MEDICO LEGAL

AUTOPSY
The Search For Hidden Truths

Necropsy a small walkthrough

 Introduction

•Post-mortem (meaning after death)examination refers to an

examination and dissection of a dead body to determine cause of death
or the changes produced by disease.

•Post-mortem is also called as autopsy and necropsy.

•But the term “autopsy”(Greek autos –self, opis –view) means “to see
for oneself”, it’s a misnomer which is commonly used,and the term
“Necropsy”(Greek ,necro –dead, opis-view).
What is postmortem
examination
 History of Autopsy

• More than 1800 years ago, GALEN (129-201 AD),did for first time
dissection on animals and primates.

• Fredrick II (1194-1250) authorised human dissection,

• Rudolph Virchow (1821-1902) founder of modern pathology,

 History of Autopsy in India

• Dr. Edward Bulkely performed ,he first documented medico- legal autopsy
in 1693 in Chennai.

• Dr.Edward Bulkely first coroner appointed by British,

• 1882 first medical autopsy was conducted at Grant medical college, Byculla
Mumbai.
 Types of Autopsy
• Academic Autopsy,

• Pathological, hospital or clinical Autopsy,

• Medico-legal Autopsies: –
• Usually done in unnatural death, sudden death and in case of suspicious
death.

• Are carried out by RMP in government hopitals, Forensic experts(Police

Surgeon) with a request by the IO(Investigating Officer).
 Objectives of Autopsy
• To establish identityy of the deceased body.

• To find out the Cause of Death i.e. Natural or Unnatural.

• Whether death is Homicidal, Suicidal or Accidental.

• To know Time since death.

• To know the weapon used

• To collect trace evidence, physical evidence &viscera for chemical analysis

and HPE.
• To know Whether the infant is still-born or live-born.
•
• THE ONLY THING WORSE THAN NO AUTOPSY,
• IS A PARTIAL AUTOPSY

• SO,IN EVERY CASE,THE AUTOPSY MUST BE

• COMPLETE
 Prerequisite for Necropsy
• Written order from the Investing Police Officer.

• Day light
• Place: In the Hospital

• Where the dead body lies

• Identity of the deceased to be established

No unauthorised person should present while doing autopsy.

 Contents of Post-Mortem Report
• Name of the deceased,

• Identification,

• Place, date and time of post-mortem,

• External Examination,
Internal Examination
• Viscera and Samples collected for analysis

• Opinion as to cause and manner of death

Instruments & Accessories for Autopsy
 Stryker Saw:
good for cutting into skull
 Equipment Body Block
Cadaver Table

Placed under the back of the body

causing arms and neck to fall back
• Waist high and is plumbed for running water and
while pushing the chest upward to
has several faucets for washing away blood that is make it easier to cut open.
released during the procedure. Raised edges keep
blood and fluids from running into the floor.
 General Examination
• Body is weighed, measured and X-rayed
• Photographs are taken of the body (front, back & naked)
• Fingerprints are taken (if any missing, parts are noted)
• Scrape underneath fingernails for evidence
• Examination of clothes
• Age, sex and race are noted
• Eye color, scars, venesection wound,
tracheostomy wound ,moles, tattoos are noted
• Examination of the eyes (blood spots & etc.)
• Any body secretions and gun powder residue/
bullet holes
• Body fluids are drawn from the body for testing
(blood, urine, spinal fluid, vitreous humour from
the eye
• Body is cleaned and ready to be put on table
• External Examination of Natural Orifices
For foreign bodies, injuries, discharges (blood/pus, froth)
• External Examination
Presence of Teeth/Dentures
• Various dental work
• External Examination of Marks
Cord,
ligature mark
Finger marks round the neck
Its exact position,
Manner
Application of the knot
 External Examination to Ascertain
Time Passed Since Death
• Rectal Temperature- . ALGOR MORTIS .

• Hypostasis- . LIVOR MORTIS.

• RIGOR MORTIS.

• Stage of Putrefaction.

• Ova of flies and maggots

 External Examination of Injuries
• From head to foot& from front to back
• Injury: Situation (Position)
• Extent
• Nature (Contusion, Abrasion,
Lacerated, Incised, Stabbed or Punctured)
• Dimension
• Condition of Edges
• Course and direction of bullet
• Direction of blood smear
External Examination Types of Injuries
• Contusion
• Abrasion
• Laceration
• Incised Wound
• Punctured/Stabbed wound
• Burns:-
First Degree
Second Degree
Third Degree
 Internal examination
Types of incision for internal examination:
• 1. “I” shaped incision: this incision is mostly used nowadays, it extends
from symphysis menti at the beginning to symphsis pubis at end.
•
• 2.”y” shaped incision: incision extends from acromion process on both
sides, runs below the breast and reaches pubic symphysis.

