POSTMORTEM EXAMINATION

AUTOPSY/ NECROPSY

CHAPTER: 7 AUTOPSY (POST MORTEM EXAMINATION)

1. Define Autopsy (post mortem examination), and mention types of

autopsy with purpose /objective of medico legal autopsy.
2. Write note on incision, types of incision
3. Write note on Negative autopsy, Second autopsy
4. Write note on Post mortem artefacts
5. Writ note on Exhumation
6. Describe Post mortem report

Definition: - Autopsy or Post Mortem Examination refers to the systemic examination of a

dead body for medical, legal and scientific purpose or to find out the cause of death in
unnatural or suspicious death. It is investigative dissection of the dead body which is done
by the doctor externally & internally to find out the cause of death.
Types of Autopsy: - It is broadly divided into three categories-
1. Academic Autopsy:- In this type Dissection carried by medical students to acquire
practical knowledge of Anatomy subject
2. Clinical /Pathological/Hospital Autopsy: - It is done by pathologist on request of
treating doctor with consent of relatives to confirm the diagnosis and to know the
cause of death. in this autopsy may be complete or partial.
3. Forensic autopsy/Medico-Legal Autopsy: - It is scientific examination of a dead
body which is carried out under the laws of state only on the requisition of legal
authority (police or magistrate) without consent of relatives complete autopsy is
done for the protection of rights of citizens in cases of sudden, suspicious, unnatural,
or criminal death.

Purpose / objective of Medicoleagal Postmortem Examination

 To know cause of death natural / unnatural
 To find out nature of death. (Suicidal, Homicidal, Accidental).
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  To estimate time since death
 To establish identity of deceased when not known
 To find out time of death, mode of death, age of injuries, and place of death.
 To find out manner of death
 To collect evidences to identify the object causing death and to identify the
criminal.
 To retain relevant organ/visceras as a evidence
 In newborn infants to determine the issues of live birth and viability.
 In case of mutilated bodies to determine they belong to one or more person,
approximate cause and time of death if they are human skeletal remains.

Rules for Conducting Medicoleagal Postmortem Examinations

 It should conducted by registered medical practitioner only.
 It should be performed as soon as possible after the requisition without
undue delay.
 Autopsy should be conducted in a place specially designed for the purpose of
postmortem (Mortuary) at earliest.
 The dead body should be accompanied by dead body challan (requisition or
official order submitted to doctor by investigating officer which contains all
details of dead body) and an inquest report
 Autopsy should be done in daylight because color changes such as jaundice,
changes in contusion/bruises and post mortem staining/postmortem Lividity,
etc., cannot be appreciated in artificial light.
 Every organ must be examined carefully
 If the body received as mortuary it is preserved at 4 0c.
 A police officer or any authorized person and 2 relatives should identify the
body in front of autopsy.
 All findings should be recorded and nothing should be erased, as it is
essential to preserve chain of evidence.
 Autopsy is conducted by two doctors, when death of female due to
suspicious reasons has occurred within 7 years of marriage.
 A panel of doctors is also constituted in case of custodial deaths, and death
in operation table
 After completion of autopsy, the body is stitched, washed and restored to the
best possible cosmetic appearance and then handed over to the constable
 autopsy should be conducted in a place specially designed for the purpose
of postmortem ( Mortuary )

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  In case death occurring in custody, video recording, video
film/tape/CD/DVD/ SD card should be sent to Chairman, National Human
Right Commission, new Delhi by the doctor himself.
 If it is possible visit to scene of crime. It is beneficial and fruitful in certain
cases, such as murder, poisoning, etc. it may provide evidence or clues to the
nature and circumstances of crime.

Postmortem Examination Report The postmortem examination report consists of

following parts:
1. Introductory part
2. Examination part/ Report
3. Opinion or Conclusion

1. Introduction: - In this part the name, age, sex and residence of dead body is mentioned.
 The place from where the body was brought, date and time of arrival of the body at
mortuary for postmortem examination should be noted
 It should be conducted on when there is an official order authorizing the autopsy,
from police or magistrate and mention the authority.

