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DIFFERENTIATION OF ANTEMORTEM &

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Journal of Forensic Medicine & Toxicology Vol. 31 No. 2, July - Dec 2014
DIFFERENTIATION OF ANTEMORTEM & POSTMORTEM BURNS
BY HISTOPATHOLOGICAL EXAMINATION
Rahul Chawla*, Kunal Chawla**, Gaurav Sharma***, Yogender Malik****, Harnam*****
Akash Deep Aggarwal******, Rashim *******
ABSTRACT
Burns constitute a major cause of death and morbidity
whatever reason may be, in the world and in this country
too. Undoubtedly a severe burn is the most devastating
injury a person can sustain and yet hope to survive. In the
medico-legal setting, determination of whether the burns
seen on a body are ante mortem or post-mortem in nature
is of paramount importance. Whether the person was alive
at the times of sustaining burns needs meticulous scrutiny
as the person might have had died due to fatal burn injury
or died due to some disease or sudden assault or injury
and suffered burns later on. The differentiation between
antemortem and postmortem burn is dependent upon the
presence of vital reaction, as to be seen by histological
examination. In the present study effort were made to
differentiate antemortem and postmortem burns by
histopathology of burnt and junctional skin. Blisters were
present in 36% cases, pus was present in 54% cases, signs
of healing were present in 26% cases and red line of
demarcation was present in 88% cases. Histopathological
findings of burnt and junctional skin showed separation
of epidermis from dermis and breaking of epithelium in
90% cases respectively, vacuolisation and petechial
* Associate Professor
** Assistant Professor, Dept. of Anatomy, IGMC
Shimla
*** Professor, Dept. of Forensic Medicine and
Toxicology, BPS Govt. Medical College for
women, Khanpur Kalan
**** Assistant Professor, Dept. of Forensic Medicine
and Toxicology, BPS Govt. Medical College for
women, Khanpur Kalan
***** Professor, Dept. of Forensic Medicine and
Toxicology, Muzzafarnagar Medical College,
Muzzafarnagar
****** Associte Professor, Dept. of Forensic Medicine
and Toxicology, Govt. Medical College, Patiala
*******Dental Surgeon
Corresponding Author
Dr Rahul Chawla, Associate Professor, Dept. of Forensic
Medicine and Toxicology, BPS Govt. Medical College for
Women, Khanpur Kalan, Sonepat (Haryana)
Phone no.-09728853464, 09855203557
Email: drrahulchawla9@gmail.com
70
haemorrages in 76% cases respectively; epithelial cells
were flattened and elongated in 86% cases respectively.
Capillary dilatation was present in 84% cases, odema
and margination of leucocytes were present in 74% cases
respectively, congestion and infiltration were present in
90% cases respectively. Skin was not available in 10%
cases as the bodies were charred. Antemortem burns were
present in 96% cases and postmortem burns in 4% cases.
So histopathological examination plays a eminent role
importance in differentiation of antemortem and
postmortem burns.
Keywords: Burns, Histopathological examination,
Junctional skin.
INTRODUCTION
Fire has been known to mankind for about 4, 00,000
years. Although the use of fire was known to ancient man,
it is probably the potential fury of an unharnessed fire that
made man bow before it. India has an ancient culture where
fire was worshiped since the civilization started. Along with
water (jal), air (vayu), earth (prithvi), fire (agni) is perceived
as one of the four basic components of universe. As
everywhere else, the modes of sustaining burn injuries in
India are the same i.e. flames, scalds, electrical and thermal.
The most common cause of flame burns is accident1. Age
of burns has been ascertained by usual and various changes
occurring after the insult like redness, vesication/blistering,
exudation, crust formation, pus, separation of slough,
granulation tissue and cicatrix formation. Various parameters
have been advocated to ascertain the ante mortem and
post mortem nature of burns. The presence of smoke or
soot particles in the air passages, evidence of thermal injury/
inhalational injury of the respiratory tract by hot fumes and
gases, elevated blood carboxyhemoglobin levels due to
carbon monoxide poisoning and presence of other toxic
gases in the blood, cutaneous reaction have been used
either alone or in conjuncture. The cutaneous reaction to
heat and flame leading to vital reaction (red-flare/red-line),
vesication/blisters and microscopic examination of the
tissues from the burnt area has been considered very
important along with the above mentioned parameters2.
Sevitt (1957) described the histopathology of cutaneous
burns. The initial changes were due to direct effects of
thermal injury and the subsequent inflammatory response3.
The only vital sign, detectable by conventional methods,
was inflammatory reaction but this was not apparent until
several hours after injury. The interval which lapses before
 Journal of Forensic Medicine & Toxicology Vol. 31 No. 2, July - Dec 2014

