The word autopsy came from Greek word ‘autopsia’ which means seeing with one's eye.

Autopsy (Necropsy or Postmortem examination)

Autopsy refers to the systematic examination of a dead person for medical, legal & scientific purposes.

Autopsy or necropsy means, postmortem examination of a body.

Purpose:
To determine time since death, causes of death & manner of death in cases of sudden, suspicious, unnatural & unattended death.

 

Types of Autopsy

1. Clinical or Pathological autopsy (consent needed- for clinical purpose)

When the autopsy is performed by a pathologist or a clinician to diagnose the cause of death, where diagnosis could not be reached during treatment, or to confirm diagnosis where it was doubtful, it is called pathological or clinical autopsy

2. Medico-legal autopsy (no consent legal permission - to aid law)

When the autopsy is compulsory by law & done in unnatural & suspicious circumstances of death, to find out the causes of death to help in the administration of justices, it is called a medicolegal autopsy.

3. Academic or Anatomical autopsy (unclaimed- authorized by governmental authority)

When dead bodies are dissected by the students of anatomy for academic purposes, to know details about the different external & internal organs & structures of the human body is called an academic autopsy.

 

Pre-requisite of medicolegal autopsy

1. One copy commanding certificate

2. Inquest report - Two copies of inquest report

3. Chalan - Two copy requisition from the authorized person.

4. Identification of the dead person by the accompanying police officer

5. Government-authorized mortuary

6. Authorized person - Any authorized Government medical officer who is registered with BMDC

7. It should be conducted preferably in natural sunlight.

 

Criteria of an ideal mortuary:

1. Cooling facilities to preserve the dead body

2. Good ventilation

3. Sufficient water supply

4. Good drainage system

5. Adequate Instruments

6. Morden dissection table

7. Effective Disinfectants

 

Authorized person for medicolegal autopsy in Bangladesh

1. Professors & Lecturers of Forensic medicine department of government medical colleges.

2. Civil surgeons in district hospitals

3. Residential medical officers (RMO) under the supervision of the civil surgeon.

 

Objectives of Medicolegal Autopsy

1. To find out the cause of death whether natural or unnatural.

2. To find out how the injury occurs.

3. To find out the manner of death.

4. To find out the time since death.

5. To establish identity, where not known.

6. To collect evidence in order to identify the object causing death and to identify the criminal.

7. To retain relevant organs or tissues as evidence.

8. In newborn infants to determine the question of live birth or viability.

9. To find out what type of weapon or which poison was used.

10. Whether the injury expected to cause death in the ordinary course of nature.

 

Rules of medico-legal autopsy:

1. The body should be labeled as soon as it arrives in the mortuary.

2. The autopsy should be done in a mortuary; never in a private room

3. It should be conducted only when there is an official order authorizing the autopsy from the police, magistrate, or coroner.

4. It should be performed as soon as possible after receiving the requisition, without undue delay.

5. The medical officer should 1st read the inquest report carefully and find out the apparent cause of death.

6. The examination should be conducted in daylight, because color changes, such as jaundice changes in bruises, changes in post mortem staining, etc. cannot be appreciated in the artificial light

7. The body must be identified by the police constable.

8. No unauthorized person should be present during the autopsy.

9. After completion, the body is handed over to the police constable.

 

Parts of autopsy report/post-mortem report

1. Preamble - name, age sex, time, place

2. Body - internal & external examination, finding

3. Conclusion - causes of death a/c to finding, clear, concisely, honest, scientific with signature

 

Conditions for refusing medicolegal autopsy by an authorized medical officer

1. Absence or insufficient inquest report or chalan.

2. Absence of police constable to identify the dead body.

3. Death from some infectious diseases - eg. AIDS, rabies, plague, smallpox, etc

 

Preservation of viscera for Histopathological examination

Brain, Heart, Lung, Liver, Kidney

 

Viscera to be preserved for chemical examination:

(1) Whole Stomach and its contents. If the stomach is empty, the wall should be preserved.

(2) The upper part of the small intestine (about 30 cm. length) and its contents.

(3) Liver 200 to 300 gm.

(4) Kidney half of each. as one kidney may be dysfunctional.

(5) Blood 30 mi. Minimum 10 ml

(6) Urine 30 ml

 

CONTAINERS:

For the preservation of viscera, the glass bottles used should be of one-liter capacity, clean, wide-mouthed, white, and fitted with glass stoppers.

Rubber inserts should not be used under caps, because they can extract from the contents certain poisons, such as chloroform and phenols.

Containers should be cleaned with sulphuric acid- chromate solution, rinsed with distilled water, and dried.

Polyethylene bags or containers can be used, but volatile poison may diffuse through the plastic.

