Autopsy

Lecture 2

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Techniques of Autopsy

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 Autopsy Dissection
Techniques
• 1. R. Virchow’s Technique
• 2. C. Rokinansky’s Technique
• 3. M. Letulle’s Technique
• 4. A. Ghon’s Technique

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 A. Virchow’s Technique
• Virchow method is an organ by organ
removal.
• First the Cranial Cavity is exposed, and
from the back the spinal cord is opened.
• Followed by Thoracic, Cervical and
Abdominal Organs.

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• This is the most commonly used
method.
• The Advantage of this technique is that,
each organ can be studied in detail.
• But The Disadvantage of this technique
is that, the Anatomic-o- Pathologic
relationship is not preserved, thus can
not be studied.
Virchow is credited with several very
important discoveries. His most widely
known scientific contribution is his cell
theory, which built on the work of Theodor
Schwann.

He was one of the first to accept the work of

Robert Remak, who showed the origins of
cells was the division of pre-existing cells.

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Virchow used the theory that all cells
arise from pre-existing cells to lay the
groundwork for cellular pathology, or the
study of disease at the cellular level.

His work made it more clear that diseases

occur at the cellular level. His work led to
scientists being able to diagnose
diseases more accurately.
B. Rokinansky’s Technique

• This technique involves in situ examination of

viscera with removal of notable organs.

• This technique is commonly preferred when

the pathologist wants to limit the spread of
infection like, HIV, Hepatitis B.

• The Disadvantage of this technique is that the

organs can not be studied in detail.

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 C. Letulle’s Technique
Letulle’s method is the En Mass removal of all the
viscera.
• In this method the cervical, thoracic, abdominal
and pelvic organs are removed en-mass but the
subsequently dissected as organ block.

• This technique is best as routine, and

preservation of connections between organs
and organ system.

• The organ block then can be studied in detail.

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 D. Gohn’s Technique
• Gohn method is also En Bloc removal of
viscera into Thoracic, intestines, Upper
abdominal, Lower abdominal, Brain and neck.

• Pathologists are more comfortable with this

technique.

• All organs should be weighed and brief

description of the organs should be recorded.

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• Which is the best method of
Forensic Autopsy Dissection?
• Virchow’s
• Letulle’s
• Rokinansky’s or
• Gohn’s

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• In Medical Autopsies on Hospital Cases,
Anatomical Orientation is observed and
Disease Processes is studied,

• Hence the Letulle’s Method in these

cases is preferred.

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• In Medico-Legal Autopsies
Virchow’s OR Gohn’s are more
commonly used due to Anatomical
Relationships and time saving
processes.

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AUTOPSY PROTOCOL

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Principal of Autopsy
• It should be uniform & adequate.

• To make it uniform and in a best possible

way, same autopsy protocol is to be
followed in every part of the world.

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• Because of its legal implications, the Protocol
of Autopsy is specific & very important.

• Before the start of work, there should be a

written valid authority addressed to him.

• And should go through all the documents

carefully.

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Autopsy should be Adequate
• To make it adequate, a complete examination of
body to find out,
• The effects of Physical and Chemical
changes on the body,
• With External and Internal Examination
and
• Collection of Specimens if required for
subsequent,

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• Toxicological Analysis
• Biological Examination for
Trace Evidence like,
– Blood, Semen, Saliva
• Hist-Pathological Examination
• Bacteriological Examination
Autopsy should be Uniform

• To make it Uniform a Standard

Protocol is observed.

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 Death Investigation
• This is done by the Police in
our country under Section
174 & 176, not by the doctor.
• Whereas in the Developed
World, this is done under a
definite Medico-Legal
System.
• There are Three Death
Investigating Systems which
are prevalent in the world,

• A. Medical Examiner System

• B. Coroner System
• C. Continental System

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 1. Medical Examiner System
A medical examiner is a Licensed
physician in a state officially
empowered,

Trained in pathology that investigates

deaths that occur under unusual or
suspicious circumstances,

To perform post-mortem examinations,

And in some cases jurisdictions to

initiate inquests. ...

The types of death reportable to the

system are determined by federal,
state or local laws.

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 2. Coroner System
• A coroner is an elected official in a
jurisdiction,
• Who investigates sudden and un-expected
deaths.
• May or may not be a Physician.

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Coroner
System England and Wales are divided
into coroner districts by the
Lord Chancellor, each district
consisting of the area or areas
of one or more local authorities.

The relevant local authority,

with the consent of the Chief
Coroner and the Lord
Chancellor, must appoint a
Senior Coroner for the district.

