MEDICOLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION

MEDICOLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATION

Autopsy or postmortem examination is performed on dead bodies with the following purposes:

1. Academic — Dead bodies are dissected by the students of Anatomy for academic purposes to know details about the different external and internal organs and structures of the human body.

2. Pathological or clinical autopsies are perfor — med by the pathologists or clinicians to diagnose the cause of death, where diagnosis could not be reached during treatment, or to confirm diagnosis where the same was doubtful. This also helps the pathologists to know the pathology of organs due to some diseases.

3. Medicolegal autopsies — In unnatural and suspicious circumstances of death, dissection of the dead bodies and their examination is compulsory by law. The purpose of medicolegal autopsies is to find out the cause of death and help dispensation of justice if any crime is involved in the circumstance of the death.

MEDICOLEGAL AUTOPSY AND ARTEFACTS IN POST MORTEM EXAMINATIONPurpose of medicolegal postmortem examination —

1. To know the exact cause of death.
2. To find out the circumstances of death.
3. To find out the time passed after death.
4. In case of unidentified dead body, to establish identity of the deceased or to help to do so.
5. In case of death due to injury or poisoning, the period for which the deceased survived after sustaining the injuries or exposure to poison.
6. To know the nature of death, whether it is a case of natural death or a case of suicide, homicide or accident.
7. What type of weapon or which poison was used?
8. Whether one or more than one person was/ were involved, in case of homicide.
9. Whether any natural disease process contributed in any way, to cause the death.
10. Whether any other offence was related with the death e.g., rape.
11. Is the injury which has caused death, expected to cause death in ordinary course of nature ?
12. Whether the dead body was disturbed sometime after death.
13. What was the place of disposal of the dead body? Whether the body has been shifted from original place of disposal.
14. To know whether more than one method or more than one weapon were used.
15. Whether the deceased received any treatment before death.
16. Whether there is anything on or with the dead body which may help identification of the assailant.
17. In case of death due to assault, the relative positions of the victim and the assailant/s.

Procedure to conduct medicolegal post-mortem examination —

For conduction of medico-legal post-mortem examination certain formalities have to be observed.

1. It can be conducted only on the strength of a requisition received from an authorised person. (Ordinarily a police officer, a magistrate or a coroner is authorised to issue a requisition for conduction of medicolegal postmortem examination).

with the requisition, a copy of the inquest or the preliminary investigation report, a dead-body challan and any other paper of importance, should accompany.

2. Medicolegal P. M. examination can be performed only in an authorised centre.

3. All registered medical practitioners in Govt, service can conduct the examination.

4. A police officer or any other authorised person should identify the dead body in connection with the concerned case, before the autopsy surgeon.

5. Conduction of medicolegal P. M. examination does not require any consent from the relatives or friends of the deceased.

6. The dead body should preferably be dissected with the help of natural sunlight. But under special circumstances of urgency, it may be carried on at night, with the help of artificial light. If feasible, the body may once be examined (external), when it first reaches the mortuary, if it reaches at night. A detail examination should be undertaken in the next day when sufficient natural light is available.

7. The mortuary should have cooling chambers for preservation of dead bodies. The doors and windows of the mortuary should be fly proof. There should be plenty of water supply in the mortuary for proper cleaning and washing purposes. The mortuary should have facilities for disposal of dead bodies. It should have dissection table, instruments and other equipments and articles.

When a dead body reaches the mortuary, the date and hour of its arrival and then the date and hour of conduction of the P. M. examination should be recorded.

It is recommended that, the autopsy surgeon should himself dissect the dead body with the help of an assistant and his other assistant will write down the findings dictated by him.

Before starting the P. M. examination proper, the doctor should go through the inquest report and the requisition and must get the body identified by the accompanying police personnel.

P. M. Examination Proper

1. The description of the dead body should first be noted with the wearing apparels in situ. Then the wearing apparels should be removed from the body disturbing the body and the wearing apparels minimum.

