All about Autopsy in forensic medicine.

1. The Forensic Autopsy
Dr.M Qadeer Naqvi

2. What is an Autopsy?
“See for yourself”
A post mortem
examination
performed to
determine the cause
of death.

3. Types of Autopsy
There are four main types of autopsies:
1.Medico-Legal Autopsy or Forensic or coroner's autopsies seek to find the cause and
manner of death and to identify the decedent. They are generally performed, as
prescribed by applicable law, in cases of violent, suspicious or sudden deaths,
deaths without medical assistance or during surgical procedures.
2.Clinical or Pathological autopsies are performed to diagnose a particular disease or
for research purposes. They aim to determine, clarify, or confirm
medical diagnoses that remained unknown or unclear prior to the patient's death.
3.Anatomical or academic autopsies are performed by students of anatomy for study
purpose only.
4.Virtual or medical imaging autopsies are performed utilizing imaging technology only,
primarily magnetic resonance imaging (MRI) and computed tomography

4. Why is a Forensic Autopsy preformed?
Cause of death
deemed suspicious,
or involves criminal
action.

5. Objectives of autopsy
• To determine the identity of a person.
• To determine the cause of death.(disease , trauma
or intoxication)
• Manner of death;
• Natural or unnatural, if unnatural –suicidal,
homicide or accidental.
• In homicide any trace evidence left by the
accused on the victim.
• To determine the time since death
• In case of new born infants, determine whether it
was a live birth and its viability.

6. • In a forensic autopsy, a medical examiner or
coroner declares the death to be:
– Natural
– Accident
– Homicide
– Suicide
or
– Unknown

7. Natural Death
• Caused by a known disease: cancer, heart
disease, stroke, genetic disorders, etc.
• Often just simply “old age”

8. Accidental Death
• Caused by mistake or freak occurrence.
• Death not planned, but can be explained by circumstances.

9. Homicidal Death
 the killing of one person by another.
 Lots of people…
 Genocide – the deliberate killing of a large group of people,
especially those of a particular nation or ethnic group.
Homicide is the most investigated death,
therefore the most autopsied.

10. Suicidal Death
• Killing of self.
• Often the easiest to identify the cause.
• Can be elaborated further in the report…
• Toxic, firearm, blunt force trauma, asphyxiation,
etc.

11. Unknown Death
• Deaths in absentia
• At sea
• Badly decayed bodies

12. Protocol for Performing
A Forensic Autopsy?
• Corpse brought to Medical Examiner
• In a new body bag/clean sheets
• Avoids cross-transfer of evidence
• Placed on dissection table

14. Here's how an autopsy is done.
-The body needs to be identified first and lawful consent should be obtained.
-The procedure is done with respect and seriousness.
-The prevailing mood in the autopsy room is curiosity, scientific interest, and
pleasure at being able to find the truth and share it.
Many autopsy services have a sign, "This is the place where death rejoices to
help those who live." Usually it is written in Latin ("Hic locus est ubi mors
gaudet succurrere vitae").
Autopsy practice was largely developed in Germany, and an autopsy assistant is
traditionally honored with the title "diener", which is German for "helper".

15. STAGES OF AUTOPSY EXAMINATION
• Physical examination of clothes and collection of evidence in
them
• Physical examination of body surfaces and collection of any
evidence
• Opening of the body cavities
• Scrutiny of internal contents of cavities and vital systems
• Collection of specimens
• Closure of the body / reconstruction
• Disposal of dead body – relatives/ police /contractor

16. External Examination
Steps of an external examination.
1. Photographed.
2. Physical evidence collected off body.
3. Samples of hair, nails, etc. are collected.
4. Undressed, examined for wounds.
• Lacerations, abrasions, bruises.
5. Measured, weighed, cleaned.

17. Physical examination of the clothes
o Preliminary inspection
o Description of holes, cuts, tears
o Removal of clothes from the body
o Drying of wet clothes and preservation
o Collection of any foreign material –glass pieces, hair, foreign fibers -n
matching the clothes of the deceased

18. Physical examination of body surfaces
• Inspection (naked eye and with magnifying glass) and
palpation of body surfaces
• Abnormal coloration of skin
• Presence of injuries
• Location and extent of hypostasis
• Examination of the natural orifices – oral, auricular, nasal, ocular,
anal, vulvar / groin / axila etc

19. Poisoning cases
• Smell of the body and viscera.
• Postmortem staining and its colour.
• If froth present,its nature.
• Colour of sclera, lips and nails.
• Mouth and surroundings.
• Injuries.
• Details of G.I tract examination.
• Description of stomach and contents.

20. Burns cases
• Smell from the body,kerosene other inflammable agents.
• Nature of burns.
• - Antemortem
• - Postmortem.
• Extent and degree of burns.
• Age of burns.
• Injuries other than burns.