2. Examination/ Report: It consist complete description of external & internal examination

of body and findings recorded by the doctor with diagnose.
A. External examination: in this all external features are noted-
 sex, age, smell, eyes ( pupil )
 face, hairs, skin, color, natural orifices, neck, thorax, abdomen, back
 deformities, scars, moles, tattoo mark, height, brushes, body built
 Clothing, tear, loss of button of clothes
 Extremities, rigor mortis, postmortem Lividity or postmortem staining
 decomposed body, wounds, fracture of bones are noted.
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B. Internal examination:
 In this step all three major cavities of body i.e. skull, thorax, and abdomen should be
opened examine the all organs of body individually for inflammation, ulcer,
congestion, perforation presence of poisons. Certain poisons are detected after
decomposition of body. For example arsenic & lead in the tissues, viscera’s, hairs,
nails, bones, teeth.
 In suspected head injury, skull is opened first then thorax and abdomen after blood is
drained out.
 In suspected Asphyxial death, the skull and abdomen is opened first followed by neck
dissection.

3. Opinion or Conclusion:
 The opinion regarding the cause of death is given.
 Cause of death is based on the postmortem finding & the opinion of medical
officer
 It should be honest, objective & scientific
 Medical officer should sign the report with designation & qualification.
Requirements for Postmortem Examination

1. Instruments:

2. Chemicals:

 Preservatives- common salt and rectified spirit

 Fixative - formalin

AUTOPSY PROCEDURE

It consists of external examination and internal examinations.

A. External Examination:

It consists of:

 Examination of cloths for any stains, soiling materials, foreign material, any cut
mark, tears, stab mark, loss of buttons etc.
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  Note down height, weight, built, gross deformities, hair pattern and color, any stain
present on body.

 Presence or absence rigor mortis

 Postmortem Lividity should be noted

 Presence or absence of sign of decomposition, maggots, larvae, eggs etc. should be

recorded

 Skin and bod surface should be search for any dermatological lesion, pustules,
bleeding spots, edema, cyanosis, any stain, mud, etc.

 Perceive for any odor emitting from body

 State of natural orifices such as nose, ear mouth, anus, vagina urethra for any
disease, injury, and foreign body

 Documentation of injuries- abrasion, contusion, laceration, incised, stab, chop,

crush, burn, electrical injury, etc. should recorded properly with size, site,
dimension.

 External genitals – examine to know presence of any disease, injury, foreign body,
stains, secretions, and any sign of sexual assault.

B. Internal Examinations:

Internal examination includes dissection and examination of all three major cavities
of body and examine the all organs of body individually for any evidence or clue.

 Cranial cavity (skull)

 Thoracic cavity (thorax)

 Abdominal cavity (Abdomen)

 Dissection of spinal cord (when indicated)

 Dissection of extremities (when indicated)

For the procedure of dissection any Cavity can be opened first it depends on the
requirement and convenience of autopsy surgeon. However, in fetus, usually abdominal
cavity is opened first to record the position of diaphragm.

INCISION

Various types of incisions used for autopsy:

 For head a coronal incision: It is more preferable and easy type of incision. The
incision begins from behind the ear and extends upward on either side to meet
coronally on head.

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  For trunk: There are various types of incisions depending on the need, an autopsy
surgeon use the following types of incisions in the post-mortem for trunk.

 I- shaped incision: this is the common method in use. In this type a straight
incision is made from chin to the pubic symphysis and avoiding the umbilicus
because of the dense fibrous tissue is difficult to penetrate with needle, when body is
stiches after autopsy.

 Y- Shaped incision: It begins at a point close to acromial process and extends down
below the breast and then medially across the xiphoid process. And from xiphoid
process incision carried downward in a straight line to the pubis.