2. Detail examination of the dress and other wearing apparels should then be made in respect of their number, make, design, stains on them, old and recent tears, cuts with their dimensions. These may have to be examined once more after conduction of the P. M. examination, to compare the tears, cuts and blood stains on them with injuries on the body. The tears and cut marks should be measured and their placements noted. After P. M. examination these should be sun-dried, packed, sealed and handed over to the police authority.

3. Examination of the dead body:
A. External examination:

The following points should be recorded.
(a) Body length.
(b) Body weight.
(c) Built, complexion.
(d) Scalp hair – length, colour, recent hair cut, part shaved, use of any dye, singeing, whether wet, presence of dust, mud, stains, if partly fallen off, vermilion mark, baldness, sharp cut on hair, crushing of hair bulb due to injury.
(e) Description of beards and moustaches in their length, colour, trimming, shaving; absence of beards and moustaches.
(f) Vermilion mark on the forehead.
(g) Any tattoo mark, moles or mentionable scars, deformities in the body.
(h) Condition of the eyes – closed or open, corneas – hazy or clear, condition of the pupils – shapes and sizes of both the sides. Any congenital or acquired deformity or disease, prosthetic eye, scar on cornea, petechial or subconjunctival haemorrhages, cataract.
(i) Any discharge from mouth or nostrils – a frothy, blood stained, dribbling of saliva, suspected poisonous stain.
(j) Protrusion or biting of the tongue.
(k) Congestion, petechial haemorrhages.
(l) Cyanosis – fingertips or elsewhere.
(m) State and distribution of post-mortem staining, its colour.
(n) Blood, mud or other stain on the body.
(o) State and distribution of rigor mortis.
(p) Cadaveric spasm, content of the hand.
(q) Cutis anserina.
(r) Any foreign material any where in the body including the nail beds. Mud or sand stain on the soles.
(s) State of decomposition.
(t) Maggots.
(u) Any adepocere or mummification change.
(v) Condition of the prepuce — circumcised or not, condition of the scrotum and testicles.
(w) Female breasts — parus, gravid (signs of past or present pregnancy).
(x) Discharge per vagina, any other findings.
(y) Any antemortem injury anywhere in the body including inside of nose, inside of lips, inside of mouth, over female breasts, private parts of females including inner aspect of thigh, hymen, vagina.
(z) Any suspected stain (poison, seminal fluid) on lips, hands, mons veneris private parts, vaginal wall.
(zz) Any ligature mark on the neck or elsewhere its position, dimension, direction, position of the knot.

N. B. If the ligature material is present in situ, then it should be taken out by tying the knot with a thread and then cutting the ligature material at a point opposite to the knot. The ligature material should then be examined in terms of, which material it is made of, the design, length of the part encircling the neck, length of the remaining part, breadth of the ligature material, how many rounds it is twisted around the neck, type of the knot, whether the ends of the ligature material bear any recent cut mark, the strength of the material.

The ligature material should then be packed, levelled, sealed and handed over to the police of the concerned police station.

Any stains on any part of the body should be scrapped out, preserved without any preservative.

Examination of External injuries

All external wounds should be recorded in all their details, on the following headings:
(a) Type of injury
(b) Size
(c) Shape
(d) Site, in relation to two external anatomical landmarks.
(e) The weapon of infliction or the mode of causation (usually not mentioned in the P. M. report).
(f) The direction of application of the force.
(g) For the fatal wounds, the distance of the wound from the same side heel may be recorded. This may help to reconstruct the incident.
(h) The time and date of infliction of the injury should be studied. This can be done from inflammatory, healing changes and also from the colour changes.
(i) The vital reaction should be noted, presence of which differentiates antemortem injuries from the postmortem ones.
(j) Presence of defence cuts or injury at the expected sites prove the homicidal nature of injury and death.
(k) Marks of resistance in the form of minor injuries on the non-vital parts of the body has the same significance.
(l) Concealed punctured wounds are homicidal in nature and search should be made for their presence.
(m) Split laceration inflicted on the forehead, scalp or some other areas, against a bony prominence looks like incised wound. Hence, such doubtful injuries at these sites should be examined carefully with the help of a hand lens.
(n) Bum injuries should be recorded in all details of their extent and other features.
(o) It should be kept in mind that, abrasions can be caused on a dead body due to rough and careless shifting of the body, from the place of death to the mortuary.
(p) In dead bodies, removed from rivers or ponds, P. M. injuries caused by fish or aquatic animals, may be present. Similarly, P. M. injuries due to gnawing by other animals, starting from dog to rodents, may be present in other bodies. Post-mortem injuries in the form of abrasion, may be caused by ants or cockroaches.
(q) Injection marks and other signs of treatment given, should be searched for and recorded.

