AUTOPSY

Col. Mohammad Asif Shahab

Autopsy:
“ A medical examination of dead body conducted in
accordance with the laws of the state.”

Also known as

Necropsy or Post-Mortem
Necros: Dead Post: After
Opis: View Mortem: Death
 TYPES OF AUTOPSY:
1. Clinical /medical or Pathological Autopsy
2. Psychological Autopsy
3. Medicolegal or Forensic Autopsy
4. Exhumation

5. Sonopsy
6.Needle Autopsy
7.PMCT..post mortem computerized tomography
8.Virtopsy…3D computerized tomography

1. CLINICAL or PATHOLOGICAL AUTOPSY:

Performed for diagnosis of disease, to see effects
of disease on different organs of the body.
Done by HISTOPATHOLOGISTS.
 2. FORENSIC OR MEDICOLEGAL
AUTOPSY:
This is for unnatural,
sudden and suspicious deaths
Done under the law of state.
Performed by:
Causality Medical officer (CMO) or
Medicolegal officer
3. PSYCHOLOGICAL AUTOPSY:
It is performed when a person commits
suicide. It is only the collection of information from
the friends, relatives to find out reason of suicide.
Not performed on the dead body. No doctor is
needed.
Performed by Social workers, Psychologists

4. EXHUMATION
Digging of a dead body after burial.
Objectives of PME
Forensic Clinical

Identification yes no
Cause of death yes yes
Time since death yes no
Manner of death yes no
STAGES OF A FORENSIC POST-MORTEM EXAMINATION:

1. PHYSICAL EXAMINATION OF CLOTHES:

Examined by i) Naked eyes
ii) Magnified Lens

2. EXTERNAL POST-MORTEM EXAMINATION:

Examine body from head to toe by
i) inspection
ii) palpation

3. INTERNAL POST-MORTEM EXAMINATION:

Open all body cavities.ie thorax,abdomen&cranial
4. CAREFUL & COMPLETE EXAMINATION OF ALL
VISCERA & BODY CAVITIES:

5. COLLECTION OF SPECIMENS:
Specimens of visera and fluid are collected and sent to
i) Chemical examiner……………. Poison, Drug.
ii) Histopathologists……………….. Disease

6. CLOSURE OF BODY:
Body is closed by continuous sutures
REQUIREMENTS OF MEDICOLEGAL AUTOPSY:
1. Authorization:
CMO/MLO is given authority to examine cadaver by
Health Department of Government of Punjab

2. Complete police paper:

i) Docket (from competent authority)
a. Police Docket
Police will decide whether Postmortem is required or not.
IF required, a written authority by name and designation to the CMO/MLO for PME.

b. Judicial Orders
ii) Police papers
a. FIR
b. Police inquest (inquiry)
iii) Medico-legal Report of injuries/poisoning:
Police describes injuries present on the body.

iv) Death Certificate

In case of hospital death
Post-mortem Examination

Death Report
Form A 2 1
for unexpected deaths
due to natural causes

Ref Police Rules 25.35(1)

4 3
Post-mortem Examination

Death Report
Form B 2 1
for unnatural deaths
due to violence

Ref Police Rules 25.35(1)

4 3
Post-mortem Examination

Death Report
Form C 2 1
for unnatural deaths
due to poisoning

Ref Police Rules 25.35(1)

4 3
3. Complete & Meticulous:
• Post Mortem should be complete and meticulous
• All cavities should be opened properly, even if the
cause of death is present in one cavity.

4. Preservation of evidence:
• All evidences should be preserved carefully

5. Proper Handing over a Dead body:

• Handing over a dead body to the police and receive a
receipt and signature of police officer
• Handover the belongings and preserved evidences,
sealed to the Police (constable).
EXAMINATION AT THE SCENE OF DEATH:
i. Position of Dead Body
ii. Temperature of Dead Body
iii. Examination of Clothes
iv. Examination of Locus
v. Photography/ Sketching
EXAMINATION IN POST-MORTEM ROOM:

1. Examination of clothing on the body

2. Removal of clothing

3. External examination of dead body

4. Internal examination of dead body

Post-mortem Examination

Techniques of post-mortem examination

1 Rokitansky’s – 1804-1878
examination and dissection in situ
2 Gohn’s - 1890
en bloc removal and examination
outside the body
3 Virchow’s – 1821-1902
organ by organ on the body
4 Le Tulle’s – 1856-1929
en masse removal of organs for
later detailed examination
1 organs for
later detailed examination
TYPES OF POST MORTEM INCISIONS:

