POSTMORTEM ARTEFCTS

POSTMORTEM ARTEFACTSDr Sujeet Kumar SamadderRMO 1st year

Points to be covered Literature regarding ARTEFACTDefinitionClassificationDescriptionMedico-legal ImportanceTake home message

British variant of artifact.First used in 1821.Origin Latin.Meaning by dissection of word artefact-arte skillfact from factum from facere something made.

Cont.Literature

2 meanings:A simple object created by humans, from a particular period in past for any practical purpose which have cultural or historical interest, so usually used by historians. (a favorite word among them)

A product of artificial characters, usually due to extraneous agency.or Something observed or evident that is not naturally present but occurs as a result of outside source or procedure.(a non-favorite word among doctors)

DefinitionArtefacts means anything which is not real but something artificial.It is a change or feature which was not physiologically or even pathologically present in the body tissues before death in natural course of events, but which have been caused or introduced into the body after death, often leading to much confusion about its nature and causative effect and often resulting in misinterpretation of medico-legally significant findings.

ClassificationFour typesDue to resuscitative or therapeutic measuresBetween death and autopsyDue to injuries or lesions of organs before deathDuring post-mortem examination

Due to resuscitative or therapeutic measuresFrom the very outset, I want to state that HISTORY OF PATIENT is of utmost importance in every branch of medical science, either clinical or non-clinical, so is applied to Forensic Medicine.Marks of injection & defibrillator on chestCPR fracture of ribs & sternumCan cause haemothorax & haemopneumothoraxFat embolism from fractured ribs or sternumLaceration of spleen, liver and diaphragmPositive pressure ventilation emphysema, sub-pleural air blebs, tension pneumothorax. Cont.

7

DEFIBRILATOR MARKS SIMULATING ANTEMORTEM ABRASION OVER CHEST

Counter irritation Chinese style on neck extravasation of blood under skin suspicion of throttling.Endo-tracheal intubation inexperienced hands injury to larynx and adjacent tissue suspicion of foul play.Carotid Angiography neck muscle bruise suspicion of throttling.Antemortem surgeons intervention on wounds may mislead autopsy findings.

By inex9

Between death and autopsyAgonal artefact agonal the struggle that precedes death. Common agonal artefact is REGURGITATION & ASPIRATION

Vascular collapse or shock before death

May prevent any significant bleedingCrux: Accidental Deaths Can Also Have Congested Viscera.Ante mortem Agonal ReactionPost mortem Agonal ArtefactStomach contents aspirated and goes to lower respiratory tract mixed with fluid and mucus choking effect deathNever reaches to lower respiratory tract.

TROCHAR INSERTION FROM NECK AND ABDOMEN

Embalming fluid may extravasate blood from veins & arteries, may mistaken as bruise; Orsmall bruise large bruiseEmbalming fluid interferes in toxicological analysis.

Exhumed body

Abrasion

Laceration

AntemortemPostmortemLooks brownish or reddishBrown or parchment likeScab is noticed if gets olderScab is never noticedBleeding surface present if freshNo bleeding surface is evidentHealing is evidentNo such thing can ever happenCan be found on any part of bodyUsually on bony prominencesSurface is moistSurface is dry

AntemortemPostmortemVital reactions will be seenNo vital reaction will be seenMargin is bruisedNo bruising is seen on margin

Post mortem abrasion

Bruise it is essentially a vital phenomena

AntemortemPostmortemSwellingCannot be similar as antemortemEvidence of extravasation of bloodCan be produced like antemortem to some extent with in 2 minutes to maximum of 2-3hrs, that to on the tissue which can be forcibly compressed against the bone.Extravasated blood will impart colouring to the affected areaBut disproportionate to effect of force, bruise will always be lessColour changes denote resolution of bruiseOccipital postmortem bruise simulate antemortem bruise , difference is absence of vital reaction apart from microscopy.Detection of enzyme ascertain antemortem origin eg. esterase, aminopeptidases, acid phosphatase, alkaline phosphatase

Clotted blood

Postmortem blood clot is of 2 types:Red current jelly: forms rapidly, soft, lump, slippery, uniformly dark red.Chicken fat: forms when clotting occurs slowly, consist of 2 layers:Reddish moist lower layer: consist of red cells, soft, lumpy.Bright yellow upper layer: of fibrin and serum, jelly like.AntemortemPostmortemIt cannot be wiped off as it fibrin.It can be wiped off easily because it does not have fibrin.

