1. Introduction to autopsy
Medico legal module
21st batch
June 2014
Dr Sanjaya Hulathduwa
MBBS, MD, DLM, DMJ Path(Lond)
DMJ Clin(Lond) , Dip. Crim MFFLM(UK)
Senior Lecturer

2. An autopsy is also known as postmortem examination.
This is the final scientific investigation into a person’s death.
There are two major forms/types of an autopsy, viz: a. Judicial/Forensic/Medicolegal autopsy
b. Pathological autopsy

3. Objectives of an autopsy
Identification of the deceased
Time since the death
Place of the death
Cause of death
Circumstance/manner of death
Interpretation of injuries
Any other opinions (period of survival, volitional activities, mode of disposal, reconstruction of the event, nature of the weapons involved, use of alcohol and drugs etc.)
Collection of trace evidence/samples

4. Medico legal autopsy
A part of the medico legal investigation into a death
Conducted by a judicial medical officer or any other designated medical officer
Authority is given at an inquest
No consent required from the relations

5. Post Mortem Report (PMR) is given to the inquirer (ISD/Magistrate)
Cause of death is given after the autopsy
Any body tissue/sample could be retained for further investigations
Mode of disposal of the body is decided by the inquirer

6. Requirements for a Medico legal autopsy
Judicial requirements
Written order from the ISD or Magistrate
Medical requirement
A government medical officer or a lecturer from University Forensic Medicine Department. They are considered as experts in the field of diseases and injuries
(Section 45 Evidence Ordinance)

7. 3. Physical requirements Equipments Autopsy room with autopsy table, ventilation, illumination and running water Others accessories Trained autopsy labourers /mortuary “cutters”

8. Procedure There are ten steps of an autopsy History Visit to the scene
Identification of the deceased
Preliminary procedures
Examination of clothing

9. 6. General external examination 7. Specific external examination 8
6. General external examination 7. Specific external examination 8. Internal examination 9. Laboratory investigations 10. Documentation and reporting

10. History
From - Relations
Eye witnesses
Police officer
Suspect/Accused
Any other person
Past medical records

11. Visit to the scene
If the body is still at the scene
After the autopsy (retrospective scene visit)
Objectives of the scene visit-read lecture on Scene of Crime

12. Identification of the deceased Close relations Friends
Associates/work mates etc.
Usually by facial identification, in the presence of the JMO, in good light, while the body is on the autopsy table.
If not how?

13. Preliminary procedures
Photography
Features for identification
Patterned injuries- Bite marks, tyre marks
Injury patterns- Child abuse, torture, bomb
Violence
Radiology
Fire arms, explosives, child abuse, burnt bodies, torture, putrefied bodies, unidentified bodies
Collection of trace materials
Sexual offences, fire arms, abortions, deaths due to explosions, burns

14. Examination of clothing
Depends on the type of the death.
Unidentified bodies
Sexual offences
Fire arms
Road traffic accidents
Burnt bodies
Explosion deaths
Drowning…..etc. etc.

15. Clothes for identification
Injuries found on clothes
cuts, tears, penetrations
Trace materials
blood, paint, vomitus, semen, oil, glass particles, firearm residues, stains…..
Any other
Suicide note

16. General external examination
Height, weight, built, nourishment, hair, eyes, complexion, post-mortem changes….
Scars, marks, tattoos and other identifying features
Evidence of natural diseases
Natural openings
And many more…………………………

17. Specific external examination
Depend on the type of autopsy and its objectives:
Unidentified bodies
Time since death
Body moved after death
Sexual offences
Injuries

18. Internal examination
Opening up of all body cavities
Evisceration of all organs
Dissection of all organs
Head
Neck
Chest, abdomen
Pelvis
(may need to dissect other parts such as spinal code and skeletal muscles)

19. Dissection techniques
Standard Dissection- “chin to pubis”
Special Neck Dissection
Facial dissection (as an extension of neck dissection)
Musculo-skeletal Dissection
Spinal Dissection
Pelvic Dissection
Other (Eye, Middle ear, Neuropathological)

20. laboratory investigations
Depends on the autopsy
Toxicological Dept. of Govt. Analyst
Blood, urine, bile, stomach contents,
Liver, kidney, brain, vitreous humor
Histopathological
Any affected organ or injury sites
Other
microbiological, Diatom studies,
haematological/serological, enzyme
studies, genetic studies, ballistic,
entomological etc.

21. Samples for laboratory investigations contd.
Histopathology
In 10% Formol saline
Toxicological samples – no presevatives

22. Documentation and reporting Findings Opinion (eg. Cause of Death )
Other remarks
Compiled in the PMR-Post Mortem Report (H 42 form)
Whom to send and how to retain?

23. Question:
What is an obscure autopsy and how does it differ from a true negative autopsy?

24. PATHOLOGICAL AUTOPSY
Clinical autopsy (also termed Hospital autopsy in the UK and Australia)
Done to gather information about:
a disease/disease process
Pathology unidentified during life
Effectiveness of treatment

25. Pathological autopsy-requirements and procedure
Cause of death must be known and must be natural
Declaration of death must be filled before the autopsy
No suspicions/allegations about the circumstance
No inquest to the death
Written consent from the next of kin
Full or partial dissection could be employed
Only relevant body cavities opened
Special consent obtained to retain samples
Done by the hospital histo-pathologist in the presence of clinical staff of the ward

26. Approval from the head of the institution
Usually not carried out in high risk cases (HIV, Hep. B, other highly infectious/hazardous conditions)
Do not delay (unethical)
PM findings, samples taken must be documented on the BHT
Findings must be kept confidential

27. Thank you