1. Primary Incision:
to open trunk and head
to open the cavities of the body
2. Secondary Incisions:
for removal of organs from the body

3. Tertiary Incisions:
to dissect the organ e.g stomach is opened to
examine food content or any injury

4. Quaternary Incisions:
Any additional incision
e.g removal of bullet
TYPES OF PRIMARY INCISIONS:
1. I shaped/ straight Incision:
in the midline avoiding the umbilicus, which extends fro
chin to pubic symphsis
2 Y-shaped incision:
• extending obliquely down from the point just in front of
the base of each ear to meet at suprasternal notch
• Further following course taken by straight incision
• Advantage of better exposure
3. Modified Y-shaped Incision:
4. Incision for scalp:
• from mastoid to mastoid
 Postmortem interval
Time between death and autopsy
I-shaped Incision:
Incision for Scalp
Entry in the registers
A. General Register
• biodata of deceased
• date and time of receipt of corpse
• name,no,police station of constable
• date and time of return of corpse back to police.
B. Autopsy Register
• biodata of deceased
• autopsy no allocated to deceased
• date and time of autopsy
• name and no of specimens collected
• date and time of dispatch of specimens and name of lab
• provisional/final conclusion of cause of death
 STANDARD AUTOPSY SUITE:
Should consist of
1. Autopsy room
2. Cold storage/freezers
for the corpse
3. Instrument room
4. Sterilization room
5. General store
6. Radiological room
7. Offices for staff
8. Medical record room
9. Waiting area for public
10.Public and private toilets
REQUIREMENTS OF AUTOPSY ROOM:
1. Plenty of running water
2. Sufficient light
3. Proper ventilation
4. Proper sterilization
5. Proper Refrigeration
6. Proper arrangements for Dissection
7. Staff wearing standard autopsy dress and shoes

AUTOPSY ROOM LIGHT:

• Natural sunlight from north
• Day-light lamp with chromium plated parabolic raster system
• Ice blue fluorescent electric tubes

 A minimum of 90 lumens of light at table level is considered

sufficient
Autopsy Room Washing:
• Plenty of water supply
• Water should come down from the ceiling
• Drainage from PM table and floors -------- open gully ------ main drain system

Autopsy Room Sterilization:

• Should be done by ULTRAVOILET LIGHT, and nobody should be allowed to
enter the autopsy room when the lights are On.
• Bacteriological tests of the walls and floors.

Autopsy Room Ventilation:

• Air enters from ceiling ----------- Air leave through vents near floor, it reduces
smell and prevents transmission of infection by inhalation
(Down – Draft-Ventilation)
MORTUARY REFRIGERATION UNIT:

• Proper cooling system maintained at +4 ᵒC

• Small doors for each cabinet preferred because it
doesn’t interfere with cooling system
• For annual load of 100 corpses, 8 body unit is
sufficient

Pre Autopsy corpse temp -------- +4 ᵒC

(So that freezing of the tissues does not occur)
Post Autopsy corpse temp-------- -20ᵒC or even lower
• Protective dressing dress
• Stainless steel autopsy table
• Autopsy instruments
• Portable X-ray machine
• Suction unit ---------------collect and measure pleural fluids etc
in cavities.

 Medical students should be seated in the viewing

gallery.
PROTOCOL OF MEDICO-LEGAL AUTOPSY:
It is a signed document containing a written record,which serves
as a proof/authorisation of autopsy.

TYPES:
1. Narrative autopsy protocol
2. Numerical autopsy protocol

1. NARRATIVE AUTOPSY PROTOCOL:

it is written in story form

Advantage:
i) Best for people who are able to tell a story
ii) Immediate storage of facts on tape
iii) Forensic expert can tell difference between normal
and abnormal
Disadvantage:
i) Narration may be sketching only
ii) subjective and personal
2. Numerical Autopsy Protocol:
it is systemic report , Listing various systems
and brief description. In PAKISTAN it is used

Advantages:
a. Minor details are mentioned and report is comprehensive
b. Provides a unifrom detail of all information in all cases
c. It is objective and impersonal
d. Facilitates immediate inspection of any particular
heading,feature or lesion found at autopsy

Disadvantages:
e. Requires more time for completion
f. Difficult to read if not properly typed
g. Requires more pages
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 1)
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 2)
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 3)
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 4)
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 5)
Post-mortem Examination

