Introduction to autopsy

Dr Sanjaya HulathduwaMBBS, MD, DLM, DMJ Path(Lond)

DMJ Clin(Lond) , Dip. Crim MFFLM(UK)

Senior Lecturer

Medico legal module 21st batchJune 2014

• An autopsy is also known as postmortem examination.

• This is the final scientific investigation into a person’s death.

• There are two major forms/types of an autopsy, viz: a. Judicial/Forensic/Medicolegal

autopsyb. Pathological autopsy

Objectives of an autopsy• Identification of the deceased• Time since the death• Place of the death• Cause of death• Circumstance/manner of death• Interpretation of injuries• Any other opinions (period of survival, volitional

activities, mode of disposal, reconstruction of the event, nature of the weapons involved, use of alcohol and drugs etc.)

• Collection of trace evidence/samples

Medico legal autopsy

• A part of the medico legal investigation into a death

• Conducted by a judicial medical officer or any other designated medical officer

• Authority is given at an inquest

• No consent required from the relations

• Post Mortem Report (PMR) is given to the inquirer (ISD/Magistrate)

• Cause of death is given after the autopsy

• Any body tissue/sample could be retained for further investigations

• Mode of disposal of the body is decided by the inquirer

Requirements for a Medico legal autopsy

1. Judicial requirementsWritten order from the ISD or Magistrate

2. Medical requirement A government medical officer or a lecturer from University Forensic Medicine Department. They are considered as experts in the field of diseases and injuries (Section 45 Evidence Ordinance)

3.Physical requirementsEquipmentsAutopsy room with autopsy table, ventilation, illumination and running waterOthers accessoriesTrained autopsy labourers /mortuary “cutters”

ProcedureThere are ten steps of an autopsy

1. History

2. Visit to the scene

3. Identification of the deceased

4. Preliminary procedures

5. Examination of clothing

6. General external examination

7. Specific external examination

8. Internal examination

9. Laboratory investigations

10. Documentation and reporting

History • From - Relations Eye witnesses Police officer Suspect/Accused Any other person

Past medical records

Visit to the scene

• If the body is still at the scene • After the autopsy (retrospective scene visit)

Objectives of the scene visit-read lecture on Scene of Crime

Identification of the deceased• Close relations• Friends• Associates/work mates etc.

Usually by facial identification, in the presence of the JMO, in good light, while the body is on the autopsy table.

If not how?

Preliminary procedures

• PhotographyFeatures for identificationPatterned injuries- Bite marks, tyre marksInjury patterns- Child abuse, torture, bomb Violence

• Radiology Fire arms, explosives, child abuse, burnt bodies,

torture, putrefied bodies, unidentified bodies• Collection of trace materials

Sexual offences, fire arms, abortions, deaths due to explosions, burns

Examination of clothing• Depends on the type of the death.

• Unidentified bodies • Sexual offences • Fire arms• Road traffic accidents• Burnt bodies• Explosion deaths• Drowning…..etc. etc.

• Clothes for identification• Injuries found on clothes

cuts, tears, penetrations• Trace materials

blood, paint, vomitus, semen, oil, glass particles, firearm residues, stains…..

• Any otherSuicide note

General external examination

• Height, weight, built, nourishment, hair, eyes, complexion, post-mortem changes….

• Scars, marks, tattoos and other identifying features

• Evidence of natural diseases • Natural openings • And many more…………………………

Specific external examination• Depend on the type of autopsy and its

objectives:• Unidentified bodies• Time since death• Body moved after death• Sexual offences• Injuries

Internal examination• Opening up of all body cavities • Evisceration of all organs • Dissection of all organs

• Head• Neck• Chest, abdomen• Pelvis• (may need to dissect other parts

such as spinal code and skeletal muscles)

Dissection techniques

• Standard Dissection- “chin to pubis”• Special Neck Dissection• Facial dissection (as an extension of neck dissection)

• Musculo-skeletal Dissection• Spinal Dissection• Pelvic Dissection• Other (Eye, Middle ear, Neuropathological)

laboratory investigations

• Depends on the autopsyToxicological Dept. of Govt. Analyst

Blood, urine, bile, stomach contents,Liver, kidney, brain, vitreous humor

HistopathologicalAny affected organ or injury sites

Othermicrobiological, Diatom studies, haematological/serological, enzyme

studies, genetic studies, ballistic, entomological etc.

Samples for laboratory investigations contd. • Histopathology

• In 10% Formol saline

• Toxicological samples – no presevatives

Documentation and reporting

• Findings • Opinion (eg. Cause of Death ) • Other remarks

Compiled in the PMR-Post Mortem Report (H 42 form)

Whom to send and how to retain?

Question:

What is an obscure autopsy and how

does it differ from a true negative

autopsy?

PATHOLOGICAL AUTOPSY

• Clinical autopsy (also termed Hospital autopsy in the UK and Australia)

• Done to gather information about:a disease/disease processPathology unidentified during lifeEffectiveness of treatment

Pathological autopsy-requirements and procedure

• Cause of death must be known and must be natural• Declaration of death must be filled before the autopsy• No suspicions/allegations about the circumstance• No inquest to the death• Written consent from the next of kin • Full or partial dissection could be employed• Only relevant body cavities opened• Special consent obtained to retain samples• Done by the hospital histo-pathologist in the presence of

clinical staff of the ward

• Approval from the head of the institution• Usually not carried out in high risk cases (HIV,

Hep. B, other highly infectious/hazardous conditions)

• Do not delay (unethical)• PM findings, samples taken must be

documented on the BHT• Findings must be kept confidential

Thank you