B. Internal Examination

For internal examination, the different body cavities are to be opened in a planned way.

A single incision is given for opening of the thoracic and abdominal cavity both. To open the cranial cavity two incisions are recommended. To expose the structures of the neck, three different incisions are recommended.

(a) To open the chest and abdominal cavities, one single incision, starting from the sternal notch above, to the symphysis pubis below, through the right side of the umbilicus is applied. If there is any injury on the right side then, left paramedian incision can be applied. With this incision, some prefer to expose the chest cavity first. Others prefer exposure of the abdominal cavity first. In the opinion of the author, the decision should better be taken considering, whether the important findings are expected in the abdominal or thoracic cavity. When no specific reason prevails, it is better to open up the abdominal cavity first. After the incision is given the skin is flapped out on both sides. The muscles are dissected in the same line of incision. The abdominal organs are then dissected out.

1. Stomach — The stomach is first taken out by placing two ligatures at the cardiac end of the oesophagus and two ligatures below the pylorus end of the stomach. The stomach is removed by cutting between the double ligatures at both the ends. The stomach is opened along the lesser curvature. The wall of the stomach is thoroughly examined. Presence of any stain, congestion, haemorrhagic points, desquamation, ulceration, sloughing or perforation should be noted. The content of the stomach is noted in respect of quantity, nature of material/food, state of digestion, colour, smell, any evidence of haemorrhage etc. After examining and weighing the stomach and its content separately, the stomach should be stitched up along the lesser curvature with the content inside, and kept for preservation.

2. The liver should be removed and any injury or pathology in it should be noted. It should be weighed. A part of the liver (minimum 500 gm.) should be taken out for preservation for chemical analysis. In case, any pathology is suspected in its gross appearance then, a small portion from the suspected area is dissected out along with bordering healthy tissue and preserved in 10% formol saline. For macroscopic examination of inside of the liver, multiple transverse incision at 1 cm. apart should be given. The gall bladder is dissected out along with the liver. Any pathology or stone formation inside is noted.

3. The kidneys are taken out along with the adrenal glands, after tying the ureters along with the vessels at least one inch away from the hilum of each kidney. The surface of the kidneys along with the covering capsules should be examined for presence of congestion, haemorrhage and injury. The capsules and the adrenals are separated. The kidneys are bisected transversely along the longitudinal axes. Any pathology, congestion, haemorrhage or injury should be noted with exact mention of the sight and extent. In case of possible pathology, suspected part along with marginal healthy tissue should be preserved in 10% formol saline.

4. The urinary bladder may be examined in situ. Before opening the bladder, if it contains urine, that should be syringed out, or can be taken out with the help of a clean spoon after incising the bladder, avoiding all chances of contamination by blood or any other material. The bladder should be examined for any pathology, haemorrhage, congestion or injury.

5. Both the ureters should be opened along their long axes.

6. The spleen is then taken out and pathology or injury noted.

7. The intestine is dissected in its entire length. It is particularly important to look for any injury or reaction due to the effect of poison or presence of a foreign body like a bullet. Curling ulcer is a phenomenon noticed in the duodenum after about 7 to 10 days of sustaining extensive bum injury. Ulcerative colitis like lesions are noticed in case of poisoning with mercuric chloride.

8. In penetrating wounds of the abdomen, the intra-abdominal vessels may be injured and there may be excessive intra-abdominal haemorrhage. Excessive intra-abdominal haemorrhage also occurs due to gross injury to abdominal organs like liver, kidneys and spleen.

