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Dr Sujeet Kumar Samadder

RMO 1st year


POINTS TO BE COVERED

 Literature regarding “ARTEFACT”


 Definition

 Classification

 Description

 Medico-legal Importance

 Take home message


 British variant of ‘artifact’.
 First used in 1821.
 Origin – Latin.
 Meaning by dissection of word ‘artefact’-
 ‘arte’ – skill
 ‘fact’ from ‘factum’ from ‘facere’ – something made.

Cont.
 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)
Definition

 Artefacts 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.
Classification

 Four types
1. Due to resuscitative or therapeutic measures
2. Between death and autopsy
3. Due to injuries or lesions of organs before death
4. During post-mortem examination
Due to resuscitative or therapeutic
measures
1. From 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.
2. Marks of injection & defibrillator on chest
3. CPR – fracture of ribs & sternum
a) Can cause haemothorax & haemopneumothorax
b) Fat embolism from fractured ribs or sternum
c) Laceration of spleen, liver and diaphragm
4. Positive pressure ventilation – emphysema, sub-pleural air
blebs, tension pneumothorax.
Cont.
DEFIBRILATOR MARKS SIMULATING ANTEMORTEM ABRASION
OVER CHEST
5. Counter irritation Chinese style on neck – extravasation
of blood under skin – suspicion of throttling.
6. Endo-tracheal intubation – inexperienced hands – injury
to larynx and adjacent tissue – suspicion of foul play.
7. Carotid Angiography – neck muscle bruise – suspicion
of throttling.
8. Antemortem surgeon’s intervention on wounds may
mislead autopsy findings.
Between death and autopsy
1. Agonal artefact – ‘agonal’ the struggle that precedes
death.
a. Common agonal artefact is REGURGITATION &
ASPIRATION
Ante mortem Agonal Reaction Post mortem Agonal Artefact
Stomach contents aspirated and Never reaches to lower
goes to lower respiratory tract respiratory tract.
mixed with fluid and mucus
choking effect death
b. Vascular collapse or shock before death

May prevent any significant bleeding


Crux: Accidental Deaths Can Also Have Congested Viscera.
• Embalming : chemical treatment
of dead body to protect from
decay.
2. • Trochar insertion for arterial
access from
Embalming • Existing wound – may change
Artefact: size shape direction , can create
false tracks
• Freshly created wound – may
simulate stab or gunshot wound
TROCHAR INSERTION FROM NECK AND
ABDOMEN
• Embalming fluid may extravasate blood from
veins & arteries, may mistaken as bruise;
Or
small bruise large bruise
• Embalming fluid interferes in toxicological
analysis.
3. Internment & Exhumation Artefacts

Fungus on Digging may


injuries & produce fracture
natural orifices of bones

Area underlying
simulate bruise
Exhumed body
4. Artefacts due to handling of cadavers
• From transportation
• Abrasion, laceration, blood spots on clothes and body
which was absent in original.
• From careless handling
• Bruise in occipital area due to head bumping on hard
surface, differentiated by wiping off the bruise.
• Fracture ribs and vertebras.
• Weak, osteoporotic bones may get fractured due to
counteract the Rigor Mortis.
• Brush abrasions on back by dragging.
 Abrasion
Antemortem Postmortem
Looks brownish or reddish Brown or parchment like
Scab is noticed if gets older Scab is never noticed
Bleeding surface present if fresh No bleeding surface is evident
Healing is evident No such thing can ever happen
Can be found on any part of body Usually on bony prominences
Surface is moist Surface is dry