 ModifiedY- Shaped incision: - It is more cosmetic, spare the skin at neck. In this
type incision from the midline of suprasternal notch to pubic symphysis is made.
Better exposure to neck region, and it is faster than Y- Shaped technique.

AUTOPSY TECHNIQUE

Following are the autopsy techniques:

 Technique of Virchow- in this technique, the organs are removed one by one, it is
more popular and convenient method

 Technique of Rokitansky: In this technique partial dissection is done with removal.

 Technique of Ghon: In this technique, thoracic, cervical, abdominal and urogenital

organs are removed.

 Technique of Letulle: - In this technique, cervical, thoracic abdominal and pelvic

organs are removed. This technique is considered as best technique.

OTHER TYPES OF AUTOPSIES

Obscure autopsy: In this type of autopsy about 20% of all post-mortem examination cases,
the cause of death may not be clear at the time of dissection of the body

Causes:
1. Natural disease: - epilepsy, fibrillation
2. Concealed trauma:- Concussion , blunt injury to heart, etc.
3. Poisoning:- Neurotic poisoning, Anesthic overdose
4. Biochemical disturbances:- Uremia, diabetes

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 5. Endocrinal disturbances:- Adrenal insufficiency
6. Miscellaneous:- Allergy, drug idiosyncrasy.
Negative autopsy: In this type of autopsy about 2-5% of all post-mortem examination
cases, the cause of death remains unknown, even after all laboratorical examination.
Causes:
1. Inadequate history
2. Inadequate external & internal examination
3. Insufficient lab examination
4. Lack of toxicological analysis
5. Lack of training of Doctor

Second autopsy: In type of autopsy post mortem examination is again conducted on an

already autopsied body in suspected cases, but in Indian law there is no provision for second
autopsy.
Causes:
1. Relatives are not satisfied by 1st autopsy
2. Cause of death cannot be opened in 1st instance
3. Expert opinion where in some question are left unanswered
4. Suspicion of doctor conducting post mortem
5. Involvement of police in concealing the fact

POSTMORTEM ARTEFACTS:

Definition:- Postmortem artefact is any change or new feature introduced into the body
after death and such features or changes possess difficulty in interpreting the autopsy
findings. And may lead wrong diagnosis.

Classification of postmortem artefacts:-

 Due to decomposition—postmortem bloating of body may create a misleading

picture of obesity, Postmortem dilatation vagina may produce the appearance of
sexual assault, and Postmortem separation of child’s skull suture by putrefaction
gases may be misinterpreted as fracture.etc.

 Third party artefacts—Animals, Bird, and Insect Activity, Embalming activity,

Autopsy Surgeon Induced Artefact.

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  Other artifacts: Environment, Heat, refrigeration, Rough handling and shifting the
body, digging tools may cause fracture in exhumation cases

Importance –

Ignorance of artefacts leads to:

 Wrong cause of death

 Wrong manner of death

 Undue suspicion of criminal interference

 Unnecessary spending of time and effort as a result of misleading findings

EXHUMATION:

Definition: - It is lawful digging out or bringing out already burred dead body from a
grave, earth for the purpose of identification & post mortem with or without chemical
examination of viscera of body. It is done in case of suspected, case of death to see the
cause of death or to find out the cause of death. It is done under order of magistrate in
presence of police officer in early morning, Exhumation doesn’t include 2nd autopsy

Reasons:

1. Criminal cases:
 Establishing the cause & manner of death in suspected homicidal cases
 Death as a result of criminal abortion & criminal negligence
 Retrieving some vital object which may throw light on case
2. Civil cases:-
 Identification of the deceased for accidental death claim
 Insurance
 workman’s compensation claim
 disputed identity
 Burial of wrong body.
Authorization:
 The body is exhumed only when there is written order from magistrate, police
cannot order for exhumation.
Procedure:

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  It should be done in daylight
 It should be done under supervision of medical officer & magistrate
 Before opening the grave , it should be identified from location of burial plot and
grave maker
 The grave with body should photographed
 The body sent for post mortem examination care fully
 Disinfectants /pesticides should not be sprinkled on body
 The soil of grave should be preserved

POST MORTEM EXAMINATION IN POISONING CASE

Post Mortem Examination or diagnosis of poisoning – it is done by the doctor externally &
internally to find out the cause of death. Especially the alimentary system should be
examined as signs of corrosive and irritants poisons likely to be found. These signs may
manifest as hyperemia, softening, ulceration and perforation may be present. In case of
doubt histological examination should be done.

