Medicolegal

autopsy
 2. Pathological or clinical autopsies are
performed by the pathologists or clinicians to
diagnose the cause of death, where
diagnosis could not be reached during
treatment, or to confirm diagnosis where the
same was doubtful.This also helps the
pathologists to know the pathology of organs
due to some diseases.
 3.Medicolegal autopsies-
In unnatural and suspicious circumstances of death,
dissection of the dead bodies and their examination is
compulsory by law. The purpose of medicolegal
autopsies is to find out the cause of death and help
disbursement of justice if any crime is involved in the
circumstance of the death.
 1.To know the exact cause of death
 2. To find out the circumstances of death.

 3. To find out the time passed after death.

 4. In case of unidentified dead body, to

establish identity of the deceased or to help
to do so.
 5. In case of death due to injury or poisoning, the
period for which the deceased survived after
sustaining the injuries or exposure to poison.
 6. To know the nature of death, whether it is a
case of natural death or a case of suicide,
homicide or accident.
 7. What type of weapon or which poison was
used?
 8. Whether one or more than one person
was/were involved, in case of homicide.
 9. Whether any natural disease process
contributed in any way, to cause the death.
 10. Whether any other offence was related with
the death e.g., rape.
 11 ． Is the injury which has caused death,
expected to cause death in ordinary course of
nature ？
 12 Whether the dead body was disturbed
sometime after death.
 13. What was the place of disposal of the
dead body ？ Whether the body has been
shifted from original place of disposal.
 14. To know whether more than one method
or more than one weapon were used.
 Autopsy or postmortem examination
isperformed on dead bodies with the following
purposes
 1. Academic 一 Dead bodies are dissected by
the students of Anatomy for academic
purposes to know details about the different
external and internal organs and structures of
the human body.
 15. Whether the deceased received any
treatment before death.
 16. Whether there is anything on or with the
dead body which may help identification of the
assailant.
 17. In case of death due to assault, the relative
positions of the victim and the assailant/s.
 Procedure to conduct medicolegal postmortem
examination －
For conduction of medico-legal post-mortem examination
certain formalities have to be observed.
1. It can be conducted only on the strength of a requisition
received from an authorised person. (Ordinarily a police
officer, a magistrate or a coroner is authorised to issue a
requisition for conduction of medicolegal post-mortem
examination).
 With the requisition, a copy of the inquest or the
preliminary investigation report, a dead-body
challan and any other paper of importance,
should accompany. 2. Medicolegal P. M.
examination can be performed only in an
authorised centre.
 3. All registered medical practitioners in Govt.
service can conduct the examination.
 4. A police officer or any other authorised person
should identify the dead body in connection with
the concerned case, before the autopsy surgeon.
 5. Conduction of medicolegal P. M. examination
does not require any consent from the relatives or
friends of the deceased ．
 6. The dead body should preferably be dissected
with the help of natural sunlight. But under special
circumstances of urgency, it may be carried on at
night, with the help of artificial light. If feasible, the
body may once be examined (external), when it first
reaches the mortuary, if it reaches at night.A detail
examination should be undertaken in the next day
when sufficient natural light is available.
 7. The mortuary should have cooling
chambers for preservation of dead bodies.
The doors and windows of the mortuary
should be fly proof. There should be plenty of
water supply in the mortuary for proper
cleaning and washing purposes. The
mortuary should have facilities for disposal of
dead bodies ．
 It should have dissection table, instruments and
other equipments and articles. When a dead body
reaches the mortuary, the date and hour of its
arrival and then the date and hour of conduction of
the P. M. examination should be recorded ． It is
recommended that, the autopsy surgeon should
himself dissect the dead body with the help of an
assistant and his other assistant will write down the
findings dictated by him.
 Before starting the P. M. examination
proper, the doctor should go through the
inquest report and the requisition and must
get the body identified by the accompanying
police personnel.
 P. M. Examination Proper
 1. The description of the dead body should
first be noted with the wearing apparels in
situ.Then the wearing apparels should be
removed from the body, disturbing the body
and the wearing apparels minimum.
 2. Detailed examination of the dress and other wearing
apparels should then be made in respect of their
number, make, design, stains on them, old and recent
tears, cuts with their dimensions. These may have to be
examined once more after conduction of the P. M.
examination, to compare the tears, cuts and blood
stains on them with injuries on the body. The tears and
cut marks should be measured and their placements
noted. After P. M. examination these should be sun-
dried, packed, sealed and handed over to the police
authority.
 3. Examination of the dead body ：
 A. External examination ：
The following points should be recorded.
 (a) Body length
 (b) Body weight
 (c) Built, complexion
 (d) Scalp hair--length, colour, recent hair cut, part
shaved, use of any dye, singeing, whether wet, presence
of dust, mud, stains, if partly fallen off, vermilion mark,
baldness, sharp cut on hair, crushing of hair bulb due to
injury
 (e) Description of beards and moustaches
in their length, colour, trimming, shaving,
absence
 (f) Vermilion mark on the forehead