Post-mortem
Protocols

Descriptive protocol
Used in Pakistan
(page 6)
AUTOPSY HAZARDS :
1. Mechanical hazards
i) Injures to limb…………...fall
ii) injuries to hands……….cuts,needle pricks,burns
iii) injuries to back………..muscle sprains
iv) injuries to eyes…………corneal ulcers by bone dust

2. Biological hazards
i) Bacterial infections……….Tuberculosis,typhoid
ii) Viral infections……………..HIV,Hepatitis.
iii) Fungal infections

3. Chemical hazards
i) Antiseptics and disinfectants……...iodine,dettol
ii) fixatives………………………………………Formaline

4. Electrical hazards
Electric Burns…………..faulty appliances, metallic autopsy table

5. Radiation hazards
Electromagnetic radiation
NEGATIVE AUTOPSY:
“ When no cause of death can be detected after complete postmortem
examination i.e gross, microscopic and toxicological analysis.”

Rate: 2-10%

Causes of Negative Autopsy:

1. Autopsy without adequate history
severe emotional disturbances, Anaphylactic shock, Vagal inhibition
and epilepsy

2. Lapses in PM examination:
a) External
electrocution,snake bite

b) Internal
due to invisible pathology e.g Air embolism,Fat embolism

3. Improper training of Autopsy surgeon

4. Death due to concealed or insignificant trauma
e.g Firearm in nose,ear,mouth

5. Death due to invisible pathology

lesion is not visible in fat embolism,myocarditis

6. Laboratory
Untrained staff, faulty apparatus, faulty technique

7. Lapses in histological and toxicological examination

expired and ineffective reagents used and corruption
Postmortem artifacts
COLLECTION OF SPECIMEN:
1. If poisoning is suspected
2. To exclude poisoning in uncertain cases
3. On request of investigator
4. Post mortem of decomposed body

VISCERA TO BE TAKEN:
5. BOTTLE NO.1…………………… stomach and its contents both ends tied
2. BOTTLE NO.2……………………500 gms liver
half spleen
one kidney in adult
both kidneys in children
3. BOTTLE NO.3………………….Small intestine 100 cms approx &
its contents ends tied
4. BOTTLE NO. 4…………………. Preservatives used
5. BOTTLE NO. 5………………….Urine sample 100-200ml
6. Sample no. 6…………………… 5-10 ml Blood in syringe

* Add preservative and pack, seal, label and dispatch

 liver – 500 gm
whole spleen

one kidney

whole stomach
with contents small intestine
(100 cm)
With content

Routine viscera for chemical analysis

LABEL CONTAINS:
1. Postmortem no.
2. Date and time of PM examination
3. Name of dead person
4. Signature of doctor
5. Police station No.

PRESERVATIVES:
are used to delay putrefaction of visceras
6. Saturated solution of common salt………….. in all cases of posioning except
acids

2. Rectified spirit or Methylated spirit…………...in suspected cases of acids

except few

3. 10% Formaline………………………………………….tissue for histopathologic

examination

4. Thymol, conc. HCL, Na benzoate……………..For preservation of urine,

urine can also be
preserved in 1 & 2
We can perform autopsy on

• Decomposed bodies
• Mutilated bodies
• Fragmentary remains
• Bones
Decomposed body:
Shows putrefactive changes depending upon
the time elapsed since death

Mutilated body:
Is disfigured,deprived of a limb or a
part of the body.Soft tissues, muscles,
skin still attached to the bones

Fragmentary remains:
Only fragments of the body e.g head, trunk or limb.
The following information is specially looked
for while doing autopsy on the Decomposed
bodies,Mutilated bodies,Fragmentary remains and Bones.

1) Source of Specimen
( human or animal)…………………. Preciptin Test
2) If human, do the part belongs to
same individual…….DNA profiling
3) Age
4) Sex
5) Stature
6) Race
7) Identity
8) Special features
9) Cause of death
10) Time since death
 Post Mortem Artefacts

Artefact:
• An artefact is an artificial product or feature which appears by
processing or handling

Post mortem Artefact:

• An artefact that is added to the dead body during post mortem period
is known as post mortem artefact
• Post mortem artefacts lacks vital reactions of the living tissues
 Post Mortem Artefacts

Causes of Post mortem Artefacts

• Physical handling
• Interference by the scavengers, insects and animals
 Classification of Post Mortem
Artefacts
Introduction during systemic death
Causes Postmortem Artefacts Misinterpretations
Regurgitation and aspiration of Chocking
gastric contents into the air
passages
Injection marls on the limbs, neck Addiction or violence
and chest
Agonal
Resuscitational Bruising of the skin of chest Violence

