Medical Jurisprudence - Autopsy

3/23/13 Medical Jurisprudence - Autopsy

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Q. What are the objectives of Autopsy? Explain the rules that govern a medico legalpost mortem examination. What facts should be incorporated in Post Mortem Report.How does post mortem help in crime detection? What is Post Mortem staining indetail. How does it help in crime detection?

What is Viscera?

Autopsy The word autopsy is from Ancient Greek with (autos) meaning to do something to oneself and (opsis) meaningeye hence autopsy means 'to see for oneself'. It is used specifically for the post-mortem examination of a human corpse. It isalso known as a post-mortem examination, necropsy (particularly as to animals), autopsia cadaverum, or obduction and is amedical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and toevaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called apathologist.

Kinds of AutopsyAutopsies are either performed for legal or medical purposes. For example a forensic autopsy is carried out when the causeof death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death andis used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into caseswhere external examination suffices, and those where the body is dissected and internal examination is conducted. Once aninternal autopsy is complete the body is reconstituted by sewing it back together. Consent of relative is required in case ofacademic autopsy but is not required in legal autopsy, which is ordered by the magistrate or other appropriate legalauthority. In case of legal autopsy, all three - cranial, thoratic, and abdominal cavities are opened, while in case of academicone, it may be limited to an area of interest.

Techniques of Autopsy

1. Virchow - organs are removed one by one.2. Tokitanski - a combination of in situ dissection with en bloc removal3. Ghon - Thoratic and cervical organs , abdominal organs, and urogenital organs are removed separately as organ

blocks.4. Letulle - All organs are removed en masse and subsequently disected into organ blocks.

Objective of an autopsy is to determine the following information -

1. Establish the identity of the body if unknown.2. Ascertain the time of death.3. Ascertain the cause of death.4. Whether the death was natural or unnatural.5. If death was unnatural, whether it was homicidal, suicidal, or accidental.6. In case of new born infants, determine whether it was a live birth and its viability.7. The manner of death such as kind injury, wound, or impact.8. Whether there was any psychological disturbance or derangement resulting in cause of death such as asphyxia,

coma, or syncope.

Rules governing medico-legal Autopsy



1. Must never be undertaken unless there is a written order from a police officer or the district magistrate. A letter fromthe IO asking the medical officer to carry out the ML autopsy and authorizing him to collect any material from the bodyfor furtherinvestigations, if necessary, is required

2. Before commencing, the MO should carefully read the police report on the appearance and situation of the bodywhen it was first found and the cause of death as ascertained. A copy of the Panchanama carried out by the IOat the site of death. This document pictures the scene of death for the prosector.

3. Dead Body Challan: Is a set of questions to be answered by the investigating officer pertaining to the death underinvestigation. This document provides background information to the prosector A police constable accompanies thedead body alongwith these documents.

4. It should be as complete and through as is possible. Incomplete or partial post mortem is not acceptable. All threecavities must be analysed.

5. In exceptional situations the MO may be taken to visit the scene of death where the dead body may be lying. In thiscase, he should note the place and nature of the soil where the body is placed, its position, and state of its clothes.The ground where the body is lying should be carefully searched for any footprints or other evidence such as fibre ordust.

6. Protect different parts of the body in plastic bags or pads to prevent loss of contact tracer.7. The MO must establish the identity and record the means of identification.8. All details of post mortem observed by the MO should be entered by him on the spot in the post mortem report, which

can be used in a legal inquiry. Nothing should be erased and all alterations must be initialized.

Facts to be incorporated in Autopsy reportAll the facts must be entered in appropriate format prescribed by law for the purpose.

On the body of: Place: Date: Time:Body identified by police constable: Probable time since death:Probable age: Height

External Examination

1. Condition of the body - muscularity, rigor mortis, livor mortis, emaciation, and putrefaction.2. Marks of identification3. Eyes4. State of natural orifices5. External injury marks6. State of limbs - contents of hand if clenched.7. Genitalia, breasts8. Additional remarks

Internal Examination

1. Head and Neck1. Scalp, skull2. Vertbrae3. Membranes4. Brain, base of skull5. Spinal cord6. neck structures7. Additional Remarks

2. Thorax1. Walls, ribs, cartilages2. Pericardium3. Pleurae, diaphragm4. Heart with weights, cavities and valves coronary5. Larynx, trachea and bronchi6. Lungs with weights7. Addititional Remarks

3. Abdomen1. Walls2. Liver and gall bladder3. Peritoneum



4. Pancreas5. Spleen6. Kidneys and Bladdar7. Esophagus8. Stomach and its contents9. Small and large intestine and their contents

10. Additional Remarks

Viscera and other samples/materials collected from the body.