9. The pancreas and the adrenal glands are to be examined. If necessary, tissue from these glands are to be preserved for histological examination.

10. The uterus and its appendages should first be examined in situ and then removed enmasse along with the vagina. The uterus should be examined in respect of its dimensions, weight, whether gravid, parous or nulliparous or whether there is any pathology in it. In case of gravid uterus, condition of the whole product of conception should be noted down. Any evidence in support of abortion or attempted abortion with remains of any part of the product of conception inside the cavity should also be recorded. If there is evidence of attempted abortion then, the endometrial surface should be thoroughly examined in respect of colour, erosion or any other damage including ulceration or perforation of vaginal canal (particularly near the fornices) or of the uterine wall. Foreign body in the form of root, bark (for that purpose any material which might have been used locally to cause abortion) may be present inside the uterine cavity. Smell and nature of the fluid present inside the uterine cavity may be further indicative in this regard. Death in occasions may occur due to other causes (pathological), preceeded by haemorrhage locally, or systemic effect indirectly. Evidence of use of instruments may be present in the Cervix or in os.

11. Rupture of an ovarian cyst may be a very rare cause of death, sometimes associated with history of trauma. The ovaries should be searched for presence of corpus luteum. Fallopian tubes and ovaries have special medicolegal significance in cases of deaths due to their rupture in ectopic pregnancies.

To open the chest cavity, after retraction of the skin sidewise, the cartilaginous parts of the ribs are cut on both sides and the manubrium is separated from the clavicles at the stemo-clavicular joints. The sternum and the marginally attached cartilaginous ribs are removed. The position of the intra-thoracic organs is observed. But, for detail examination they should be taken out of the chest cavity. Before that, the neck should be dissected and the structures there are examined. The intra-thoracic organs should be taken out along with the neck structures namely, larynx, trachea, oesophagus and also the tongue. Before examining these organs, the chest cavity is examined for haemorrhage or haematomas, injuries including fracture of ribs. Fractures of ribs are better examined by dissecting the intercostal muscles.

1. After taking out the thoracic structures they are once inspected before separation.

2. The heart is separated after applying double ligatures at the base of the heart over each large vessel and then dissecting them in between the two ligatures of each vessel. The size and weight of the heart is noted. The walls of the heart may be hypertrophied or dilated. The condition of the valves and presence and degree of atheroma, noticed in the valves and the intima of the large vessels, are noted. Aneurysm or other pathology in the vessels should be kept in mind, in some cases of death. Any ischaemic lesion, old or new infarction, should be searched for. The patency of the coronary vessels and intra-vascular clotting in the coronary vessels may be looked for. For the purpose of examination of the coronary vessels, probe of suitable size can be used. Others prefer multiple transverse incisions on the vessels, while some others prefer longitudinal incisions along the length of the vessels. Presence of subendocardial haemorrhagic spots should be searched for in some poisoning cases or pathological conditions. Patent foramen ovale may be noticed, though very rare. To examine the myocardium, transverse incisions are better. The cavities can be opened by longitudinal or transverse incisions. Any septal defect, haemorrhage at any site or injury anywhere can thus be clearly seen. For confirmation of any suspected pathology, tissue should be preserved for histological examination. Presence of clotted or liquid blood or froth or air bubbles in the chambers of heart should be noted with mention of the quantity, which can be either due to antemortem or postmortem causes.

3. The pericardium should be examined for presence of any pathology or injury. The content of the pericardial sac and its quantity should be noted. Pericardial effusion, cardiac tamponade, subpericardial haemorrhage, constrictive pericarditis etc. should be looked for.

4. Both the lungs are to be separated from the mediastinal structures after tying the vessels and the bronchioles. The condition of pleura, any sign of pleurisy or pleuritis or pleural adhesion, subpleural petechial haemorrhages, injury to pleura, condition of the pleural space (effusion, haemothorax, pneumothorax, pyothorax etc.) should be noted.