 

Preservatives used for chemical examination

1) Saturated sodium chloride solution,

2) Rectified spirit,

3) Ten. mg./ml of sodium or potassium fluoride. (prevents glycolysis, inhibits enzyme enolase, and inhibits bacterial growth) and 3 mg. potassium oxalate (anti-coagulant) should be used for preserving blood.

Fluoride should also be added to urine, CSF, and vitreous humor if alcohol estimation is required,

 

Preservative is not necessary if

(1) viscera can be analyzed within 24 hours,

(2) if the sample can be kept in a refrigerator or icebox,

(3) bone, hair, nails,

(4) lung for detecting inhaled poisons.

 

Viscera should be preserved:

(1) If death is suspected to be due to poisoning

(2) Deceased was intoxicated or used to drugs.

(3) Cause of death not found after autopsy.

(4) In cases where an unusual smell, color, or unidentifiable material is detected in stomach contents.

(5) Anaphylactic deaths.

(6) Death due to burns.

(7) Advanced decomposition.

(8) Accidental death involving the driver of a vehicle

 

Incisions of autopsy

1. ‘I’ incision (chin straight down to the symphysis pubis passing either to right or left of the umbilicus)

2. ‘Y’ incision (close to the acromial process. extends down below the breast and across to the xiphoid process)

3. ‘Modified Y’ incision ( midline from the suprasternal notch to the symphysis pubis. extends from suprasternal notch over the clavicle to its center on both sides and then passes upwards over the neck behind the ear.)

 

Exhumation

Exhumation is a legal digging out of an already buried body from a grave.

 

Objective of Exhumation:

Identification of an individual

To determine the cause of death

For 2nd autopsy: When the first autopsy report is being challenged or is ambiguous.

 

Procedure of Exhumation:

Authorization:

The body is exhumed only when there is a written order from the Executive Magistrate.

Done by: The body is exhumed under the supervision of a medical officer and Magistrate in the presence of a police officer.

 

1. Order from a 1st class Magistrate.

2. It should be done in ‘day-light’ at dawn (early morning)

3. The Magistrate, doctor, and police should be present.

4. Identify the grave: by relatives/headstone/grave marker/trees, etc.

5. The officers should be stand in favor of air to avoid inhaling offensive gases and wears rubber gloves and gauze mask.

6. Photograph of the grave should be taken.

7. Soil sample collected for chemical analysis in case of mineral poisoning : (not less than 500g)

8. Soil should be removed 10-15 cm in every step.

9. Before the body is lifted, the doctor should examine the body inside the grave.

10. Finally, the body is sent to a morgue for post mortem examination.

 

Causes/indication of exhumation:

 

EXAMINATION OF MUTILATED BODIES OR FRAGMENTS:

Mutilated bodies are those which are extensively disfigured. or in which a limb or a part is lost but the soft tissues, muscles, and skin are attached to the bones. Sometimes, only a part of the body, such as the head, trunk, or limb may be found.

 

Sex determination MUTILATED BODIES OR FRAGMENTS

Presence or absence of facial or body hair

Distribution of pubic hair

Presence of breast or other sexual organ

Shapes of the shoulder, hip, buttock, thigh

Toughness of skin

Predominance of musculature, subcutaneous fatty tissue

Characteristics of bones

 

AIDs autopsy/HIV autopsy

- HIV can be isolated from CSF, brain, bone marrow, and blood. HIV is viable for 3 weeks in other viscera and 2 months in the blood.

Precaution:

1. Body should be wrapped with tough plastic bags with a red color tag mentioning ‘biologically hazards. The label should mention the name, age sex, registration number, etc.

2. Workers who have exudative lesions or weeping dermatitis or external injury should not handle AIDS victims.

3. Proper protective clothing, full sleeves, overall and had a cap face mask, googles, double gloves, rubber gumboot, up to the knee.

4. Avoid sharp instruments and accidental prick.

5. Cut gloves should be removed.

6. Handling specimen for laboratory examination 10% formalin with gloved hands.

7. Disposal of used instruments: the instruments should be sterilized by 20% gluteral hydrate for half an hour and then wash with soap and water, then rinsed in methylated spirit and air dry.

8. All soiled gauze and cotton are collected in a double plastic bag for incineration.

9. Laundry materials soaked in 1% bleach for half an hour, washed with detergents and water, and autoclaved.

10. Clean-up procedure: wear new intact disposable gloves. Blood and other body fluids can be wiped up by tissues or towels which are discarded. The autopsy table and floor should be cleaned with 1% bleach solution followed by washing with soap and water.

11. Disinfected 1:10 dilution of common household bleach is freshly prepared. Sodium hypochloride solutions are recommended.

12. In case of injury the wound should be disinfected.

13. After the autopsy the body should be wrapped with a double-layer heavy plastic sheet bag with a tag or identification.