22

Gas stiffening may simulate Rigor Mortis, but with the following features one can easily differentiate it from Rigor Mortis:Putrefactive changes will be seen, as it is due to inflation of tissue spaces by gases of putrefaction, which is not seen in heat or cold stiffening.No particular order of appearance or disappearance as in Rigor Mortis Joints are not tight, so can be moved easily.No muscle shortening as in heat stiffening.Stiffening will pass if gas is allowed to escape by incisions over the areas.

Rigor Mortis

Heat Stiffening

Gas Stiffening

Hypostasis like bruise

Hypostasis of lung

hypostasis in refrigerated body: pink colour

Sl. No.ArtefactMisinterpretationRemark1Swollen oedematous corpulent in early stageAntemortem obesity2Blood stained froth from mouth and nostrils Pulmonary oedema, head injury etcHistory can tell about head injury or drowning3Postmortem blisters Antemortem blisters due to burn or scaldDifference shown in other slide.4Post mortem bleeding from severed blood vesselsAntemortem bleedingAntemortem bleeding cannot be wiped off5False groove over neck due to tight collar, neck tie StrangulationClose observation, history, ecchymosis if evident.6Separation of head sutures or burst of abdomen due to gasTraumaClose observation and history7Gas in heart and blood vesselsEmbolism Alkaline Pyrogallol gas treatment - gas will turn brown due to O2 in antemortem embolism

Sl. No.ArtefactMisinterpretationRemark8Rupture of oesophagus & stomach due to gastric juices corrosive acid poisoningAbsence of vital signs9Hypostatic discolouration of intestinestrangulated or infarcted bowelHistory of hospitalization, histopathology.10Stains on face due to regurgitation chemical burnschemical analysis 11Vaginal introitus will be loose, lax and flaccid with blood stained discharge with bluish discolouration of mucosasexual assaultHistory, vaginal swab, uterus examination and histopathology will bring the truth.12Decomposing pancreasacute pancreatitisSigns of inflamation and fat necrosis willn be seen in antemortem cases13Fissure or split in skinlacerated or incised wound

Heat cracks resemble lacerations

Postmortem and antemortem blisters

Artefacts associated with accidental deathsRailway electrician on electric poles Get electrocuted die fall on trackrun over by trainAccidental run over antemortempost mortem run over

Identification is difficultdifficult to tell aboutante / post mortem

Artefacts due to animals or insect bitesRats & rodents nibbled pale whiteDogs & jackals deeper teeth impressionSuperficial Stab InjuryCat bite small & roundedIn drowned bodies lips cheek eyelids, genitalia, tips of genitalia, finger toes, muscles of limbsHomicidal inflictions by fish, crab etc

Animal bite resembling stab wounds

Gnawing Effect

Postmortem vulture eating, appearing gun shot

Ants, cockroaches bites in moist area (eyes, lips, axila, etc), brown parchmentised area

antemortem abrasionMaggots in antemortem injuries

changes stab or gun-shot wounds

Ant Bite

Gun shot appearing wound, made by maggots

Due to lesions of organs before death

Artefacts during Post Mortem ExaminationInjury to visceral organs ante mortem injuriesFracture of skull bones, may continue with antemortem fracture, misinterpretation of whole fractureHyoid and thyroid fracture during forceful extraction the heart and lungsBleeding in neck; anti/post mortem ?Can be told only after enzyme study.So, take out heart, lung, brain before neck.4

Medico Legal Importance

Take home message

THANK YOU