1. Post mortem examination

A. External Examination:
1. Surface of body & clothes are examined- for any evidence of stain, struggle &
injury mark, Injections mark/ Insect bite.

2. Natural orifices- mouth, nostrils, anus, vagina, urethral, orifice, examine for the
presence of poisonous substance.

3. Color of Skin-& Mucous Membrane – The color changes in corroded skin &
mucous membrane is Examine in suspected case of poisoning to identify the
specific poisoning agent.

 yellow skin color indicate- copper & phosphorous poisoning

 Bright Cherry red skin indicates- carbon mono oxide poisoning (CO)
 Gray & Black color indicates—sulphuric, Hydro chloric & Acetic Acid.
 Brown & Yellow Color- in Nitric Acid
 Gray- White color in- Carbolic Acid & Caustic Alkalis.
 Gray- Black color in- Oxalic Acid.
 Bluish- White color in Mercuric Chloride
 Whitish color in Zinc-Chloride.

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 4 .Color of Post Mortem Staining - (P.M. Lividity, P.M. Hypostasis, and P.M.
Suggillation)

it is bluish or reddish purple discoloration at the undersurface of the skin of the

dependant part of the body due to capillo-venous distension with blood & setting of
blood in those area due to pull of the gravity when circulation of blood ceases. Post
Mortem Staining appears 30 minutes to 2 hours after death

 Cherry Red color- in Carbon Monoxide

 Deep Blue color - in Carbon Di-Oxide
 Bright Red/ Pink in- Cyanide Poisoning
 Dark Brown/ Yellow- in Phosphorus or Copper
 Black Color- in opiates poisoning.

5. Odor / Smell— odor of substance help in identify the poisoning-

Garlicky Smell – indicates- Phosphorus, Arsenic, Thallium, Parathion, Melathion,

Aluminum Phosphide (Celphos)
Sweet & Fruity Smell---indicates- Ethyl alcohol, Chloroform, and Nitrites.
Acrid Smell- indicates-- Chloral Hydrate, Formal-dehyde.
Rotten Egg Smell –Indicates---Hydrogen sulphide, Di-sulphiram.
Bitter Almond Oder –indicates- Hydro-Cyanic Acid (Prussic Acid)
B. Internal examination:-

It is done during process of postmortem of the body.

Odor / Smell In suspected case of poisoning skull should be opened first to detect
unusual odor in the Brain because body mask such odors
Mouth-& Throat - Mouth & Throat examine for any evidence of inflammation,
erosion, or staining
Upper respiratory tract- examine for any evidence of edema, of glottis & congestion
of mucous membrane of trachea & bronchi.
GIT- (Esophagus, Stomach, Intestine)- examine for any evidence of inflammation,,
hyperemia of mucous membrane of G.I. Tract & perforation of stomach.
Liver & Kidney- examine for any generative changes which may occurs due to
Hepato toxic &Nephro Toxic poisons Arsenic, mercury phosphorus, Alcohol,
Aluminum Phosphide, Zinc phosphide , Oxalic Acid, Carbolic Acid, Thallium, ,
Turpentine.
Spleen, urinary bladder, rectum- seen for any changes

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 Heart & brain- are examined properly for any inflammation, staining or any
changes if present noted clearly Sub endo cordial Hemorrhage in Lt. ventricle seen
in poisoning with Arsenic, Mercury, Phosphorous, Viper bite.
2. Chemical Analysis:-

The most important proof of poisoning is the analytical detection of poison in the
parenchyma of the organs of the body, in food, medicine or fluid which is taken by the
victim/ patient.

