regarding procedures of autopsy

1. PostMortem Examination
Necropsy a small walkthrough
Dr.S.Valliappan
PG JR,
Dept of Forensic Medicine & Toxicology
GMCH 32,CHANDIGARH.
The Search For Hidden Truths

2. Introduction
What is postmortem
examination
•Post-mortem (meaning after death)examination refers to an
examination and dissection of a dead body to determine cause of
death or the changes produced by disease.
•Post-mortem is also called as autopsy and necropsy.
•But the term “autopsy”(Greek autos –self, opis –view) means “to
see for oneself”, it’s a misnomer which is commonly used,and the
term “Necropsy”(Greek ,necro –dead, opis-view).

3. History of Autopsy
• More than 1800 years ago, GALEN (129-201 AD),did for first time
dissection on animals and primates.
• Fredrick II (1194-1250) authorised human dissection,
• Rudolph Virchow (1821-1902) founder of modern pathology,

4. History of Autopsy in India
• Dr. Edward Bulkely performed ,he first documented medico- legal
autopsy in 1693 in Chennai.
• Dr.Edward Bulkely first corner appointed by British,
• 1882 first medical autopsy was conducted at Grant medical college,
Byculla Mumbai.

5. Types of Necropsy
• Academic Autopsy,
• Pathological, hospital or clinical Autopsy,
• Medico-legal Autopsies: –
• Usually done in unnatural death, sudden death and in case of
suspicious death.
• Are carried out by RMP in government hopitals, Forensic
experts(Police Surgeon) in request to IO(Investigating Officer).

6. Objectives of Autopsy
• To establish identify of the deceased body.
• To find out the Cause of Death i.e. Natural or Unnatural.
• Whether death is Homicidal, Suicidal or Accidental.
• To ascertain Time passed since death.
• To asses the weapon used,
• To collect trace evidence, physical evidence &viscera for chemical
and HPE.
• Whether still-birth or live-birth of newly born infant

7. •
• THE ONLY THING WORSE THAN NO AUTOPSY,
• IS A PARTIAL AUTOPSY
• SO,IN EVERY CASE,THE AUTOPSY MUST BE
• COMPLETE

8. Prerequisite for Necropsy
• Written order from the Investing Police Officer.
• Day light
• Place: In the Hospital
• Where the dead body lies
• Identity of the deceased to be established
No unauthorised person should present will doing autopsy.

9. Contents of Post-Mortem Report
• Name of the deceased,
• Identification,
• Place, date and time of post-mortem,
• External Examination,
Internal Examination
• Viscera and Samples collected for analysis
• Opinion as to cause and manner of death

10. Instruments & Accessories for Autopsy

11. Stryker Saw:
good for cutting into skull

12. Equipment
• Waist high and is plumbed for running water
and has several faucets for washing away
blood that is released during the procedure.
Raised edges keep blood and fluids from
running into the floor.
Body Block
Placed under the back of the
body causing arms and neck to
fall back while pushing the
chest upward to make it easier
to cut open.
Cadaver Table

13. General Examination
• Body is weighed, measured and X-rayed
• Photographs are taken of the body (front, back & naked)
• Fingerprints are taken (if any missing, parts are noted)
• Scrape underneath fingernails for evidence
• Examination of clothes
• Age, sex and race are noted
• Eye color, scars, venesection wound, tracheostomy wound
,moles, tattoos are noted
• Examination of the eyes (blood spots & etc.)
• Any body secretions and gun powder residue/ bullet holes
• Body fluids are drawn from the body for testing (blood, urine,
spinal fluid, vitreous humour from the eye
• Body is cleaned and ready to be put on table

14. • External Examination of Natural Orifices
For foreign bodies, injuries, discharges (blood/pus, froth)
• External Examination
Presence of Teeth/Dentures
• Various dental work
• External Examination of Marks
Cord,
ligature mark
Finger marks round the neck
Its exact position,
Manner
Application of the knot

16. External Examination to Ascertain
Time Passed Since Death
• Rectal Temperature- . ALGOR MORTIS .
• Hypostasis- . LIVOR MORTIS.
• RIGOR MORTIS.
• Stage of Putrefaction.
• Ova of flies and maggots

17. External Examination of Injuries
• From head to foot& from front to back
• Injury: Situation (Position)
• Extent
• Nature (Contusion, Abrasion,
Lacerated, Incised, Stabbed or Punctured)
• Dimension
• Condition of Edges
• Course and direction of bullet
• Direction of blood smear