14. After completing autopsy hands and face should be washed with soap and water and rinsed in 70% methylated spirit.

 

2nd autopsy

The autopsy which is done for 2nd time with the authorization of law. Must presence of a doctor of 1st autopsy.

Document required for 2nd autopsy

First autopsy report
Photographs of the scene of the death of the body, taken during the first autopsy, hospital records, police investigative reports, x-rays, etc

 

NEGATIVE AUTOPSY:

When gross and microscopic examination, toxicological analyses, and laboratory investigations fail to reveal a cause of death, the autopsy is considered to be negative.

 
A negative autopsy may be due to:

1. Inadequate history:  vagal inhibition, hypersensitivity reaction, laryngeal spasm in drowning, etc.

2. Inadequate external examination

3. Inadequate or improper internal examination: Air embolism and pneumothorax are often missed.

4. Insufficient laboratory examinations.

5. Lack of toxicological analysis.

6. Lack of training of the doctor.

 

OBSCURE AUTOPSY

OBSCURE AUTOPSIES are those which do not show a definite cause for death, in which there are minimal, indefinite, or obscure findings or even no positive findings at all.

The obscure causes are:

1) Natural diseases:

(a) With obscure or some microscopic findings.

(b) Death precipitated by emotion, work-stress, and

(c) Functional failure, such as epilepsy, paroxysmal fibrillation.

 

Causes:

1. Natural diseases

2. Biochemical disturbance (Uremia, DM, K+ deficiency)

3. Endocrine dysfunction (Thyrotoxicosis, Myxedema)

4. Concealed trauma, Poisoning, Miscellaneous (allergy, drugs)

 

VIRTUAL AUTOPSY (VIRTOPSY):

It is a non-invasive technique of examining dead bodies to find out the cause of death. It does not destroy some important evidence that may be destroyed in the usual autopsy.

It is a combination of CT and MR imaging.

CT images give information about morbid anatomical findings and MR imaging demonstrates soft tissue injury, organ trauma, state of blood vessels, tissue, and bones.

 

PSYCHOLOGICAL AUTOPSY:

Psychological autopsy is a set of postmortem investigative procedures that help ascertain and evaluate the role that physical and psychological factors play in the death of a victim of suicide, thus to determine the manner of death to as high a degree of certainty as possible.

It involves the systematic collection of psychological data through structured interviews of the deceased's family members. friends, coworkers. employers and fellow students, who had dealt with the deceased.

Data are sought about his medical, educational, sexual, marital, employment, alcohol, drugs, phobias, moods, interpersonal relationship, friends and colleagues, personality coping style, psychiatric history, and general emotional life, judging abilities, concentration, l.Q. and chronology of events leading up to the time of committing suicide.

Indication:

In some cases of suicide, police reports may be incomplete as sources of information.

those involving custodial care taking (police custody and prisons) and those of contested life insurance claims.

In criminal cases, suicide or homicide

Professional negligence, worker compensation

 

 

EFFACEMENT OR OBLITERATION OF IDENTITY:

(l) Purposive removal of the identifying features, e.g, fingerprints, tattoo marks, scars, moles, teeth, hair, etc., and articles of clothing.

(2) Animals, e.g., rats, dogs, jackals and hyenas, and birds, such as vultures may attack a dead body and mutilate it in a very short time, when the body is exposed in an open place.

(3) Burning or incineration.

(4) Advanced putrefaction.

(5) Dismemberment and burying or throwing different parts in different places.

(6) Chemical destruction of the body in corrosive acids or alkalis.

7) Dismemberment by moving vehicles, like trains or by machinery.

(8) Bomb explosions. which may disintegrate the body.

 

 

METHOD OF REMOVAL OF ORGANS:

(I) Virchow's technique: Individual organs are removed one by one. The spinal cord is removed from the back. In this, the anatomic-pathologic relations are not preserved.

(2) Rokitansky's technique: It involves in situ dissection in part, combined with en block removal. It is the preferred choice in patients with highly transmissible diseases, such as HTV, hepatitis B.

(3) Lettulle's technique: Cervical, thoracic, abdominal, and pelvic organs are removed en masse and dissected as organ blocks. It has the advantage of leaving all attachments intact.

(4) Ghon's Technique: Cervical, thoracic, abdominal organs, and urogenital system are removed as organ blocks.

 

 

Embalming:

Embalming is the treatment of the dead body with antiseptics and preservatives to prevent putrefaction and preserve the body.

By this process proteins are coagulated, tissues are fixed, organs are bleached and hardened and blood is converted into a brownish mass.

Intestinal contents are syringed out.

Formalin is injected into the body through some important vein & the whole body is dipped into formalin.