Fracture of ribs and sternum Violence

Bruising of the heart Violence

 Classification of Post Mortem
Artefacts
Introduction during postmortem period
Causes Postmortem Artefacts Misinterpretations
Pseudo groove on the neck by tight collar Ligature mark
Situational handling
Dislocation of shoulder and hip joints Violence

Bloatment Obesity
Decomposition Rupture of stomach wall due to acid digestion Corrosive Poisoning
Separation of skull sutures in infants Violence
Nibbling by rats and rodents Incised wounds
Animal Ravage by fish and crabs Incised wounds
Ripping apart by vultures Lacerated wounds
Postmortem Burning Heat ruptures of skin and scalp Open wounds
 Classification of Post Mortem
Artefacts
Introduction during Autopsy

Causes Postmortem Artefacts Misinterpretations

Pseudo bruising in the subcutaneous tissue

Faulty technique Throttling
of the neck
 AUTOPSY IS A DIALOGUE
b/w the doctor and dead body.
The body and its surroundings tell nothing
but truth.
What dialogues?
Who are you?
Identity
How you died?
cause of death
When you died which system failed first?
mode of death
Your death was suicidal, accidental or homicidal?
manner of death
When you died?
time since death
What was position of body?
lividity
EXHUMATIO
N
DEFINITION:
“Lawfull disinternment or digging out of a
buried body from the grave for postmortem
examination or re-examination”

THREE parties required:

i) Judicial party--------- Magistrate
ii) Police------------------ arrangement for
exhumation
iii) Medical board------ 3 Doctors
Procedure of EXHUMATION:
1. Medical board proceeds to the burial place with area magistrate.Exumation
is conducted in early hours of morning.police will cordon the area.

2. Magistrate gets
i) the grave identified
ii) the dead body exhumed
iii) the dead body identified

3. Than hands over the body to medical board in writing.

4. Medical board conduct Post mortem examination by the side of the

grave,shielded from the on lookers.

5. Samples must be taken including soil samples from above, below, sides of
coffin and a control sample of earth is taken.

6. After completion of Postmortem examination,dead body is handled back to

the Magistrate in writing.

7. Magistrate is responsible for Re-burial of the dead body.

 Precautions :
1. Should be performed during daylight
2. Ventilation should be adequate
3. Person should stand wind side
4. Face mask preferably impregnated in KMnO4
5. Gloves should be intact
6. Disinfectant is sprinkled on sides of the body,not on the body.
7. Police officer provides witness for identification of grave,coffin
and dead body
 LIMITATIONS:
1. Time lapse between death and exhumation.

2. Soft tissue findings may be obscured.

3. Enviornmental condition of soil, water level and rains.

4. Post-Mortem Artefacts

5. Decomposition causes loss of all cell details --Histopathological

limitation
6. Toxicological analysis------- disappear soon after death e.g vegetable
poisons,volatile poisons,synthetic poisons.

7. Inexperienced and untrained staff.

MEDICOLEGAL ASPECTS OF EXHUMATION:
1. When suspicion of foul play has been raised after burial.

2. When identity of the dead body is to be established.

3. When cause of death is disputed and further medical

evidence is required.

4. For permanent burial(ammanat)

LAWS RELATED TO MEDICAL
EXAMINATIONS
Criminal procedure code
1. Cr. PC Section 174
2. Cr. PC Section 176
 LAWS RELATED TO MEDICAL
EXAMINATIONS
ii) Cr.PC Section 174
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:
a. Has committed suicide, or
b. Has been killed by another, or by animal, or by machinery, or by
an accident or
c. Has died under circumstances raising a reasonable suspicion---
some of the person has committed an offence.
 LAWS RELATED TO MEDICAL
EXAMINATIONS
ii) Cr.PC Section 176
(Inquiry by Magistrate into cause of death)
1) When any person dies while in the custody of police, the nearest
Magistrate empowered to hold inquests shall, and in any other case
mentioned in section 174, clauses (a), (b) (c) of subsection (1) any
Magistrate so empowered may hold any inquiry into the cause to 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 shall record the evidence
taken by him in connection therewith in any of the manners hereinafter
prescribed according to the circumstances of the case.
LAWS RELATED TO MEDICAL
EXAMINATIONS
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 , the Magistrate may, cause the body
to be disinterred and examined.
THANK YOU
Q/A