its first stage, the invasion of polymorphs, was not with 1% aqueous eosin for 1-3 minutes and excess of stain
precisely established. Thus it could had been with in the was removed by washing with tap water. Finally before
first 24 hours, 8 hours (Fatteh, 1966) 6 hours (Mallik, 1970) mounting, the slide was dehydrated with ascending series
or only one hour (Ojata, 1969)4. The line of redness being of 50%, 70%, 90% alcohol and absolute alcohol for 2-3
a vital reaction in antemortem burns persists even after minutes duration each and then mounting was carried out
death5. Mallik (1970) described histological methods of by putting few drops of DPX (Distrene Plasticizer Xylene)
distinguishing antemortem and postmortem burns using on dried slide (slide was dried by placing it over the heater).
burns inflicted experimentally on guinea pigs, burns of Cover slips were placed with precautions taken to avoid
humans obtained from autopsy examination and burns collection of air bubbles. Then the slides were examined
inflicted experimentally in amputated human tissues2. The under the light microscope to get the information in relation
differentiation between antemortem and postmortem burn to different histopathological changes6.
is dependent upon the presence of vital reaction, as to be
seen by histological examination5. In human burns, the OBSERVATIONS
earliest histological change in antemortem burn was
leucocytic infiltration at 6 hours after burning 2 . Incidence and Distribution of Morphological Changes in
Histopathological section of the affected burn tissue with Burnt Skin
adjoining intact skin will show evidence of congestion,
Changes Present Absent
small areas of haemoorage and infiltration of
polymorhonuclears. These characteristic changes will not No. % No. %
be present in burns sustained after death. 5 Blisters 18 36% 32 64%

MATERIAL AND METHODS Pus 27 54% 23 46%

Healing 13 26% 37 74%
The present study was carried out in 50 cases alleged
to have died of burns and brought to mortuary attached to Red line of demarcation 44 88% 6 12%
the Department of Forensic Medicine and Toxicology,
Government Medical College, Amritsar from May 2004 to Blisters were present in 36% cases and absent in 64%
July 2005. cases. Pus was present in 54% cases and absent in 46% of
Skin tissue was taken from the burnt and junctional cases. Signs of healing were present in 26% cases and
area of burnt and unburnt region which was subjected to absent in 74% cases. Red line of demarcation was present
histopathological examination as described by Culling et al in 88% cases and absent in 12% cases. (As shown in table
(1985)6. no. 1 and figure I, Plates A, B ).

Method : The procedure started with fixation of tissue that

was done in 10% formalin solution for 6-12 hours at room
temperature. Dehydration of the tissue was done in the
ascending series of alcohol i.e. 50%, 70%, 90% absolute
alcohol. Then the tissue was cleared by two changes in
xylene. The tissue was impregnated with paraffin wax for
10-12 hours and block was made. 3-5 microns thick section
of the tissue was cut with the help of rotatory microtome
floated in water with a petridish and subsequently
transferred to a clean glass slide. The slides were placed on
the hot plate for melting of wax and then were given three
changes in xylene for 5 minutes each for removal of paraffin.
Slides were hydrated by bringing them to descending series
of alcohol i.e. absolute alcohol 90%, 70% and 50% and
then by placing them under running water for 2 minutes for
complete hydration. Then the slides were stained with
haematoxylin and eosin. The procedure of haematoxylin
and eosin staining started with the section from distilled
water dipped in haematoxylin solution for 15 minutes. The
slide with section was then removed and washed thoroughly
with tap water for half minute. One percent acid alcohol
was kept on the slide for 15 seconds and then washed with
tap water. Bluing of the section was done by keeping the
slide in tap water for 10 minutes. Counter staining was done Plate A : Photo showing pus and healing
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Journal of Forensic Medicine & Toxicology Vol. 31 No. 2, July - Dec 2014

Plate B: Photo showing pus and healing

Table 2: Incidence of histopathological findings
of burnt skin
Burnt Skin Present %
Separation of epidermis from dermis 45 90%
Breaking of epithelium 45 90%
Vacuolisation 38 76%
Petechial haemorrages 38 76%
Epithelial cells flattened & elongated 43 86%