• 3.”modified y” incision :usually done in case of hanging or

strangulation, where neck dissection is important .
Modified ‘Y’
Incision
 Internal examination
• Internal Examination of Body:
•
Order of Exam:
•
Abdomen  Thorax  Head

• But this order of examination is also can be changed, its based on medical officer
decision .
 Internal examination
• Different types of organ removal:

• 1.Virchows method -removal of single organ one by one

2.Rokitansky method -in situ dissection

3.Letulles method -en masse removal

4.Ghons method -en block removal

 Internal Examination of Thorax
• Split the ribcage, open it up, and examine the lungs and heart,
note any abnormalities, and take a second blood sample directly
from the heart.
– Ribs Fracture
– Sternum fracture
• Pleural Cavities- for blood, fluid
Lungs- Collapsed, Full, Water
 Internal Examination of Thorax
• Pericardium
• Heart
• Chambers of Heart
• Coronary Arteries
• Aorta,
• Larynx,
• Trachea,
• Oesophagus
 Examination of Heart

• Evaluation of coronaries:

• -Before any forms of cardiac dissection is applied, coronaries should be

inspected for calcification and tortuosity.

• -Subjects younger than 30yrs or where cause of death is

non cardiac: coronaries may be opened longitudinally

• -Otherwise, transverse section : 3.5-5mm .

• -Calcified vessels are stripped off and decalcified

• Air embolism in heart chambers should be also checked .
 Cardiac Dissection
• Inflow-outflow method:
• Right: -Using entrotome, initial cut is made from IVC to right atrial appendage
sparing SVC and SA node.
• -Right ventricle opened with knife along 1cm parallel to the posterior
ventricular septum
• -Outflow tract :1cm parallel to anterior
ventricular septum
• Left: -Left atrium-between R and L pulmonary veins
• -Left atrial appendage checked for mural
thrombus.
• -Inflow tract: left ventricle opened along its inferolateral
border.
• -Outflow tract :to avoid damage to mitral valve, 1cm parallel to
anterior ventricular septal groove
 LUNGS
• Anterior surface is faced upwards  PA is identified
and cut as far as possible using small scissors 
check for atherosclerosis, thrombi or emboli.
• Steps are re-traced via PV  check for thrombi.
• At hilum, a long bladed knife is placed with the
blunt end facing upwards  pierced into the hilum
and the knife is turned upwards so that the sharp
end now faces upwards  Sawing motion  hilum
is cut.
• Lungs are mounted on a board or held in the
left hand incision is made from the apex to
the base.
• Hence, producing an antero-posterior slice.
• Cut sections are then examined for
consolidations, edema, atelectasis, congestion,
emphysema, Tardieu spots, emboli etc.
 Internal Examination of Abdomen
• Peritoneum
• Abdominal Cavity
• Abdominal Organs
• Pelvic Cavity
• Stomach
• Small and Large Intestine
• Liver,
• Gall bladder
 Internal Examination of Abdomen
• Pancreas
• Spinal cord ,
Spleen
• Vertebral column ,
Kidneys
• For Necrosis • Pelvis
• Size, Colour Weight,
• Rupture, Calculi
• Bladder
Prostate
Testes
 STOMACH
After applying double ligatures, the stomach is
opened along the greater curvature  from the
cardiac to the pyloric end  size of the pyloric ring is
noted.
Contents are examined for any nature of food which
might be present & its state of digestion, smell,
colour, character, the presence of foreign bodies or
any other suspicious matter etc.
Mucous membrane is examined for congestion,
haemorrhage, ulcerations or any other abnormality.
 LIVER
• Either liver is removed by itself or attached to
the stomach and the duodenum.
• It is examined for its weight, size, consistency
and for the presence of any other pathology /
injury.
• It is cut along the long axis into 2 cm thick
slices.
 KIDNEYS
• Size and weight are noted.
• Capsules are excised and examined carefully.
• Kidney is sectioned longitudinally the convex
border of the hilum so that it splits into half
and opens the pelvis.
• Checked for calculi, inflammation etc.
• Ureter is cut into and examined.
 INTERNAL EXAMINATION BRAIN
CAVITIES
• After the main organs are examined the examiner proceeds to the brain; (The body block is then
moved to underneath the head)
• Next, examine the head. Check for any trauma to the skull like fractures or bruises
• Deep incision begins behind one ear, travels over the top of the head and behind the opposite
ear.
• The scalp is pulled away from the skull in two flaps; front going over the face and the rear going
over the back of the neck so the skull is fully exposed.
• Electric saw known as the “ Stryker saw” is used to cut and remove a wedge shape portion of
the skull which exposes the brain.
• Brain is removed, weighed
• and examined.
• Any findings noted
Internal Examination Brain Cavities
• Once everything has been examined, all the internal organs are returned to the body cavities or
incinerated.
• The body is sewn back together
A report will be done based on notes and findings while performing the autopsy
• Send tissue samples, blood, urine & etc. to lab for testing
• Refrigerate body to preserve it until its ready to be moved elsewhere
 Post-Mortem Reports Value
• Provides information about cause of death,
• Statement of the Medical Officer made in Court is substantive
evidence
• Medical Officer can use it for refreshing his memory while
giving evidence
• For Corroboration & Contradiction of Medical Officer
Reserving Opinion as to the cause of death
pending result of chemical analysis.
• Negative Autopsy
• Obscure autopsy.
Thank you….