5. The lungs are examined for disease, injury and some other findings. In asphyxial deaths the surface of the lungs, particularly, the interfaces of the lobes will show the presence of tardieu’s spots, and there will be congestion of both the lungs, with oedema sometimes. In case of death due to drowning, there won’t be any tardieu’s spot on the surface of the lungs. But the lungs will be more oedematous. The cut section exudes frothy blood-tinged fluid. The lungs of submerged body may show evidence of emphysema aquosum or oedema aquosum change. Punctured or lacerated wounds cause collapse of the particular lobe. In case of blunt force injury, wound of the lung corresponds with the fractured end of a rib. In case of any pathology in the lungs, tissue may be preserved for histological test. Thymus should be examined and the tissue from the gland preserved, if necessary.

Examination of the structures of the neck — The internal structures and tissues of the neck should be examined thoroughly, in case of death due to constriction of the neck or injury or any pathology. For exposure of the structures of the neck, ordinarily, the upper end of the main incision at the sternal notch is extended upto the symphysis mentii. Skin, subcutaneous tissue, muscles and other structures are examined layer by layer. But, when a more detail examination is necessary or exposure of a wider area of the neck is necessary, then a different type of incision is preferred to.

(a) A ‘V’ shaped incision is given, the apex being at the sternal notch, with the two wings extending upwards and laterally upto the mastoid processes of both sides. The skin is flapped up upto the margin of the mandible.

(b) A third variety of incision exposes still wider area of the neck. Here, actually two incisions are required. One incision extends from sternal notch to the symphysis mentii. The other extends from the acromion process of the clavicles of one side to the same point of the other side. The skin is flapped upward and outward.

Irrespective of the type of the incision, most autopsy surgeons like to examine the neck structures, before removal of the thoracic organs so that the tongue, larynx, trachea and oesophagus can be taken out along with the lungs. This helps examination of the whole of the upper respiratory tract in its continuity.

In case of death due to alleged constriction of the neck, there may be fracture of hyoid bone or thyroid cartilage with extravasation of blood in the tissue and injury to carotid arteries, stemo-mastoid muscles or platysma. Compression of the neck with hard materials may cause injury to the cervical vertebrae and the corresponding part of the spinal cord. Level and extent of other mechanical injuries on the neck should be cautiously examined to know the type of injury and organs or structures injured causing the death.

Exposure of the Cranial Cavity

One of the two conventional incisions can be used —

(a) A circular incision around the head at a level 1″ above the eyebrow, extending sidewise upto the occipital protruberance, keeping the scalp over the protruberance intact. The scalp is flapped out posteriorly. Any haematoma in the soft tissue of the scalp is noted. The periosteum is removed and any fracture in the skull bone is recorded as to its type, position and extent.

(b) The other type of the incision extends from just above the attachment of one ear to the point just above the attachment of the other ear. In this incision, the skin is flapped out both anteriorly and posteriorly. Rest of the procedure is same.

Many prefer the second variety of the incision for cosmetic reason, as because this incision does not distort the facial appearance.

The cranial cavity is finally exposed by sawing and chiselling out the skull vault at a level 1″ above the eyebrow in front and about the level of the occipital protruberance at the back. Some dissectors feel comfortable with manual saw, while others use electric or battery operated saw. Any injury to the dura and extra-dural haemorrhage is noted. With a criss-cross incision the dura is removed. Any subdural or subarachnoid haemorrhage or injury to deeper meninges or surface of the brain or any evidence of any disease is noted at this stage. The meninges may be congested due to asphyxia, apoplexy or other intra-cranial lesions. The brain is dissected out at its stem, along with the roots of the cranial nerves. The whole brain is taken on a clean enamel tray. Haemorrhage and fracture at the base of the skull is searched out. Before dissecting the substance of the brain the circle of Willis is examined for any aneurysm and rupture of the aneurysm. All the ventricles are opened and examined. The cerebral hemisphere is dissected out along with base and the cerebellum. Both side cerebral and cerebellar hemispheres are sectioned, first, longitudinally and then transversely. In this way most of the parts of the brain substance will be exposed. Any haemorrhage, injury, congestion or pathology is noted. Haemorrhage in the pons and base of the brain of any amount is most important. In case of gunshot injury the projectile may be present in the brain substance or inside the cranial cavity. The track of the projectile or the wound should be noted in case of gunshot and stab wounds.

