Forensic autopsy

1. Forensic Autopsy
Waoud Makhdom

2. Objectives
By the end of this lecture you’ll be ableto:
O Understand the fundamentals of the forensic
autopsy.
O Illustrate how to identify cadavers and the
mortuary process.
O Recognize dealing with high risk cases.
O The importance of external and internal
examination.
O Explain the process following postmortem
autopsy.

3. Category of death
O Natural causes
O Accident
O Suicide
O Homicide

4. Autopsy
O Autopsy is defined as “scientificdissection
of the dead body”.
O There are two types of autopsies in practice:
i. Pathological autopsy
ii. Medicolegal autopsy

5. Autopsy
i. Pathological autopsy
 Academic autopsies are done toacquire
knowledge.
 cases of natural death
 Consent is mandatory
t
ii. Medicolegal autopsy
 Investigative scientific dissection of a dead
body
 Done under an authorization of thepolice
 here is no need for consentof the relatives
 Unnatural I
at
ndsuddenIet
deaths

6. The purpose of Forensic
Autopsy
O Determine the identity of the body
O Estimate the time ofdeath
O Identify and document the nature and numberof
injuries
O Interpret the significance and effect of theinjuries
O Interpret the significance and effect of thenatural
disease present
O Identify the presence ofpoisons
O Interpret the effect of any medical or surgical
treatment
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7. No post-mortem examination
O Occasionally in high riskcases
O Some occasions after examination of historyand
medical notes
O Post-mortem diagnosis
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from CT or MRI Biopsy

8. Dealing with high risk cases
A high risk case is defined as a case where there is a serious infectiousdisease
which can be caught by those present at the autopsy
O Serious infections that causeconcern:
◦ Human Immunodeficiency Virus (HIV), Hepatitis A, B or C,Tuberculosis,
Anthrax, and Typhoid
O Precautions:
 e.g., history of drug addiction. Test blood prior to autopsy for HIV and
Hepatitis status.
 Wear protective clothing including double gloves.
 Electric saws should only be used by working under plastic.
 Cleaning agents and disinfectants such a bleach, formalin, cidex and
sodium hydroxide should be available for cleaningup
 Care with sewing up afterautopsy.
E

9. Fundamentals of Forensic Autopsy
1) History tothe
pathologist
2) Chain of custody
3) Identification
4) Documentation
5) External Examination
6) Internal Examination
7) Taking and retaining
samples
8) Re-visiting the body
9) Communicate withthe
Police

10. Review of the history and
medical notes
O Review of the circumstances prior to the autopsy
O Witness statements: lay and professional
O Examining and interpreting medical notes
O Consultation with medicalcolleagues

11. Identification
“Essential to identify body in any
investigation”

12. Identification of the Non-
decomposed cadaver
O Recognition process – relies on memory
I
O General identification – what type of individual
are we trying to identify?
O Comparative – collection of antemortem records
for comparison

13. Visual - Recognition
O Difficulties in identification
 family in ‘denial’
 less similarity than in life as anticipated – ‘lifeless
appearance’
 facial injuries or other disfiguring factors
effect of psychological stress on ability toidentify
O LIVE OR ON TVMONITOR
 2D image. Shadows and other quality issues.
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Short answer question

14. Documentation
O Needs to be accurate, ordered,retrievable,
transmissible, secure and consistent.
O One person to coordinate informationUnique
and clear identifiers

15. Photography
O The post-mortem findings and photographs are
taken at the direction of thepathologist.
O It is essential to take general views of the body,
dressed and undressed, front and back, then all
injuries, with a scale.
O Internal photographs of the body are also taken,

16. External examination of the clothed body
O Typeof clothing
O Property
◦ It is essential to consider the contents of the deceased's pockets
 identification,
 clue to motive fordeath,
 attempt to prevent identity and/or theft
O Damage and stains
◦Tears, cuts and stains on clothing such as blood stains, paint etc.
should be assessed in relation with the injuries and other marks to
thee
body.
O Arrangement of clothing
◦ The body may have been dragged; there maybe sexual interference,
de
oath.
with movement or repositioning or occasionally re-clothin
fg
obodyafter

17. External examination of the unclothed body
O General examination
◦ general description of the nourishment, height, hairdistribution,
colouration and general state of the body. This should include an
assessment of rigor mortis, body temperature, distributionof hypostasis,
state of cleanliness, distribution of any blood and other body fluids or marks
on thebody.
O Labeling and numbering ofinjuries
◦ documenting injuries with numbers or letters is useful in similar wounds e.g. stab
wounds. All injuries should also be accompanied by a scale when photographed.
O Classification and assessment of injuries
◦ Injuries should be examined in terms of the distribution, morphological
appearance and assessed as to mode of causation; occasionally, there may
be a pattern which will assist in identifying the type of object or surface
causing the injury.Injuries age and severity and whether they are ante-
mortem orpost-mortem.
O Time of death
◦ to make a reasonable estimate of the time of death.
or
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l e
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19. The internal examination
 T
odetermine extent and severity of injury in cases
involving trauma.
 If cases with a number of injuries, to determinethe
role of each in causing death.
 T
odetermine the cause of death.

20. Laboratory investigation following post-mortem
O Blood
• For DNA profile identification.
• Essential for comparison with other samples
• of blood found e.g. blood stains atscene.
• Toxicology: Alcohol and drugs analysis, poisons
O Urine:
• Toxicology
• Biochemistry
O Other fluids or tissues: e.g. vitreoushumor,
stomach contents, bowel contents, muscle, brain,
kidney, lung, bone marrow, hair, nails etc
• Toxicology
• Biochemistry
• DNA
• Diatoms
O Swabs
• Oral
• Genital
• -anal, rectal
• -penile (glans, coronal, sulcus and urethra)
• -vaginal (low, high and external)
• Semen, vaginal material
O Fingernail clippings orscrappings
• Transfer of material from suspect
O Head hair
• Compared with other transferred hair, DNA, drugs
O Pubic hair
• Transfer of semen or comparison with hairat
scene
O Histology
• Microscopical assessment of disease process,
ageing injuries etc
Dr
most accurate

21. Samples – Packaging
O Aim to prevent destruction and contamination
O New containers must be used, sterile ones with
some evidence
O Seal at crimescene/mortuary
O Drying of biological fluids, prevents destruction or
contamination by bacteria

22. Sending the tissues ororgans
for analysis:
Histopathology:
O The tissues are preserved using formalinas
preservative (10% formaldehyde).
O Labeled and sent to the pathology lab,with
description of autopsy findings concerned
with that particular organ.

23. Further action after theautopsy
O Pathologist will initially identify key issues at thepost
mortem and from background information
O Pathologist discussing the post mortem findingswith
next of kin is good practice and provides a better
understanding of the cause ofdeath
O Obtaining assistance from other experts/
multidisciplinary approach is essential in somecases

24. Preparation of reports and presentation
of evidence
Reports should be prepared, taking into accountthe
following:
• Authority to carry out autopsy
• Identification methodology
• Documentation of evidence
• Chain of custody
• Statement of facts
• Statement of opinions including cause ofdeath
• Further reports/conferences as required toclarify
issues

25. THANK YOU