• Head injury
• Non-availability of nursing care-neonate may die due to smothering, choking,
suffocation, drowning.
• Precipitated labour-may cause death of the newborn due to head injury,
suffocation or drowning or bleeding from umbilical stump.
Criminal causes
May be divided into two groups :

1.Acts of Omission

2.Acts of Commission
1.Acts of Omission or deliberate neglect
Intentional failure to extend those cares to the newborn, that may lead to its
death and may amount to infanticide.
Examples:
A)failure to tie the cord.
B)failure to protect the child from being suffocated by linens.
C)failure to protect it from exposure of cold or other adverse site.
2.Acts of commission to cause infant death.
• Suffocation by Smothering , gagging, pressure over chest wall.
• Strangulation.
• Drowning.
• Poisoning.
• Head injury.
• Concealed punctured wound-may be caused by nail or needle through fontanelle,
inner canthus of eye.
• Cut throat injury.
• Burying of newborn alive.
• Burning.
• Twisting of neck –fracture dislocation of cervical vertebrae.
Sudden infant death syndrome—SIDS
(Synonyms: Cot Death, Crib Death)

‘’Sudden infant death syndrome (SIDS) is a condition in which apparently

healthy infants are found dead without any signs or symptoms that would have
enabled such an event to be predicted, and on PM examination, there is
insufficient pathology to explain their death satisfactorily.’’
Incidence;
• 2 and 3 per 1000 live births.
• Death usually occurs between the ages of 2weeks and 06months
• Boys>girls.
• Common among low birth weight (LBW) babies and among lower income
families, among children whose mothers smoke or are drug addicted and is
commonly associated with seasonal upper respiratory diseases. About half of
the victims have some symptoms of a cold during the week prior to death.
Causes
Aetiology on this is obscure. However, following are suspected to be the true causes:
1. Viral infection.
2. Milk allergy.
3. Autobeverage syndrome— The enzymatic content in the stomach converts the
milk into alcohol, resulting in alcohol poisoning.
4. Respiratory infection.
5. Overlaying— If the mother has a habit of feeding her baby lying on the cot, there
is every possibility that mother may overlie the baby, (breast of the mother may press the
face of the infant), resulting in smothering and death. An important and widely
accepted view is 'sleep apnea' leading to death.
6. Shaken infant syndrome— Violent shaking as a part of playing with the kid may
produce intracranial haemorrhage due to hyperextension or hyperflexion.
Autopsy findings
• At autopsy, the trachea contains a small amount of edematous fluid,
sometimes blood stained petechial hemorrhages are found on the visceral
surface of pleura, pericardium and thymus, and often there is microscopic
evidence of respiratory inflammation.
• There is usually evidence of a brief burst of spasmodic motor activity, bladder
and bowels are empty and sometimes blanket fibres are found under the
fingernails.
Medicolegal importance of SIDS
• Cot death being natural or very occasionally accidental, the parent may be
wrongfully linked for having criminal involvement or negligence.