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• The history dates back to the Feudal
England.

• Office of the Coroner existed before 10th

century.

• Coroner interpreted as “Crown of the King”

and assumed as judicial functions.

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• Acted as Inquisitional Judge,
responsible for investigating,
interviewing and make Judgment in the
cause of death.

• This was the most common system as

far as determination of death and other
legal/forensic issues related with death.
 3. Continental System
Continental (European) Systems:
The common and major difference is that no
official comparable to the coroner or medical
examiner exists to investigate or supervise
the handling of deaths in the community.

This interest is retained by the executive and

judicial officers of the law enforcement
apparatus.

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• Most of the countries define the investigation of
suspicious or criminal death.

• Every citizen has the statutory duty to inform the

circumstances of death to the police.

• Who are the initiators of all the investigations.

• As an adjunct to this system the medico-legal

experts, who are specifically designated, are there
to assist the police in their investigation.

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Laws Related With Death
Investigation in Pakistan

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• Section 174 of PPC:

• Section 176 of PPC:

• Police Rules for Conduction of Autopsy

• Health Department also issues Instructions

for Conduction of Autopsy

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 Section 174 (1,2&3) of Criminal
Procedure Code (PPC):
Police to inquire on suicide, Homicide, Accidental
etc.

Sec. 174 (1) The officer in-charge of a police-station

or some other police- officer specially empowered by
the Provincial Government in that behalf, on receiving
information that a person:

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(a) has committed suicide, or
(b) has been killed by another, or by an
animal, or by machinery, or by an accident, or

(c) has died under circumstances raising a

reasonable suspicion that some other person
has committed an offense.
Shall immediately give intimation thereof to the
nearest Magistrate empowered to hold inquests, and,

unless otherwise directed by any rule prescribed by

the Provincial Government,

or by any general or special order of the District or

Sub-Divisional Magistrate,

shall proceed to the place where the body of such

deceased person is,

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And there, in the presence of two or more respectable
Inhabitants of the neighborhood, shall make an
investigation,

And draw up a report of the apparent cause of death

describing such wounds fractures, bruises and other
marks of Injury as may be found on the body,

And stating in what manner, or by what weapon or

instrument (if any), such marks appear to have been
inflicted. 38
(2) The report shall be signed by such police officer
and other persons, or by so many of them as concur
therein, and shall be forthwith forwarded to the
District Magistrate or the Sub-Divisional Magistrate.

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(3) When there is any doubt regarding the cause
of death, or when for any other reason the police
officer considers it expedient so to do,

He shall, subject to such rules as the Provincial

Government may prescribe in this behalf,
forward the body, with a view to its being
examined,

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 To the nearest Civil Surgeon, or other
qualified medical man appointed in this behalf
by the Provincial Government,

If the state of the weather and the distance

admit of its being so forwarded without risk of
such putrefaction on the road as would render
such examination useless.
 Section 176 of Criminal
Procedure Code (PPC)
176. Inquiry by Magistrate into cause of death.

(1) When any person dies when in the custody of the police,
the nearest Magistrate empowered to hold inquests shall,

And, in any other case mentioned in section 174, clauses (a),

(b) and (c) of sub-section the Magistrate may cause the body
to be disinterred and examined.

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(1), any Magistrate so empowered may hold an
inquiry into the cause of death either instead of, or
in addition to, the investigation held by the police-
officer, and if he does so, he shall have all the
powers in conducting it which he would have in
holding an inquiry into an offense.

The Magistrate holding such an inquiry shall record

the evidence taken by him in connection therewith
in any of the manners hereinafter prescribed
according to the circumstances of the case.

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(2) Power to disinter corpses.
Whenever such Magistrate considers it
expedient to make an examination of the dead
body of any person who has been already
interred, in order to discover the cause of his
death,
AUTOPSY PROTOCOL

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 Autopsy Protocol
“ It is a written signed legal document of
records of autopsy findings and the conclusion
drawn, which acts as a proof and is an
evidence to be presented in the court of law.”