21. Autopsy
• Palpation of the body surface
• Detection of rigor mortis
• Detection of lump or foreign body – bullet, pallet
• Examination of the external injuries
• Shape, size, site (in relation to fixed anatomical landmark),
number and pattern of distribution
• Correlation of holes, cuts, extent of blood soaking with injuries
• Defense wounds / hesitational cuts / cadaveric spasm

22. Signs of death
• Respiratory arrest (no breathing)
• Cardiac arrest (no pulse)
• Pallor mortis, paleness which happens in the 15–120 minutes
after death
• Livor mortis, a settling of the blood in the lower (dependent)
portion of the body
• Algor mortis, the reduction in body temperature following
death. This is generally a steady decline until matching
ambient temperature
• Rigor mortis, the limbs of the corpse become stiff (Latin rigor)
and difficult to move or manipulate
• Decomposition, the reduction into simpler forms of matter,
accompanied by a strong, unpleasant odor.

23. INTERNAL EXAMINATION
It consists of:
1. Incising the body
2. Inspecting the various organs
3. Examining the cavities systematically
4. Weighing and measuring the organs
5. Checking for any pathology
6. Putting all the organs back in and padding
7. Suturing the body

24. 1. ‘I’ shaped Incision: It is a straight line incision
extending from the chin to the symphysis pubis.
2. ‘Y’ Shaped Incision: This type of incision starts
near the acromion process and progresses
downwards towards the xiphoid process. The
incision is then extended till the symphysis pubis.
Also, a similar incision is made on the opposite side
of the body.
3. Modified ‘Y’ Shaped: A ‘Y’ shaped incision is
made from the suprasternal notch to symphysis
pubis. It extends from the suprasternal notch over
the clavicle to its center on both sides and passes
upwards over the neck, behind the ear.

28. Viscera to be collected for Chemical Examination
• Stomach with contents.
• Upper part of small intestine.
• - 30cms with contents.
• 500gms of liver and half of each kidney.
• 5-10ml of blood.
• 30ml of urine.

29. REMOVAL OF ORGANS
1. Virchow’s Technique:
• In the Virchow technique, the organs are removed one by one
and dissected as removed.
• Head  Thorax  Abdomen
2. Rokitansky’s Technique:
• This procedure is characterized by in situ dissection, in part
combined with en bloc removal
3. Letulle’s Technique:
• (Removed en masse and dissected as organ block.)
• Cervical  Thoracic  Abdominal  Pelvic Organs

30. • Virchow’s approach is good for
demonstrating pathological change in
individual organs, especially in high-risk
autopsies or where permission is limited to
one organ
• Letulle method is the best technique for
preserving the vascular supply and
relationships between organs.

31. ORDER OF EXAMINATION
VIRCHOW’S TECHNIQUE 
Head
Thoracic (Cervical)
Abdominal Organs

33. AFTER COMPLETING INTERNAL EXAMINATIO
• Body cavities should be cleaned and made free from blood, fluids etc.
• Organs are placed back in and excess space is packed with cotton/cloth
etc. (esp. in the pelvis and the neck regions.)
• Dissection flaps are closed and sutured.
• Skull is filled with cotton and absorbent material and the skull cap is
placed back in and the scalp is stitched.
• Body is washed with water, dried, covered with clothes and handed over
to the police officials.

34. Autopsy
 Reconstruct the body – to make it presentable for the
relatives
 Disposal – hand over to relatives through police – if
unclaimed keep in refrigerator and arrange to inform the
official burial contractor / may be handed over to anatomy
department

35. Autopsy
Post mortem artifacts
 Artifact – artificial product or feature which is not real but
added to original by processing / handling
 Artifacts added to dead body during post mortem period
Causes:
 Post mortem phenomenon
 Physical handling
 Interference by scavengers / insects / animals

36. Before death
 Therapeutic artifacts.
 Surgical artifacts.
At the moment of death
 Agonal artifacts. (Aspiration of gastric contents)
 Resuscitation artifacts

37. After death
 Artifacts due to the handling of the body.
 Artifacts related to rigor mortis.
 Artifacts related to postmortem lividity.
 Artifacts due to animal bite.
 Artifacts due to chemicals.
 Artifacts due to refrigeration.
 Embalming artifacts. (preserving effects)

38. Artifacts during autopsy
 Air in blood vessels.
 Skull fractures.
 Visceral damage.
 Extravasation of blood.
 Fracture of hyoid bone.

39. Negative Autopsy
 When gross and microscopic examination and other
investigations fail to reveal a cause of death,the autopsy is
considered to be negative.
- Men.
- Material.
-Method.

40. Men
 Lack of experience.
 Lack of training.
Material
 Inadequate microscopic examination.
 Insufficient laboratory examination.
 Lack of toxicological analysis.

41. Method
 Inadequate history.
 Lapses in external examination.
 Inadequate or improper internal examination.

42. Obscure Autopsy
 Which do not reveal the cause for death in which there are
trivial,equivocal or obscure findings or no positive findings.
Causes
 Natural diseases.
-Death by emotion or work stress.
-Death due to functional failure-
epilepsy,paroxysmal fibrillation.

43. Biochemical disturbances
 Uraemia,diabetes,potassium deficiency.
 Anoxic anaemia.
Endocrine dysfunction
 Adrenal insufficiency.
 Thyrotoxicosis or Myxoedema.
Concealed trauma
 Concussion.
 Blunt injury to heart.
 Reflex vagal inhibition.

44. Poisoning
 Narcotic poisoning.
 Anesthetic over dosage.
 Neurotoxic or Cytotoxic poisons.
 Plant poisoning.
Miscellaneous
 Allergy.
 Drug idiosyncrasy.