Opinion as to the cause and manner of death.

Place :Date: Medical Officer:

The National Human Rights Commission has recommended video recording of the autopsy in case of custodial death.Circular directing the police to do this recording have been issued by many states such as Gujarat and TN.

In case of Dayaram vs State 1986, it was observed that a post mortem report is undoubtedly a very important document,which not only aids the medical officer in determining the nature of the injuries during their evidence at the trial but also hepsthe court in appreciating the evidence in the case.

In Gofur Sheikh vs State 1984, it was held that where the MO who conducted the autopsy is not examined in court nor thePM report has been tendered in evidence, the same cannot be used as substantive evidence.

In Sharad vs State of Mah 1984, serious interpolations were found in the PM report. The entries in the PM report filed incourt and in the copy of PM report sent to the chemical examiner were different. The SC invalidated the PM report and alsodebarred the medical officer from performing the PM in future.

Post Mortem Staining (aka Livor Mortis) - Livor mortis or postmortem lividity or hypostasis (Latin: livorbluish color, mortisof death), one of the signs of death, is asettling of the blood in the lower (dependent) portion of the body, causing a purplish red discoloration of the skin: when theheart is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. This discolorationdoes not occur in the areas of the body that are in contact with the ground or another object, as the capillaries arecompressed.

Coroners can use the presence or absence of livor mortis as a means of determining an approximate time of death. It canalso be used by forensic investigators to determine whether or not a body has been moved (for instance, if the body is foundlying face down but the pooling is present on the deceased's back, investigators can determine that the body was originallypositioned face up).

Livor mortis starts 20 minutes to 3 hours after death and is congealed in the capillaries in 4 to 5 hours. Maximum lividityoccurs within 6-12 hours. The blood pools into the interstitial tissues of the body.

How does autopsy help in crime detection

Fatta

Viscera

Viscera are the internal organs of the body, specifically those within the chest (as the heart or lungs) or abdomen (as theliver, pancreas or intestines). The singular of "viscera" is "viscus" meaning in Latin "an organ of the body."

The following procesure is usually adopted to collect viscera for medicolegal purposes:

1. The viscera are preserved in wide mouthed glass bottles of 1 to 1.5 ltr capacity having a screw cap lid. Containersmade up of synthetic material like polyurethane,plastic etc are not to be used as the material is likely to react with theviscera preserved and alter their chemical composition. Saturated salt solution is the common preservative used toprevent putrefaction except in cases of corrosive mineral acid (H2SO4, HCl,HNO3) poisonings. Rectified spirit (notdenatured spirit) is ideal preservative which can be used in all cases, except ethyl/methyl alcohol poisoning. Sodium



fluoride is used as preservative for blood along with potassium oxalate as anticoagulant. 30 mg of potassium oxalateand 10 mg of sodium fluoride are required for 10 ml blood.

2. For viscera the preservative solution is added in equal volume. As a rule 1/3 volume of the container is to be occupiedby viscera, 1/3 by the preservative and 1/3 to be empty as room for any gases evolving. This also prevents spillage ofthe contents during transportation and thus avoids spoiling of the label on the bottle. The viscera should be fullyimmersed in the preservative. Large pieces should be partly sliced to ensure entry of the preservative to the innerportions.

3. Usually, whole of stomach, after having opened (along the greater curvature) and examined, and its contents; 6- 8(one loop) of small intestine tied at both ends with contents inside, are put into one bottle. This represents theunabsorbed, still in the gut, portion of the poison.

4. 500 gm of liver along with intact gall bladder, one half of each kidney, de-capsulated, and half of spleen are put intothe second bottle. This represents the absorbed portion of poison. 50 ml of blood is preserved in a third smallmouthed screw capped bottle. A small penicillin vial containing control sample of preservative used is also to be sentalong with.

5. These bottles, sealed with a legible specific seal of the prosector and labeled legibly, are handed over to theauthorised police constable, packed in the wooden viscera box. The receipt obtained from the constable to that effectis to be preserved as proof of chain of custody of evidence.

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Medical Jurisprudence - Autopsy