18. External Examination Types of Injuries
• Contusion
• Abrasion
• Laceration
• Incised Wound
• Punctured/Stabbed wound
• Burns:-
First Degree
Second Degree
Third Degree

20. Internal examination
Types of incision for internal examination:
• 1. “I” shaped incision: this incision is mostly used nowadays, it
extends from symphysis menti at the beginning to symphsis pubis at
end.
•
• 2.”y” shaped incision: these incisions are usually made in female
deceased body, for cosmetic purpose .it extends from acromion
process on both sides, runs below the breast and reaches pubic
symphysis.
• 3.”modified y” incision :usually done in case of hanging or
strangulation, where neck dissection is important.

21. Y incisions

22. Internal examination
• Internal Examination of Body:
•
Order of Exam:
•
Abdomen  Thorax  Head
• But this order of examination is also can be changed, its based on medical
officer decision.

23. Internal examination
• Different types of organ removal:
• 1.Virchows method-removal of single organ one by
one
2.Rokitansky method-in situ dissection
3.Letulles method-en masse removal
4.Ghons method-en block removal

24. Internal Examination of Thorax
• Split the ribcage, open it up, and examine the lungs and
heart, note any abnormalities, and take a second blood
sample directly from the heart.
– Ribs Fracture
– Sternum fracture
• Pleural Cavities- for blood, fluid
Lungs- Collapsed, Full, Water

25. Internal Examination of Thorax
• Pericardium
• Heart
• Chambers of Heart
• Coronary Arteries
• Aorta,
• Larynx,
• Trachea,
• Oesophagus

26. Examination of Heart
• Evaluation of coronaries:
• -Before any forms of cardiac dissection is applied, coronaries
should be inspected for calcification and tortuosity.
• -Subjects younger than 30yrs or where cause of death is
non cardiac: coronaries may be opened longitudinally
• -Otherwise, transverse section : 3.5-5mm .
• -Calcified vessels are stripped off and decalcified
• Air embolism in heart chambers should be also checked.

27. Cardiac Dissection
• Inflow-outflow method:
• Right: -Using entrotome, initial cut is made from IVC to right atrial appendage
sparing SVC and SA node.
• -Right ventricle opened with knife along 1cm parallel to the
posterior ventricular septum
• -Outflow tract :1cm parallel to anterior
ventricular septum
• Left: -Left atrium-between R and L pulmonary veins
• -Left atrial appendage checked for mural
thrombus.
• -Inflow tract: left ventricle opened along its
inferolateral border.
• -Outflow tract :to avoid damage to mitral valve, 1cm parallel to
anterior ventricular septal groove

28. Internal Examination of Abdomen
• Peritoneum
• Abdominal Cavity
• Abdominal Organs
• Pelvic Cavity
• Stomach
• Small and Large Intestine
• Liver,
• Gall bladder

29. Internal Examination of Abdomen
• Pancreas
Spleen
Kidneys
• For Necrosis
• Size, Colour Weight,
• Rupture, Calculi
• Bladder
Prostate
Testes
• Spinal cord ,
• Vertebral column ,
• Pelvis

30. INTERNAL EXAMINATION BRAIN
CAVITIES
• After the main organs are examined the examiner proceeds to the brain; (The body
block is then moved to underneath the head)
• Next, examine the head. Check for any trauma to the skull like fractures or bruises
• Deep incision begins behind one ear, travels over the top of the head and behind the
opposite ear.
• The scalp is pulled away from the skull in two flaps; front going over the face and the
rear going over the back of the neck so the skull is fully exposed.
• Electric saw known as the “ Stryker saw” is used to cut and remove a wedge shape
portion of the skull which exposes the brain.
• Brain is removed, weighed
• and examined.
• Any findings noted

31. Internal Examination Brain Cavities

32. • Once everything has been examined, all the internal organs are returned to the body
cavities or
incinerated.
• The body is sewn back together
A report will be done based on notes and findings while performing the autopsy
• Send tissue samples, blood, urine & etc. to lab for testing
• Refrigerate body to preserve it until its ready to be moved elsewhere

33. Post-Mortem Reports Value
• Provides information about cause of death,
• Statement of the Medical Officer made in Court is
substantive evidence
• Medical Officer can use it for refreshing his memory while
giving evidence
• For Corroboration & Contradiction of Medical Officer
Reserving Opinion as to the cause of death
pending result of chemical analysis.
• Negative Autopsy
• Obscure autopsy.