• Some criminal infant death cases may be presented as natural cot death
cases.
Autopsy of an infected body
Learning objectives;
• Autopsy of an infected body.
• Describe the protocols for autopsy of the infected dead body.
• Describe the precautions required for autopsy of an infected person.
• Enlist the diseases transferred from during autopsy infected dead
body Autopsy of fragmentary remains.
Diseases transferred
(from during autopsy of infected body)
• Highly infectious diseases transmitted by direct contact or contact with
infected materials, clothing, discharges, vomit, etc. are cholera, rabies,
tetanus, anthrax, poliomyelitis, mumps, septicaemia, typhoid, tuberculosis,
hepatitis B & C, diphtheria, C.S.F. meningitis, smallpox, plague, tick-borne
encephalitis, encephalomyelitis, T-cell Iymphotropic viruses I and II, and HIV.
• Patients with presenile dementia may have Creutzfeldt-Jakob disease (CJD)
caused by virus, which is present in highest concentration in nervous and
lymphoid tissues. It appears that the CJD agent can be acquired only by
ingestion, inoculation or transplantation.
• Hepatitis B and C viruses are present in blood stream and concentrated in
hepatic tissue.
Mode of transfer
• There is a risk of transmission of HIV through needle prick injury during collection of
blood and other body fluids, and mucosal splashes and skin contact with superficial
injury during autopsy on a HIV infected dead body.
• HIV in high concentrations has been found to remain viable for three weeks and
from liquid blood after two months.
• HIV and hepatitis viruses are not associated with air-borne transmission.
• HIV is present mostly in lymphoid tissue and brain, and also in colon and lungs.
• It is better to leave some organs in situ in the cadaver rather than eviscerating en
masse. Another method is to fix lungs and other organs whole after removal rather
than slicing them before fixation.
Precautions & protocol of autopsy in infected body
 All infected bodies should be wrapped and tied in double layer tough plastic bag,
with a red colour tag mentioning "Biologically Hazardous". The label should
mention the name, age, sex, registration number, etc.
 Workers who have exudative lesions or weeping dermatitis or external injury
should not handle AIDS victims.
 Proper protective clothing, full sleeves overalls instead of simple surgical gowns,
water-proof plastic apron, head cap, face mask, goggles if eye glasses are not
worn, double gloves (heavy autopsy gloves over surgical gloves), waterproof
rubber gumboots of knee length with shoe covers. A plastic visor will protect eyes
and mucosal surfaces from splash injury. A high efficiency particulate air filled
respirator or a powered air-purifying respirator should be worn.
• Handling sharp instruments: A void accidental pricks and cuts from needles,
scalpels, etc. If a cut is made in the rubber gloves or needle injury occurs they
should be removed immediately and replaced with new ones. Hands and
other skin surfaces should be washed immediately and thoroughly if
contaminated with blood or other body fluids. Infection of AIDS can be
acquired by transdermal inoculation through cuts and needle punctures. About
0.3 to 0.5% of individuals will become seropositive. Transmission rates from
contaminated needle punctures or close contact are 10 to 30 times higher for
serum hepatitis than for AIDS. The incident should be reported to proper
authority to get their blood check for HIV seropositivity.
• Handling specimens for laboratory examination: Mucocutaneous contact with the
body fluids, and aerosol inhalation should be avoided. They should be properly
labelled and filled with 10% formalin solution and should be handled with gloved
hands.
Disposal of used instruments:
• They should be dipped in 20% glutaraldehyde (cidox) for half-an-hour, washed with
soap or detergent and water, dried and then rinsed in methylated spirit and air dried.
• All soiled gauze and cotton, etc. should be collected in a double plastic bag for
incineration.
• Laundrv material, such as aprons, towels, etc. should be soaked in one percent
bleach for half-an-hour, washed with detergent and hot water, and autoclaved.
• Cleanup procedure: Wear new intact disposable gloves. Small spatters and spills of
blood and other body fluids can be wiped up with disposable tissues or towels which
are discarded in special bio-hazard bags and properly disposed. The autopsy table
and floor should be cleaned with one percent bleach solution, followed by washing
with soap and water.
• Disinfectants: 1:10 dilution of common household bleach or a freshly prepared
sodium hypochlorite solution are recommended. Liquid chemical germicides
commonly used in health care facilities and laboratories are effective against HIV.
• In case of accidental injuries or cuts with sharp instruments, contaminated with
blood or body fluids or not, while working on a body, the wound should be
immediately washed thoroughly under running water, bleeding encouraged and
disinfected.
• To minimise aerosol splatter, skull can be opened with an electrical oscillting
saw attached to a vacuum dust exhaust and filter or with a band saw under a
transparent anti-slash cover. After autopsy all body orifices should be packed
and the body should be wrapped in double layer heavy plastic sheet bag and
secured properly, so that there is no leakage. A tag should be attached for
identification.
• After completing autopsy, hands and face should be washed with soap and
water and rinsed in 70% methylated spirit.