The pituitary fossa should be examined specifically and cautiously.

Examination of the Spinal cord

When there is no indication, the spinal cord need not be exposed. When necessary, it should be exposed from the back. A midline incision is given on the back along the entire length of neck and trunk. The skin is flapped out sidewise or laterally 1″ on either side. The vertebral column is cut along the medial margins of the transverse processes of the vertebrae. The whole length of the spinal column can be taken out in this way without causing any P. M. trauma.

Scrotal Sac — To open the scrotal sac and examine the testicles and other organs, some prefer two lateral incisions, though it can be done by one midline incision also. Examination of the scrotal sac is a must when the sac is enlarged, tense in look or deformed in appearance. Injury, haemorrhage or pathology should be noted.

Apart from these, to confirm a bruise, to confirm and examine a fracture, to trace the track of a wound, to recover a foreign body e.g. pellet or bullet, to examine the site of an injection mark and to examine any deformity or pathology, incisions may have to be given at any place on the body surface.

In relation to medicolegal postmortem examinations, preservation of some organs, some viscera or some other materials is necessary or even essential in some cases.

Viscera which are usually preserved from the dead bodies —

1. Stomach with whole of its content and a loop (1′) of small intestine from its upper part are preserved in absolute alcohol or saturated solution of common salt, in one container.

2. Half of liver or 500 gm. of it, (whichever is more), whole of spleen, longitudinal half of each kidney are preserved in absolute alcohol or saturated solution of common salt in another container.

Other organs or materials may have to be preserved in some specific cases.

1. Blood is preserved with suitable preservative for chemical examination, if there are reasons to believe that there has been systemic absorption of some poison. Preservatives used, are oxalates, mercuric chloride, E.D.T.A. etc.
2. For the purpose of grouping, small amount of blood is well-preserved by being soaked in blotter.
3. Brain is preserved in case of cerebral poisoning.
4. Lungs should be preserved in case of poisoning with volatile agents which are exhaled out through the lungs.
5. Spinal cord is preserved in case of strychnine or other spinal poisoning.
6. Uterus — in case of abortion or attempted abortion leading to death.
7. Skin from the injection site along with deeper tissue (suspected injection of poison or drug) or from the site of entrance of bullet or splinters of a bomb should be preserved.
8. Urine — should be preserved, if available in all cases of systemic poisoning.
9. Scalp hair – a bunch is pulled out with roots and preserved.
10. Nail cutting and scraping are preserved.
11. Vaginal swab and cervical smear — should be preserved in cases of death following suspected sex violence.
12. Swab is taken from the glans penis when the deceased is allegedly killed after commission of a sex offence by him.
13. Pubic hair from such bodies as in no. 11 and 12 above should be preserved .
14. Swab or scrapping from suspected stained areas of the body is also preserved.
15. Ligature material – in case of hanging, strangulations.
16. Wearing apparels and belongings of the dead body including the pocket articles.

Note : The materials should be preserved in suitable container or packet with or without any preservative as is necessary for each material. These are then properly labelled, sealed and sent for laboratory examination with a requisition with mention of special test, if any required.

Stomach and small intestine are preserved in one container and rest of the usual viscera e.g. liver, kidneys and spleen are preserved in a separate container. This will help to know whether a poison has been absorbed in the system after ingestion, or death has taken place before the absorption of the poison due to some other cause or whether the poison was given to the victim just before death to simulate death due to poisoning.

For preservation of viscera, clean and preferably sterile glass jar with glass lid should be used. The size of the jar should be such, so that, at least l/3rd of the volume of the container remains empty to allow accommodation of the gas which will evolve out of the organs preserved. The lid should be airtighted by using molten wax.