 (g) Any tattoo mark, moles or mentionable

scars, deformities in the body-
 (h)Condition of the eyes--closed or open,
corneas--hazy or clear, condition of the
pupils--shapes and sizes of both the sides.
Any congenital or acquired deformity or
disease, prosthetic eye, scar on cornea,
petechial or subconjunctival haemorrhages,
cataract.
（ i ） Any discharge from mouth or nostrils
－ frothy, blood stained, dribbling of saliva,
suspected poisonous stain.
 (j) Protrusion or biting of the tongue.

 (k) Congestion, petechial haemorrhages.

 (l) Cyanosis 一 fingertips or elsewhere.

 (m) State and distribution of post-mortem
staining, its colour.
 (n) Blood, mud or other stain on the body.

 (o) State and distribution of rigor mortis.

 (p) Cadaveric spasm, content of the hand.

 (q) Cutis anserina.

 (r) Any foreign material any where in the body
including the nail beds. Mud or sand stain on the
soles.
 (s) State of decomposition.
 (t) Maggots.
 (u) Any adepocere or mummification change.
 (v) Condition of the prepuce 一 circumcised or not,
condition of the scrotum and testicles.
 (w) Female breasts--parous, gravid.
 (x) Discharge per vagina, any other
findings.
 (y) Any antemortem injury anywhere in the
body including inside of nose, inside of
lips, inside of mouth, over female breasts,
private parts of females including inner
aspect of thigh, hvmen, vagina.
 (z ） Any suspected stain (poison, seminal
fluid) on lips, hands, mons veneris private
parts, vaginal wall.
 (zz) Any ligature mark on the neck or
elsewhere, its position, dimension, direction,
position of the knot.
 If the ligature material is present in situ, then it
should be taken out by tying the knot with a
thread and then cutting the ligature material at a
point opposite to the knot. The ligature material
should then be examined in terms of, which
material it is made of, the design, length of the
part encircling the neck, length of the remaining
part, breadth of the ligature material, how many
rounds it is twisted around the neck, type of the
knot, whether the ends of the ligature material
bear any recent cut mark, the strength of the
material ．
 The ligature material should then be
packed, levelled, sealed and handed over to
the police of the concerned police station.
 Any stains on any part of the body should
be scrapped out, preserved without any
preservative.
 Examination of External Injuries
 All external wounds should be recorded in all their
details, on the following headings ：
 (a) Type of injury
 (b) Size
 (c) Shape
 (d) Site, in relation to two external anatomical
landmarks.
 (e) The weapon of infliction or the mode of
causation (usually not mentioned in the P.M.
report).
 (f) The direction of application of the force.
 (g) For the fatal wounds, the distance of the
wound from the same side heel may be
recorded. This may help to reconstruct the
incident.
 （ h ） The time and date of infliction of the
injury should be studied ． This can be done
from inflammatory, healing changes and also
from the colour changes.
 (i) The vital reaction should be noted, presence of
which differentiates antemortem injuries from the
postmortem ones.
 (j) Presence of defence cuts or injury at the expected
sites prove the homicidal nature of injury and death.
 (k) Marks of resistance in the form of minor injuries on
the non-vital parts of the body has the same
significance.
 (1)Concealed punctured wounds are
homicidal in nature and search should be
made for their presence.
 (m) Split laceration inflicted on the forehead,
scalp or some other areas, against a bony
prominence looks like incised
wound ． Hence, such doubtful injuries at
these sites should be examined carefully with
the help of a hand lens.
 (n) Burn injuries should be recorded in all
details of their extent and other features.
 (o) It should be kept in mind that, abrasions can
be caused on a dead body due to rough and
careless shifting of the body, from the place of
death to the mortuary.
 (p) In dead bodies, removed from rivers or
ponds, P. M. injuries caused by fish or aquatic
animals, may be present. Similarly, P. M. injuries
due to gnawing by other animals, starting from
dog to rodents, may be present in other bodies.
Post-mortem injuries in the form of abrasion,
may be caused by ants or cockroaches.
 (q) Injection marks and other signs of treatment
given, should be searched for and recorded.
 B. Internal Examination
 For internal examination, the different body
cavities are to be opened in a planned way.
 A single incision is given for opening of the
thoracic and abdominal cavity both. To open
the cranial cavity two incisions are
recommended. To expose the structures of
the neck, three different incisions are
recommended ．
 (a)To open the chest and abdominal
cavities, one single incision, starting from
the sternal notch above, to the symphysis
pubis below, through the right side of the,
