Introduction to autopsy

Medico legal module

21st batch
June 2014

Dr Sanjaya Hulathduwa
MBBS, MD, DLM, DMJ Path(Lond)
DMJ Clin(Lond) , Dip. Crim MFFLM(UK)
Senior Lecturer
• 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
autopsy
b. 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 requirements
Written 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 requirements
Equipments
Autopsy room with autopsy table, ventilation,
illumination and running water
Others accessories
Trained autopsy labourers /mortuary “cutters”
 Procedure
There 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

• Photography
Features for identification
Patterned injuries- Bite marks, tyre marks
Injury 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 other
Suicide 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 autopsy

Toxicological Dept. of Govt. Analyst
Blood, urine, bile, stomach contents,
Liver, kidney, brain, vitreous humor

Histopathological
Any affected organ or injury sites
Other
microbiological, 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 process
Pathology unidentified during life
Effectiveness 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