3. Moral and Circumstantial Evidence:- Clues regarding from, relatives, friend, recent
purchase of poison by the victim or accused, his behavior, suicide note, history of quarrel,
financial problems may provide valuable information.

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COLLECTION & PRESERVATION OF SPECIMEN & VISCERAS FOR
TOXICOLOGICAL ANALYSIS & HISTOPATHOLOGICAL EXAMINATION
Procedure for sample collection & preservation:
The sample must be labeled with the patients name, address, hospital number, & date
of collection. The doctor signature should be placed on the label& sample should be
handed to a authorized person maintaining the chain of evidence like- police officer,
lab in charge

For chemical analysis samples are collected under following circumstances:

1. When investigating officer request.
2. When medical officer suspect the presence of poison while conducting autopsy
3. In unnatural & suspected death of poisoning
4. In decomposed bodies
5. In Alcoholic person

Commonly in most of cases following specimens are collected & preserved for
examination
1. Blood
2. Urine
3. Stool
4. Vomitus material
5. Whole Stomach & intestine its content
6. Upper part of small intestine about 15-30 c.m. & its content
7. Liver 300 gm.
8. Kidney longitudinal half
9. Spleen Whole
10. Complete hair with root
11. Nails with nail bed
12. Skin & muscle
13. Bone & bone marrow
14. Maggots from decomposed body.

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Collection of samples for laboratorical investigations
The specimen are preserved at 40c until they are analyzed, for long term storage freezer (-
100c) is used.
1. Blood sample obtain from femoral vein or subclavien vein. Or from right ventricle of
heart, at least 10 ml blood collected in bottles containing suitable preservative like:-
a) 0.5% Sodium citrate solution containing 0.25% formalin
b) Potassium oxalate solutions, Sodium fluoride solution
c) Sodium nitrate solution
2. Urine sample obtained by supra pubic puncture & collect 100 ml urine with suitable
preservatives in screw tight bottles
a) sodium chloride solution, Thymol
b) Rectified spirit, Sodium benzoate solution
3. Feces/ stool: placed in plane screwed tight jar in saturated solution of sodium chloride.
4. Vomit& stomach contents placed in clear jar with a tight fitting lid in sodium chloride
solution.
5. Liver & other organs placed in jar for histopathological examination with suitable
preservatives like:-
a) Saturated solution of common salt / Sodium chloride solution
b) Rectified spirit or 95% alcohol, 10% Formalin
6. Hair & Nails collected in envelop in suspected heavy metal poisoning: - Arsenic,
Antimony, Thallium etc.
7. Bone sample taken from shaft of femur bone & collect in formaldehyde/ rectified spirit
8. Bone marrow collects from sternum/ femur/vertebrae & preserved in rectified spirits
9. Skin & muscle obtained from Thigh :-( Quadriceps) & preserve in 10% formalin
10. Maggots from decomposed body collect in jar with absolute alcohol or 10% hot
formalin
11. In case of Alcohol poisoning body parts preserved in Ethylene glycon.
Generally body organs & tissues are preserved in 10% Formalin.

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Different Visceras and material are required in suspected circumstances or poisoning
cases

1. Heart: in strychnine , digitalis, aconite, poisoning

2. Brain: Alkaloids, Organophjosphorus, Opiates, Cyanide, Carbon monoxide and

strychnine poisoning

3. Spinal cord: in Strychnine poisoning

4. CSF: alcohol poisoning

5. Lungs: Irrespirable gases , HCN acid, and alcohol poisoning

6. Skin: injected poisoning

7. Bone , Hair & nails: in heavy metal poisoning

8. Fatty tissue : in pesticides & insecticides poisoning

9. Muscles: in decomposition

10. Uterus: in Criminal abortion

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