umbilicus is applied. If there is any injury on
the right side then, left paramedian incision
can be applied ．
 1.Stomach 一 The stomach is first taken out
by placing two ligatures at the cardiac end of
the oesophagus and two ligatures below the
pylorus end of the stomach. The stomach is
removed by cutting between the double
ligatures at both the ends. The stomach is
opened along the lesser curvature.
 Thewall of the stomach is thoroughly examined.
Presence of any stain, congestion, haemorrhagic
points, desquamation, ulceration, sloughing or
perforation should be noted ． The content of the
stomach is noted in respect of quantity, nature of
material/food, state of digestion, colour, smell, any
evidence of haemorrhage etc.
 2. The liver should be removed and any
injury or pathology in it should be noted ．
It should be weighed. A part of the liver
(minimum 500 gm.) should be taken out
for preservation for chemical analysis. In
case, any pathology is suspected in its
gross appearance then, a small portion
from the suspected area is dissected out
along with bordering healthy tissue and
preserved in 10% formol saline.
 For macroscopic examination of inside of
the liver, multiple transverse incision at 1
cm. apart should be given. The gall bladder
is dissected out along with the liver. Any
pathology or stone formation inside is
noted ．
 3. The kidneys are taken out along with the
adrenal glands, after tying the ureters along
with the vessels at least one inch away from
the hilum of each kidney. The surface of the
kidneys along with the covering capsules
should be examined for presence of
congestion, haemorrhage and injury. The
capsules and the adrenals are separated ．
 The kidneys are bisected transversely along
the longitudinal axes ． Any pathology,
congestion, haemorrhage or injury should be
noted with exact mention of the sight and
extent. In case of possible pathology,
suspected part along with marginal healthy
tissue should be preserved in 10% formol
saline.
 4. The urinary bladder may be examined in situ.
Before opening the bladder, if it contains urine, that
should be syringed out, or can be taken out with the
help of a clean spoon after incising the bladder,
avoiding all chances of contamination by blood or
any other material. The bladder should be examined
for any pathology, haemorrhage, congestion or
injury.
 5. Both the ureters should be opened along their long axes.
 6. The spleen is then taken out and pathology or injury
noted ．
 7. The intestine is dissected in its entire length. It is
particularly important to look for any injury or reaction due
to the effect of poison or presence of a foreign body like a
bullet. Curling ulcer is a phenomenon noticed in the
duodenum after about 7 to 10 days of sustaining extensive
burn' injury. Ulcerative colitis like lesions are noticed in
case of poisoning with mercuric chloride.
 8. In penetrating wounds of the abdomen, the
intra-abdominal vessels may be injured and there
may be excessive intra-abdominal
haemorrhage ． Excessive intra-abdominal
haemorrhage also occurs due to gross injury to
abdominal organs like liver, kidneys and spleen.
 9. The pancreas and the adrenal glands are to be
examined. If necessary, tissue from these glands
are to be preserved for histological examination.
 10. The uterus and its appendages should
first be examined in situ and then removed
enmass along with the vagina. The uterus
should be examined in respect of its
dimensions, weight, whether gravid, parous
or nulliparous or whether there is any
pathology in it.
 In case of gravid uterus, condition of the
whole product of conception should be
noted down. Any evidence in support of
abortion or attempted abortion with remains
of any part of the product of conception
inside the cavity should also be recorded.
 If there is evidence of attempted abortion then,
the endometrial surface should be thoroughly
examined in respect of colour, erosion or any
other damage including ulceration or perforation of
vaginal canal (particularly near the fornices) or of
the uterine wall. Foreign body in the form of root,
bark (for that purpose any material which might
have been used locally to cause abortion) may be
present inside the uterine cavity.
 Smell and nature of the fluid present inside
the uterine cavity may be further indicative in
this regard. Death in occasions may occur
due to other causes (pathological),
preceeded by haemorrhage locally, or
systemic effect indirectly. Evidence of use of
instruments may be present in the Cervix or
in os.
 11 ． Rupture of an ovarian cyst may be a
very rare cause of death, sometimes
associated with history of trauma ． The
ovaries should be searched for presence of
corpus luteum. Fallopian tubes and ovaries
have special medicolegal significance in
cases of deaths due to their rupture in ectopic
pregnancies.
 To open the chest cavity, after retraction of the
skin sidewise, the cartilaginous parts of the ribs