 Laceration
Antemortem Postmortem
Vital reactions will be seen No vital reaction will be seen
Margin is bruised No bruising is seen on margin
Post mortem abrasion
 Bruise – it is essentially a vital phenomena
Antemortem Postmortem
Swelling Cannot be similar as antemortem
Evidence of extravasation of blood Can 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 But disproportionate to effect of force,
colouring to the affected area bruise will always be less
Colour changes denote resolution of Occipital postmortem bruise simulate
bruise antemortem bruise , difference is
absence of vital reaction apart from
microscopy.
Detection of enzyme ascertain
antemortem origin eg. – esterase,
aminopeptidases, acid phosphatase,
alkaline phosphatase
False simulated artificial bruise
• Irritant substances can do so
• Done to substantiate a false charge of assault
• By plumbago zeylanica, rolsea, semicarpus anacardium
• Margins contain tiny vesicles containing acrid serous
fluid
• Surrounding skin shows inflammatory reaction
• Diagnosis is made by incision, clot cannot be wiped off
 Clotted blood
Antemortem Postmortem
It cannot be wiped off as it It can be wiped off easily
fibrin. because it does not have
fibrin.
 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.
5. Artefacts due to Rigor Mortis
• To move the body, breaking is done, resulting in
asymmetrical Rigor Mortis
• May cause misinterpretation of Time Since Death.
• Heat/Cold stiffening may pose as an artefact against Rigor
Mortis.
• How to differentiate heat/cold stiffening to Rigor Mortis:
 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
6. Artefacts due to hypostasis
• Localised hypostasis may be mistaken as bruise
• Hypostasis in dependent part of –
• Heart - Resemble Myocardial Infarction.
• Lung - Pneumonic or broncho-pneumonic consolidation.
• Intestine – suggest corrosion or strangulation.
• Stomach – looks like poisoning.
• Hypostasis in nails sometime confuses with cyanosis.
• Hypostasis artefact colors in –
• Refrigeration – pink.
• Carbon Monoxide poisoning– cherry red.
• Hydrogen Cyanide poisoning – bright red.
• Potassium Chromate / Bichromate – chocolate brown.
• Phosphorus poisoning – dark brown.
Hypostasis like bruise
Hypostasis of lung
hypostasis in refrigerated body: pink
colour
Decomposition
artefacts:
• It brings lots of significant
changes which can be mistaken
as artefact on naked eye
examination. Some of the
following are:
Sl. No. Artefact Misinterpretation Remark
1 Swollen oedematous Antemortem obesity
corpulent in early stage
2 Blood stained froth Pulmonary oedema, History can tell about
from mouth and nostrils head injury etc head injury or drowning
3 Postmortem blisters Antemortem blisters Difference shown in other
due to burn or scald slide.
4 Post mortem bleeding Antemortem bleeding Antemortem bleeding
from severed blood cannot be wiped off
vessels
5 False groove over neck Strangulation Close observation,
due to tight collar, neck history, ecchymosis if
tie evident.
6 Separation of head Trauma Close observation and
sutures or burst of history
abdomen due to gas
7 Gas in heart and blood Embolism Alkaline Pyrogallol gas
vessels treatment - gas will turn
brown due to O2 in
antemortem embolism
Sl. No. Artefact Misinterpretation Remark
8 Rupture of oesophagus corrosive acid Absence of vital signs
& stomach due to poisoning
gastric juices
9 Hypostatic strangulated or History of hospitalization,
discolouration of infarcted bowel histopathology.
intestine
10 Stains on face due to chemical burns chemical analysis
regurgitation
11 Vaginal introitus will sexual assault History, vaginal swab,
be loose, lax and flaccid uterus examination and
with blood stained histopathology will bring
discharge with bluish the truth.
discolouration of
mucosa

12 Decomposing pancreas acute pancreatitis Signs of inflamation and fat


necrosis willn be seen in
antemortem cases
13 Fissure or split in skin lacerated or incised
wound
Heat cracks resemble lacerations
Postmortem and
antemortem blisters
8. Artefacts due to post mortem
corrosion

Gasoline exposure to skin in


accidents causes soiling

After drying –
abrasion or thermal
burn
9. Artefacts associated with accidental deaths
– Railway electrician on electric poles
• Get electrocuted die
fall on track
run over by train
• Accidental run over antemortem
post mortem run over

Identification is difficult difficult to tell about


ante / post mortem
10.Artefacts due to animals or insect bites
– Rats & rodents – nibbled pale white
– Dogs & jackals – deeper teeth impression
Superficial Stab Injury
– Cat bite – small & rounded
– In drowned bodies – lips cheek eyelids, genitalia,
tips of genitalia, finger toes, muscles of limbs
Homicidal 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 abrasion
– Maggots – in antemortem injuries

changes stab or gun-shot wounds


Ant Bite
Gun shot appearing wound, made by
maggots
11. Toxicological artefacts :
Erroneous results of tests.
• Faulty collection & faulty preservation of samples
• Blood sampling for alcohol estimation – from peripheral
veins
• Preservative used is NaF (Sodium Fluoride).
• Introduction of contaminants in body fluid may lead to
erroneous results of tests.
• Decomposed and embalmed bodies can have ethanol &
methanol respectively.
12. • Blood came out from
Artefacts torn or cut vessels
due to • Post mortem clot can be
post wiped off
mortem • Ante mortem clot
cannot be wiped off
bleeding
Due to lesions of organs before
death
1. Artefacts in respect to gun-shot wounds
• Surgical/Medical tending – cleaning debridement
etc, removes gun powder, and changes the all over
character, as in J F Kennedy murder case
• Decomposition causes peeling of epidermis,
disintegration of tissue
• Trochar insertion in embalming – track distortion,
false track, detection of direction of fire may
become difficult
2. X-ray Artefact
• In a dead body x-ray for gun-shot bullet, false
missile shadow can be found due to, bullet in
shirt pocket, bullet not fired, bullet between shirt
fold etc.
3. Artefacts induced by criminals
• Dismemberment of body part, mutilation
• Post mortem injuries
Artefacts during Post Mortem
Examination
1. Injury to visceral organs – ante mortem injuries
2. Fracture of skull bones, may continue with antemortem
fracture, misinterpretation of whole fracture
3. Hyoid and thyroid fracture during forceful extraction the
heart and lungs
4. Bleeding in neck; anti/post mortem ?
Can be told only after enzyme study.
So, take out heart, lung, brain before neck.4
Medico Legal Importance
Wrong conclusion as to
• Cause of death
• Mode of death
• Nature of death
• Antemortem or Postmortem
Unjustified suspicion of foul play

Misguided direction to investigating officer

Miscarriage of justice
Take home message

ARTEFACT MAY
LEAD
IMPRISONMENT
OF INNOCENT
AND FREEDOM
OF THE GUILTY.
THANK YOU