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It contains,
1. Bio-data (Personal Information)
2. Identification (Third Party)
3. Findings of the Examinations
1. External Examination
2. Internal Examination
3. Systemic Examination Preview
4. Collection of Samples and Recoveries
5. Conclusion Drawn
4. Documentation

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Pre Autopsy Formalities

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• They are,
• 1. Visit of the Scene of Crime

• 2. Transportation of Dead Body

• 3. Registration of Body

• 4. Pre Autopsy Storage

• 4. Legal Formalities

• 5. Other Formalities

• 6. Place of Performing Autopsy

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Pre-Autopsy Protocol

• Pre-Autopsy
Protocol

• Visit to the • Transportati • Pre-Autopsy

Scene on of Body Storage

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1. Visit To The Scene of Crime
• In our country it is the job of
police
• Whereas in developed
countries systems it is the job
of Autopsy Surgeon.
• 1. Cordoning the Area

• 2. Searching the Scene of

Crime

• 3. Sketching and taking

the photographs of the
scene of crime

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• 4. Position of Body

• 5. Collection of
material like,
weapons

• 6. Looking for signs of

struggle and
preserving them

• 7. Searching for
Biological and Non-
Biological Trace
Evidences
 2. Transportation of Dead
Bodies

• The dead body should be transported with due care,

not to loose any evidence or may not induce any
post-mortem injuries.
• The body should be wrapped in Plastic Sheet, tied at
head and foot ends.
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 3. Registration of Dead Bodies
• On receipt of dead body at the Autopsy Center,
the authorized staff will register and make
entries in,
• 1. Entry Into General Register
• 2. Entry Into Autopsy Register
• 3. Putting the Identification Tag showing
name, age, sex, police station
• 4. Shifting the body to Storage Room into
the freezer

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Columns Of Registers

General Register
a. Serial Number
b. Date & time of Receipt of body
c. Name & Identity Number of Deceased
d. Name & Numbers of the constables and their
police Station
e. Date & time of Delivery of the body

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Autopsy Register
a. Yearly Number
b. Autopsy Number
c. Name, Date & Time of Autopsy
d. Details of the specimens Collected
e. Provisional conclusion about the
cause of death.
 4. Pre Autopsy Storage

• For short term storage, bodies are kept in freezers having +4º Celsius
• For long term storage, which is usually required after autopsy, the bodies
are kept at -20º Celsius.

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 5. Legal Formalities
• When police brings the body to
Mortuary, initially they request for
preservation of dead body for three
days, during which the legal formalities
are fulfilled.

• Most important formality is lodging of

FIR (First Information Report) by the
legal heirs in case of any suspicious,
homicidal, accidental or suicidal death.

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• Issuing of Authority Letter in the name
of Doctor or Head of Institution, where
the autopsy is going to be conducted.

• This Authority Letter is the most

important document, without which you
can not conduct autopsy.
 6. Other Formalities
• Documentation:
• 1. Documents Prior To Autopsy
• 2. Documents After Autopsy

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Documents Prior To Autopsy

• 1. Authority for conduction of autopsy.

• Authority is State, Police acting as
state gives the authority.
• 2. Documents
• NECESSARY DOCUMENTS
• CONDITIONAL DOCUMENTS

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• Documentations Prior To Autopsy:
• 1. Necessary Documents:
• (i) Authority Letter
• (ii) Dead Body Chalan
• (iii) Copy of the FIR
• (iv) Inquest Report
• (v) Injury Statement by the Police
Officer

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• 2. Conditional Documents: If the person was
initially injured and was hospitalized, then
the following documents are conditionally
required,
• (i) MLC (Medico-Legal Certificate)
• (ii) Hospital Chart and Treatment Notes
• (iii) Operation Notes
• (iv) Death Certificate

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 An ‘inquest report’ or ‘panchnama’,
It is a report in which the available history of the
case and circumstances under which the body was
found or recovered are recorded.

This recorded opinion of the witnesses and the

police officer’s, regarding the injuries, manner of
their causation, the cause of death, and indication
of suspected foul play, if any.

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 The whole purpose of preparing an inquest report under Section
174(1) Cr.P.C. is to investigate into and draw up a report of the,

1. Apparent cause of death,

2. Describing such wounds as may be found on the body of the

deceased

3. And stating in what manner,

4. Or by what weapon or instrument, if any,

such wounds appear to have been inflicted.

That the inquest report was not the statement of any person
wherein all the names of the persons accused were to be
mentioned.

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3 Types of Forms
• 1. Form Alif (For Natural Deaths)
• 2. Form Bay (Un-Natural Deaths)
• 3. Form Jeem (Poisoning Cases)

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7. Place of Performing Autopsy

• A well developed and well Designed Autopsy Suit is the basic

requirement for conduction of autopsy.

• It is designed as an operation theatre, But in operation theatre

the main objective is to prevent infections not to be introduced
to the patient.

• But in autopsy lab the main objective is that the infections

should not be transmitted to the staff and autopsy surgeon.

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