are cut on both sides and the manubrium
isseparated from the clavicles at the sterno-
clavicular joints. The sternum and the marginally
attached cartilaginous ribs are removed ． The
position of the intra-thoracic organs is observed.
But, for detailed examination they should be taken
out of the chest cavity. Before that, the neck
should be dissected and the structures there are
examined
 The intra-thoracic organs should be taken out
along with the neck structures namely, larynx,
trachea, oesophagus and also the tongue.
Before examining these organs, the chest
cavity is examined for haemorrhage or
haematomas, injuries including fracture of
ribs ． Fractures of ribs are better examined
by dissecting the intercostal muscles.
 1. After taking out the thoracic structures they are
once inspected before separation.
 2. The heart is separated after applying double
ligatures at the base of the heart over each large
vessels and then dissecting them in between the
two ligatures of each vessel. The size and weight
of the heart is noted ． The walls of the heart may
be hypertrophied or dilated ．
 The condition of the valves and presence and
degree of atheroma, noticed in the valves and the
intima of the large vessels, are noted Aneurysm or
other pathology in the vessels should be kept in
mind, in some cases of death. Any ischaemic
lesion, old or new infarction, should be searched
for. The patency of the coronary vessels and intra-
vascular clotting in the coronary vessels may be
looked for. For the purpose of examination of the
coronary vessels, probe of suitable size can be
used ．
 Others prefer multiple transverse incisions on the
vessels, while some others prefer longitudinal
incisions along the length of the vessels. Presence
of subendocardial haemorrhagic spots should be
searched for in some poisoning cases or
pathological conditions. Patent foramen ovale may
be noticed, particularly in young individuals, though
very rare ．
 To examine the myocardium, transverse
incisions are better. The cavities can be
opened by longitudinal or transverse
incisions. Any septal defect, haemorrhage
at any site or injury anywhere can thus be
clearly seen.
 For confirmation of any suspected pathology,
tissue should be preserved for histological
examination. Presence of clotted or liquid
blood or froth or air bubbles in the chambers
of heart should be noted with mention of the
quantity, which can be either due to
antemortem or postmortem causes.
 3. The pericardium should be examined for
presence of any pathology or injury. The
content of the pericardial sac and its
quantity should be noted ． Pericardial
effusion, cardiac tamponade, subpericardial
haemorrhage, constrictive pericarditis etc.
should be looked for.
 4. Both the lungs are to be separated from the
mediastinal structures after tying the vessels and
the bronchioles. The condition of pleura, any sign of
pleurisy or pleuritis or pleural adhesion, subpleural
petechial haemorrha-ges, injury to pleura, condition
of the pleural space (effusion, haemothorax,
pneumothorax, pyothorax etc.) should be noted.
 5. The lungs are examined for disease, injury and
some other findings. In asphyxial deaths the
surface of the lungs, particularly, the interfaces of
the lobes will show the presence of tardieu's spots,
and there will be congestion of both the lungs, with
oedema sometimes. In case of death due to
drowning, there won't be any tardieu's spot on the
surface of the lungs. But the lungs will be more
oedematous. The cut section exudes frothy blood-
tinged fluid.
 The lungs of submerged body may show evidence
of emphysema aquosum or oedema aquosum
change. Punctured or lacerated wounds cause
collapse of the particular lobe. In case of blunt
force injury, wound of the lung corresponds with
the fractured end of a rib. In case of any pathology
in the lungs, tissue may be preserved for
histological test. Thymus should be examined and
the tissue from the gland preserved, if necessary.
 Examination of the structures of the neck 一
The internal structures and tissues of the
neck should be examined thoroughly, in case
of death due to constriction of the neck or
injury or any pathology. For exposure of the
structures of the neck, ordinarily, the upper
end of the main incision at the sternal notch is
extended upto the symphysis mentii.
 Skin,subcutaneous tissue, muscles and
other structures are examined layer by
layer. But, when a more detail examination
is necessary or exposure of a wider area of
the neck is necessary, then a different type
of incision is preferred to.
 (a)A 'V' shaped incision is given, the apex
being at the sternal notch, with the two
wings extending upwards and iaterany uvto
the mastoid processes of both sues. The
skin is flapped up upto the margin or the
mandible.
 (b) A third variety of incision exposes still
wider area of the neck. Here, actually two