Separation of epidermis from dermis and breaking of

epithelium were both present in 90% cases respectively.
Vacuolisation and petechial haemorrages were present in
76% cases respectively. Epithelial cells were flattened and
elongated in 86% cases respectively. As shown in table no. Plate D: Histopathology of Burnt Skin
2 and figure II, Plates C, D).
Table 3: Incidence of histopathological findings of
junctional skin in burn cases
Junctional Skin Present %
Capillary dilatation 42 84%
Oedema 37 74%
Congestion 45 90%
Margination of leucocytes 37 74%
Infiltration of leucocytes 45 90%

Capillary dilatation was present in 84% cases. Odema

and margination of leucocytes were present in 74% cases
respectively. Congestion and infiltration were present in
90% cases respectively. Skin was not available in 10%
cases as the bodies were charred (As shown in tables no. 4
and figures III, Plate E).

Plate C: Histopathology of Burnt Skin

72
 Journal of Forensic Medicine & Toxicology Vol. 31 No. 2, July - Dec 2014

DISCUSSION
Histopathological findings in burnt and junctional skin
In the present study, blisters were seen in 36% cases,
pus in 54% cases, healing in 26% cases and red line of
demarcation was seen in 88% cases. (Table 1 and Figure I,
Plate E: Histopathology of Junctional Skin Plate A, B). Sevitt (1957)3 and Foley (1970)7 observed blisters
in various degrees of burns. The histopathology of burnt
skin showed the separation of epidermis from dermis and
breaking of epithelium in 90% cases, vacuolisation and
petechial haemorrages were present in 76% cases, epithelial
cells were elongated and flattened in 86% cases. (Table 2
and Figure II, Plates C, D) In the present study,
histopathology of junctional skin showed infiltration of
leucocytes and congestion in 90% cases, capillary dilatation
in 84% cases, oedema and margination of leucocytes in
74% cases. (Table 3 and Figure III, Plate E) Mallik (1970)8
Table 4: Incidence and distribution of manner of death by inflicting burns on guinea pigs observed oedema with
in burn cases congestion and dilatation of capillaries and arterioles,
margination and infiltration of leucocytes. Vacuolisation,
ANTEMORTEM BURNS No. % elongation and flattening of epithelial cells was also
Accident 42 84% observed. Cuppage et al (1973)9 observed dilatation of
capillaries and oedema. Mant (1984)10 observed separation
Suicide 2 4%
of epidermis from dermis to form blisters, elongation of
Homicide 4 8%
cells and inflammatory reaction with polymorphonuclear
POST MORTEM BURNS 2 4% leucocytic infiltration. Parikh (2002)11 describes petechial
Total 50 100% haemorrhages microscopically in a burn, skin showed
petechial haemmorages in deeper layers, epithelial cells were
84% cases of total cases that were studied were alleged flattened and stained deeply with hemotoxylin and eosin
cases of accident, 8% cases were of homicide, 4% cases and vacuolization of epidermal and dermal layers was
were of suicide, and 4% cases were of post mortem burns prominently seen. Sevitt (1957) 3 observed oedema,
where bodies were burnt after killing to conceal the crime. separation of dermoepidermal junction, coagulative
One of the cases was that of a newlywed bride whose body necrosis, vasodilation, neutrophilic infiltration and
was burnt after she died of some poison given to her by in- regeneration of epithelium in the later stages. Foley (1970)7
laws. Second case was that of strangulation whose body also observed the same findings. Ritchie (1990)12 describes
was burnt after strangulating with a ligature. An intact swelling of epidermal cells with pyknosis, oedema,
ligature was present around the neck at the time of autopsy. congestion and transitionary inflammatory reaction, lifting
(As shown in table no.4 and figures IV,V). of necrotic epidermis from dermis and re-epithelization.
Emanuel and Faber (1988) 13 describes congestion,
vasodilatation, oedema, necrosis of epithelium and its
separation from underlying dermis. The findings of present
study are in consonence with the findings of above
mentioned authors.
Manner of death
In the present study, 96% cases were of antemortem
burns and 4% cases were of postmortem burns. In
antemortem burns, 84% of accident, 4% cases of suicide,
8% cases of homicide were observed. 4% cases were of
