medico legal autopsy

MEDICO LEGAL AUTOPSY

AN OVERVIEW

WHAT IS AN AUTOPSY?

Autopsia (Greek) –

Auto – Self, Opsia – seeing

Other names: Post mortem examination

Necropsy (Animals)

Definition:

-thorough examination of a dead body

- to determine the cause and manner of death and

- to evaluate any disease or injury that may be present.

TYPES OF AUTOPSY

1. Medico legal autopsy

2. Clinical/Hospital autopsy.

Difference between medico legal & clinical autopsy:

Trait Medico legal Clinical

Objective Help in investigation Academic purpose

Authority Investigating authority Treating doctor

Consent Not necessary Must

Doctor Forensic pathologist/ RMP

Pathologist along with treating doctor

Dissection Always complete Can be partial

Who can conduct medico legal autopsy?

• Forensic pathologist: To help in investigation of death.

• Any R.M.P. can conduct medico legal autopsy.

• Usually limited to Govt. Hospitals.• Medico legal work can’t be denied,

delayed or referred.• Can take help of post mortem assistant /

diener.

History:

• Egypt – Mummification (3000 B.C.E.)• India – Shushruta (600 B.C.E.)• China – 16 C.E.• Japan – 456 C.E.• Arabian countries – Condemned.• Europe –

Greece – Herophilos, Erasistratus (335 – 250 B.C.E.)

Romans – 1st official autopsy – Julius Caesar

(44 B.C.E.)

- Frederic II(1194 -1250 C.E.) – 1st law

authorizing autopsies.

continue…

History:

• Europe:

Romans – Varignana (1302 C.E.) – 1st medico legal autopsy.

Leonardo da Vinci (1452 -1519)

France – Andraes Vesalius (1514 -1564) students

Italy – Morgagni (1682 -1771)• America –

1st autopsy – 1525 , on conjoined twins.

19th & 20th Centuries: Rokitansky, Bichat, Osler, Virchow.

Objectives:

1. Cause of death

2. How the injuries occurred

3. Manner of death

4. Time since death

5. Identity

6. Collect physical evidence

Benefits:

1. Physician & health care organization

2. Family of the deceased

3. Public health

4. Medical discovery & applied clinical research

5. Basic biomedical research

6. Medical education

7. Law enforcement.

Where to be conducted?Morgue /Mortuary:

Instruments required -

Instruments required -

Ideal time:

• Natural Vs Artificial light• India – Rules regarding night post mortem

examination.

Which cases are send for medico legal autopsy?

• Un natural deaths• Natural deaths – Cause of death not

known• Suspicious deaths.

Procedure:1. Death reported to police.

Procedure:2. Preparation of inquest panchnama

Procedure:3. Body send to mortuary:

Procedure:Prerequisites:

1. Inquest panchnama

2. Requisition from investigating authority or Magistrate.

3. Identification by accompanying police.

Autopsy report:

A} General particulars:

1. Name, address.

2. By whom was the corpse sent?

3. Name of place from which sent?

4. By whom identified?

5. Date & time of autopsy

6. Substance of accompanying police

report, supposed cause of death.

Autopsy report:

B} External Examination:

a) Examination of clothes

b) Identification marks, dental status

c) Post mortem changes

d) Condition of the skin

e) Natural orifices

e) Surface Injuries

f) Fractures

g) Injuries: Ante mortem or Post mortem?

a) Examination of clothes

1. Stains: Blood stains – Injury.

Saliva stains – Hanging

Mud stains – Site of death

Vomit – Poisoning cases

Oil, grease stains – RTA

2. Dry or wet? – Drowning.

3. Damages – Tears, cut marks

4. Identification – Laundry mark, Tailor/ company label etc.

b) Identification marks

1. Tattoo marks

2. Old scars

3. Any malformation

4. Any peculiarity

5. Dental status

c) Post mortem changes:1. Rigor Mortis:

c) Post mortem changes:2. Post mortem lividity

c) Post mortem changes:2. Post mortem lividity

c) Post mortem changes: 3. Cooling of the body

C) Post mortem changes4. Changes in the eyes

C) Post mortem changes4. Changes in the eyes

C) Post mortem changes:5. Signs of decomposition

C) Post mortem changes:5. Signs of decomposition

C) Post mortem changes:5. Signs of decomposition

C) Post mortem changes:5. Signs of decomposition

D) Condition of natural orifices

E) Surface Injuries

Description of Injury:

1. Nature of Injury

2. Situation over body

3. Size

4. Any peculiarity

5. Age

E.g. An incised wound present over back of left forearm middle 1/3rd, 6cm below back of elbow, of size 3cm X 0.5cm X Muscle deep, fresh.

F) Ante mortem or post mortem

1. Haemorrhage

2. Signs of inflammation

3. Signs of healing

4. Signs of infection.

F) Ante mortem or post mortem

INTERNAL EXAMINATION:

Incisions:

1. To open cranial cavity

2. To open thoracic & abdominal cavity.

Cranial cavity:

Extending from one mastoid process to other, passing through vertex.

Cranial cavity:

Under scalp haematoma:

Epidural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Skull fractures

Skull fractures

Skull fractures

Opening thoracic & abdominal cavity:

Opening thoracic & abdominal cavity:

Opening thoracic & abdominal cavity:

Opening thoracic & abdominal cavity:

Opening thoracic & abdominal cavity:

Opening of spine & spinal cord:

Opening of spine & spinal cord:

Dissection of individual organs:1. Brain:

Dissection of individual organs:1. Brain:

Dissection of individual organs:1. Brain:

Dissection of individual organs:2. Heart:

Dissection of individual organs:2. Heart:

Dissection of individual organs:2. Heart:

Dissection of individual organsLungs

Dissection of individual organsKidneys:

Dissection of individual organs:Liver

Dissection of individual organs:Spleen

Preservation of viscera:

1. Stomach & loop of intestine with their contents

2. 1/3rd of liver, ½ of spleen, ½ of each kidneys.

Preservative:

Opinion

Sufficient in ordinary course of nature to cause death.

Negative or Obscure Autopsy:

Other Types of Autopsies:

1. Virtual Autopsy2. Verbal Autopsy3. Psychological Autopsy