incisions are required ． One incision extends
from sternal notch to the symphysis mentii.
The other extends from the acromion process
of the clavicles of one side to the same point
of the other side. The skin is flapped upward
and outward ．
 Irrespective of the type of the incision, most
autopsy surgeons like to examine the neck
structures, before removal of the thoracic
organs so that the tongue, larynx, trachea
and oesophagus can be taken out along with
the lungs. This helps examination of the
whole of the upper respiratory tract in its
continuity.
 In case of death due to alleged constriction of the
neck, there may be fracture of hyoid bone or
thyroid cartilage with extravasation of blood in the
tissue and injury to carotid arteries, sterno-mastoid
muscles or platysma. Compression of the neck
with hard materials may cause injury to the
cervical vertebrae and the corresponding part of
the spinal cord. Level and extent of other
mechanical injuries on the neck should be
cautiously examined to know the type of injury and
organs or structures injured causing the death.
 Exposure of the Cranial Cavity
 One of the two conventional incisions can be used.
 (a) A circular incision around the head at a level
1˝above the eyebrow, extending sidewise upto the
occipital protruberance, keeping the scalp over the
protruberance intact. The scalp is flapped out
posteriorly. Any haematoma in the soft tissue of the
scalp is noted. The periosteum is removed and any
fracture in the skull bone is recorded as to its type,
position and extent.
 (b) The other type of the incision extends from just
above the attachment of one ear to the joint just
above the attachment of the other ear. In this
incision, the skin is f1apped out both anteriorly and
posteriorly. Rest of the procedure is same.
 Many prefer the second variety of the incision due
to its cosmetic value, as because this incision
does not distort the facial appearance.
 The cranial cavity is finally exposed by
sawing and chiselling out the skull vault at
a level 1˝ above the eyebrow in front and
about the level of the occipital
protruberance at the back. Some
dissectors feel comfortable with manual
saw, while others use electric or battery
operated saw.
 Any injury to the dura and extra-dural
haemorrhage is noted. With a criss-cross incision
the dura is removed ． Any subdural or
subarachnoid haemorrhage or injury to deeper
meninges or surface of the brain or any evidence
of any disease is noted at this stage. The
meninges may be congested due to asphyxia,
apoplexy or other intra-cranial lesions. The brain is
dissected out at its stem, along with the roots of
the cranial nerves. The whole brain is taken on a
clean enamel tray.
 Haemorrhage and fracture at the base of the skull
is searched out. Before dissecting the substance
of the brain the circle of willis is examined for any
aneurysm and rupture of the aneurysm. All the
ventricles are opened and examined ． The
cerebral hemisphere is dissected out along with
base and the cerebellum. Both side cerebral and
cerebellar hemispheres are sectioned, first,
longitudinally and then transversely. In this way
most of the parts of the brain substance will be
exposed.
 Any haemorrhage, injury, congestion or pathology
is noted. Haemorrhage in the pons and base of
the brain of any amount is most important. In case
of gunshot injury the projectile may be present in
the brain substance or inside the cranial cavity.
The track of the projectile or the wound should be
noted in case of gunshot and stab wounds. The
pituitary fossa should be examined specifically and
cautiously.
 Examination of the Spinal cord
 When there is no indication, the spinal cord need
not be exposed. When necessary, it should be
exposed from the back. A midline incision is given
on the back along the entire length of neck and
trunk. The skin is flapped out sidewise or laterally
1˝on either side. The vertebral column is chiselled
along the medial margins of the transverse
processes of the vertebrae. The whole length of
the spinal column can be taken out in this way
without causing any P. M. trauma.
 Scrotal Sac 一 To open the scrotal sac and
examine the testicles and other organs, some
prefer two lateral incisions, though it can be done
by one midline incision also. Examination of the
scrotal sac is a must when the sac is enlarged,
tense in look or deformed in appearance. Injury,
haemorrhage or pathology should be noted ．
 Apart from these, to confirm a bruise, to
confirm and examine a fracture, to trace the
track of a wound, to recover a foreign body
e.g. pellet or bullet, to examine the site of an
injection mark and to examine any deformity
or pathology, incisions may have to be
given at any place on the body surface.
 Inrelation to medicolegal postmortem
examinations, preservation of some organs,
some viscera or some other materials is
necessary or even essential in some cases.