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 Journal of Forensic Medicine & Toxicology Vol. 31 No. 2, July - Dec 2014
postmortem burns. (Table 4 and Figure IV, V) Aggarwal and
Chandra (1971)14 observed 88% cases of accidental burns,
11% cases of suicidal burns and 1% case of homicidal burns
were noted. The incidence of accidental burns was 8 times
then that of suicide. Ganguli (1976)15 observed in his study
that accidental burns were responsible for 87.66% of the
cases and 4.34% cases committed suicide by burning.
Suarez-Penaranda (1999)16 studied two cases of homicidal
ligature strangulation with extensive burning of the bodies.
Naralwar and Meshram (2002)17 observed majority of
victims sustaining burn accidentally. The current study also
shows that burn injuries are mainly due to accident which
is similar to the observations of above authors.
SUMMARY AND CONCLUSIONS
This study was based on the observations of autopsy
of 50 cases of burns, brought to Mortuary of the Department
of Forensic Medicine & Toxicology, Govt. Medical College,
Amritsar, during the period from 2nd May 2004 to 19th July
2005. The salient observations that have emerged out of
this study are as follows:
1. Histopathological findings of burnt and junctional skin
showed separation of epidermis from dermis and
breaking of epithelium in 90% cases respectively;
vacuolisation and petechial haemorrages in 76% cases
respectively; epithelial cells were flattened and
elongated in 86% cases respectively. Capillary
dilatation was present in 84% cases. Odema and
margination of leucocytes were present in 74% cases
respectively. Congestion and infiltration were present
in 90% cases respectively. Skin was not available in
10% cases as the bodies were charred.
2. Antemortem burns were present in 96% cases
postmortem burns in 4% cases. Accidental burns, 88%
cases, constituted the majority of burns followed by
8% cases of homicide and 4% cases of suicide.
REFERENCES
1. Sawhney CP, Ahuja RB, Goel A. Burns in India :
Epidemiology and Problems in Management. Indian
Journal of Burns 1993; 1(1): 1.
2. Vij K. Thermal Deaths. Textbook of Forensic
Medicine and Toxicology. 2nd Ed. B I Churchill
Livingstone. New Delhi. 2002. p. 319-328.
74
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3. Sevitt S. Histopathological changes in burned skin.
Burns Pathology and Therapeutic Applications.
Butterworth and Co. Ltd. 1957. p. 18-27.
4. Polson CJ, Gee DJ, Knight B. Burns. The Essentials
of Forensic Medicine. 4th Ed. Oxford : Pergamaon
Press. 1985. p. 141-142, 322-324.
5. Mukherjee J B. Thermal injuries.Injury and its
medicolegal aspects. JB Mukherjee’s Forensic
Medicine and Toxicology.Edited by R.N.Karmakar. 4th
Edition.2011.Kolkata:Academic Publishers.467-468.
6. Cullings CFA, Allison RT, Barr WT. Staining and
Mounting. Cellular Pathology Techniques. 4th Ed.
London: Butterworths. 1985. p. 261.
7. Foley FD. Pathology of cutaneous burns. The Surgical
Clinics of North America 1970; 50(6): 1201-1210.
8. Malik MOA. Enzyme Changes in the Early Phase of
Healing Skin Burns in Guinea Pigs. British Journal of
Experimental Pathology 1971; 52: 345-352.
9. Cuppage FE, Leape LL, Tate A. Morphologic Changes
in Rhesus Monkey Skin After Acute Burn. Archives
Pathology 1973; 95: 402,405,440.
10. Mant AK Death from Physical and Chemical Injury,
Starvation and Neglect. Taylor’s Principle and Practice
of Medical Jurisprudence. 13th Ed. London : Churchill
Livingstone. London. 1984. p. 251-253, 257-258.
11. Parikh CK. Thermal Injuries. Parikh’s Textbook of
Medical Jurisprudence and Toxicology. 6th Ed.
Bombay : CBS Publication. Bombay 2002. p.4.156.
12. Ritchie AC. Physical injury Boyd’s Textbook of
Pathology. 9th Ed. Philadelphia London : Lea and
Febiger. 1990. p. 567-568.
13. Emanuel R, John LF. Environmental and nutritional
pathology. Company Philadelphia : JB Lipin Cott. 1988.
p.303-304. South Zone Delhi. Punjab Medical Journal
1970; XX(12): 451.
15. Ganguli AC. Burns. Journal of Indian Medical
Association1976; 67: 150-152.
16. Suarez-Penaranda J M, Munoz JI, de Abajo B Lpiez,
Vieira DN, Rocho R et al. Concealed homicidal
strangulation by burning. American Journal of
Forensic Medicine and Pathology 1999; 20(2): 141-
144.
17. Narlawar UW, Meshram FA. Epidermiological
determinants of burns and its outcome in Nagpur
Journal of DMER 2002;19.