• The body should be burnt or incinerated.
• Universal precautions apply to blood. semen and vaginal secretions as well as
to CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardia! fluid and
amniotic fluid.
• Universal precautions do not apply to faeces, nasal secretions. sputum,
sweat, tears, urine and vomitus unless they contain visible blood. If the
recommended guidelines are adhered to, there is no risk to the staff
conducting autopsies on infected bodies.
Examination of Mutilated Bodies and
Fragmentary Remains
Learning objectives;
• Describe autopsy of a fragmentary remains and mutilated body.
• Discuss the protocols adopted for autopsy of fragmentary remains.
• Describe the samples needed for autopsy of fragmentary remains.
Examination of decomposed bodies
Protocol
• Autopsy should be done on same line as in other autopsies.
• Record the injuries/ligature marks/fracture carefully.
• Identify artefact produced by decomposition.
• Note presence of any foreign body, mud, sand particles etc. in
mouth/respiratory tract.
Samples Needed:
• The necessary viscera and material evidence should be preserved for
chemical analysis.
• Pay attention to entomological aspects, if feasible.
• If body is not identified, preserve appropriate samples viz. samples
for DNA profiling, skull for superimposition, fingerprint etc.
Examination of Mutilated Bodies and
Fragmentary Remains
• Sometimes the mutilated bodies and fragmentary remains of the
body such as one limb, part of trunk or only the head, a mass of soft
tissue etc. is brought for examination by the investigating police
officer.
• In such cases, not only the body parts mutilated but there are
chances of disfiguring the face and dismembering the limbs to
destroy the identity in order to hide the crime.
• The body may also get mutilated by the dogs, rats, jackals, vermins
specially when left exposed in open places and also by the fishes
when the body is recovered from the water, to such an extent that
the body remains unrecognizable even by the near relatives.
Protocols adopted for autopsy
• In such cases, the medical examiner should first ascertain if the parts sent are human or
not. A definite opinion can be given by resorting to the precipitin test, which is equally
applicable to blood as well as muscle or any other soft tissue, provided the tissue is not
severely decomposed. If specialised laboratory facilities are available, the anti-globulin
inhibition test is also definitive.
Having determined that they are human, he should try to elucidate the following points:
1. All separate parts should be kept together, and determined whether they belong to
one and the same body. Bones from different skeletons can be distinguished by
exposing them to a short wave ultraviolet lamp, which shows different colour
emissions from different skeletons.
2. The nature and character of the parts should be described, as also the color of the
skin, if any.
3. The manner of separation, as to whether they had been hacked, sawn through, cut
cleanly, lacerated, or gnawed through by animals.
4. If the head or trunk are available, the gender can be determined from the
presence and distribution or absence of hair, general conformation and
shape of pelvis, sacrum or femur. It may also be determined from the
recognition of prostatic, ovarian, mammary or uterine tissue under a
microscope, if available, and unrecognizable with naked eye.
5. The probable age may be ascertained from the skull, teeth, colour of the
hair, trunk, size and degree of development of fragments and ossification
of the bones.
6. Identification can be determined from tattoo marks, fingerprints, scars,
color of hair, condition of teeth, deformities, recent and old fractures, or
from the discovery or certain articles of clothing known to have belonged
to a missing person in association with the mutilated bodies or fragments
of a skeleton. Height can be calculated from the measurements of long
bones.
7. The probable time since death may be ascertained from the condition of
the parts.
8. The cause of death can be ascertained, if there is evidence of a fatal
injury to some large blood vessel or some vital organ.
9. Identity can be established by superimposing a life size photograph
of the head of a person of the skull, and thus reconstructing the
features. This superimposition techniques has a limited value and
full of difficult problems, but corroborative and even conclusive
evidence may be obtained.
• The assailants are also likely to destroy finger tips for fingerprints, tattoo
marks, scars, moles and also remove jewellery, clothing and other personal
belongings to further make it difficult to the identify the person.
• The body may be burnt or incinerated. Also because of advanced
decomposition, the soft tissue and viscera putrefy leaving behind the bare
skeleton.
• The body parts may be deliberately dismembered after death and thrown
off in rivers, canals, sewage holes. The body may be put in a vat of
corrosive acids or alkalis to get it chemically destroyed as was in Acid bath
murder case. The body parts may get mutilated into fragmentary remains
beyond recognition in bomb explosions.
The questions listed below should be answered in detail while examining the
fragmentary and mutilated body parts.
1. Whether the remains of human or animal origin?
• The mass of soft tissue without any preservative should be sent to the
forensic science laboratory for the precipitin or antiglobulin inhibition test
that is a species specific test.

2. Whether the parts belong to one or different individuals?

• When the mutilated parts fit to each other snugly and anatomically with
no disparity or duplication, bearing more or less the same skin colour etc.
it can be said that all the parts are of the same individual. Bone from
different skeletons can be differentiated, when they show different colour
emissions on exposing them to short wave ultraviolet lamp.
3.Do the fragments belong to male or female?
• In case of skeletal remains, the characteristic sex features in skull, pelvis,
sacrum, femur etc. will be helpful.
• General configuration, remnants of cosmetics, jewelleries, clothing etc. will
speak of characteristic feminine features.
• It is known that prostrate and non-gravid uterus resist putrefaction for a
long period.
4. The age of the person:
• general development, teeth, ossification of bones, union of sutures,
calcification of laryngeal cartilages, union of pieces of sternum and sacrum,
changes in the symphyseal surface of pubic bone, osteoarthritic changes in
the joints, colour of scalp, moustache and beard hair.
5. Stature:
• The stature can be determined from the long bones, if any.
6. Race:
• scalp hair, skin complexion, cephalic index and other anthropological
features in the skull, vertebral column or other body parts.
7. Establishing identity:
• The identity can be established from the finger print, tattoo marks,
scars, moles, deformities, congenital abnormalities if any, dental
study, recent or old fractures, personal belongings of the deceased if
available.
8. Any marks of habit or occupation:
• Occupational marks can help in determining the profession of the
deceased.
9. Manner of separation of parts:
• This can be determined by close examination of the margins of the
dismembered parts to see, whether these had been cleanly cut, sawn,
disarticulated by several strikes at different levels done haphazardly
or gnawed through by animals.
10.Time since death:
• The probable time since death can be ascertained from the conditions
of the soft parts in relation to the stage of putrefaction.
11. Cause of death:
• It is easily determined in case of antemortem fatal injuries affecting
large blood vessels, vital organs or body parts are there.
• Other causes are extensive antemortem burns, head injury with
fracture of skull, fracture dislocation of cervical vertebra, fracture of
hyoid bone or several bones. Sometimes bullet or its fragments and
part of the weapon used are recovered from the body that points
towards the nature of death.
• As the soft tissues decompose quickly, the injuries involving these
tissues may be easily missed as in the case of neck tissues when
death has been caused by compression of neck.
EXAMINATION OF DECOMPOSED BODIES
The autopsy examination of a decomposed body should be complete and be
conducted like a routine autopsy.
• On a decomposed cadaver, a pair of steel hooks with bent, adequately long
handles are very convenient for hooking up the abdominal and other
incisions so as to keep the parts open and also for opening the pericardium
and hooking up the heart, lungs and other organs.
• In a highly decomposed body, even after 5-6 days of death with skin peeled
of epidermis, in violent asphyxial cases of strangulation and hanging, the
ligature mark would be apparent.
• Body in advanced putrefaction, the presence of mud in the bronchus is
diagnostic of death due to drowning.
• Valuable clue to the cause of death may be derived by presence of
foreign bodies, such as a bullet, a piece of a weapon or some other
objects in a decomposed body.
• In fracture skull bones, presence of clotted blood may be found on
their inner plates, or on the surface of the dura mater and on the
brain, would not be enough to give an opinion that the fracture was
caused before death.
• In all doubtful cases, it is better to give a guarded opinion that the
injuries found on the body, if inflicted during the life, were sufficient
enough to cause death.
• In cases where the cause of death cannot be found owing to
advanced decomposition, necessary viscera should always be
preserved for chemical analysis.
Embalming
Learning objectives;
• Define Embalming.
• Enlist the chemical used for Embalming.
• Describe the procedure for Embalming.
• Describe the used of Embalming.
 Embalming
‘’The treatment of the dead body with antiseptics and preservatives to
prevent putrefaction is called embalming.’’

Principle
• By this process proteins are coagulated, tissues are fixed, organs are
bleached and hardened and blood is converted into a brownish mass.
• Embalming produces a chemical stiffening similar to rigor mortis, and
normal rigor does not develop. Embalming rigidity is permanent.
Decomposition is inhibited for many months, if the injection is made
shortly after death, and if done several hours after death, the body will
show mixture of bacterial decomposition and mummification, and will
disintegrate in a few months.
• It should be done as early as possible after death and for satisfactory
results, preferably within 6 hours.
Chemicals used for embalming
The main constituents of embalming fluid are:
• A body weighing 70 kg will require a fluid equivalent of ten litres.
• About 10% of it will be lost through venous drainage, purging, etc. To be very
satisfactory, embalming should be done within six hours of death.
Procedure
• The fluid has to be forced into the arteries for diffusion to occur into the cells and
tissues through the capillaries.
• It can be done by hand/foot pump, stirrup pump, bulb syringe, gravity injector and
motorized injectors.
• The injection can be continuous or interrupted with a continuous or interrupted
drainage.
• Embalming is arterial when the fluid is injected in the arteries and then cavity
embalming is done in which the fluid is injected in the body cavities.
• The vessel to be chosen for the arterial embalming should be preferably nearer to
the heart for better results.
• A common method is the ‘six point’ injection system in which the carotids, axillary
and the femoral arteries of both the sides are used for pumping the fluid for the
different body regions.
Uses of embalming
• Embalming is required when a body has to be transported to distant places
either by road, rail or air.
• It assures that the body is not hazardous to public health.
• If ascites is present, the fluid should be removed.
• No objection certification should be taken from police for transportation of a
dead body.