Absolute alcohol or rectified spirit is the best preservative in most of the cases. But these cannot be used in case of death due to ethyl or methyl alcohol poisoning.

These also cannot be used in case of poisoning with white phosphorus, chloral hydrate, formaldehyde, chloroform, paraldehyde etc. In these cases conclusive opinion becomes difficult, as the alcohol used as preservative may mask the actual agent of poisoning. In case of phosphorus, alcohol destroys the luminous property of the poison. On the other hand normal saline being the normal constituent of the body, saturated solution of common salt has no limitation in this regard. It can be used as preservative in all cases. But as a preservative it is not as effective as absolute alcohol.

10% formol saline is used to preserve tissue for the purpose of histological examination. For preservation of organs for the museum, formalin is used with traces of glycerine, pot-acetate and carbolic acid. Preservation of blood and urine ordinarily does not need any preservative. When the cells of the blood need to retain their morphology, then preservative as mentioned earlier should be used. Swabs can be preserved without any preservative. Preservation of hair, bone or nails do not need any preservative. Wearing apparels are first sun-dried and then packed. Bullets or pellets are preserved in clean glass jar (without being washed), wrapped by cotton or soft mosleen cloth, after imprinting identification marks on them. Skin from near the entrance wound due to a splinter or projectile or an injection mark should better be preserved without any preservative.

When some preservative is used, some amount of the same should be preserved in a separate container for control test.

EXHUMATION

Exhumation means authorised digging out of a buried dead body from the grave. This is done for performing medicolegal postmortem examination. The indication for exhumation are mostly same as for usual P. M. examination, e.g. suspected homicide, suicide cases, or when any suspicion concerning nature of death arises after burial of the body. A dead body may also be exhumed in relation to some civil issues like, identification of the deceased for settling of inheritance cases or succession of property or some other claims.

Procedure and Precautions recommended for Exhumation

1. To exhume a dead body, order from a Govt, officer who enjoys the power of a first class judicial or executive magistrate should be there.

2. It should be done and completed in broad daylight, for which it should be started during the morning hours of the day.

3. The magistrate and a doctor should be present during the process of exhumation.

4. Before opening, the particular grave in the graveyard should be located with full satisfaction, so that wrong body is not disinterned.

5. Soil from above, below and two sides of the body or the coffin should be preserved in clean containers, separately.

6. Before the body is lifted out, the medical officer should examine the body inside the grave or the coffin regarding its position and appearance.

7. Before removal from the grave or the coffin the body should be photographed.

8. After all these are done, the body is then sent to a mortuary for post-mortem examination as in all other cases, along with a requisition and a preliminary investigation report which contains the brief history of the case which acts as guideline for the autopsy surgeon. In the mortuary post-mortem examination on the body is performed as in all other cases.

Postmortem examination of mutilated and dismembered body parts

It should be remembered that examination of dismembered body parts does not mean postmortem examination of that part. In many cases dealt by the author, human body parts were sent for examination, which were not linked with death of the victims.

Medicolegal importances of different dismembered body segments —

Depending on the body part, the following informations can be obtained from them.

I. Identification:
1. Race— from Head (scalp hair, cephalic index, other bony features), eye, skin, teeth, limbs (long bones, ratio of parts of limbs).

2. Stature — from length of limbs and their parts, bones of limbs.

3. Sex — Scalp hair, distribution of hair in different body parts; physical, morphological feature of the part examined, histological study of Barr bodies in epithelial cells, presence of sex organs, study of bones. Parts of wearing apparels, ornaments.

4. Age — greying of hair, wrinkling of skin, archus senilis cataract, study of teeth and bones ; pubertal changes in younger subjects. In case of foetal body parts, developmental changes in the parts.

5. Blood group detection.

6. Tattoo marks, occupation marks, scars, moles teeth, vermilion marks, use of cosmetics, use of dye, deformities, skin complexion, fingerprint.

7. Wearing apparels e.g. wrist-watch, bangles, ring in dismembered forearm and fingers.

8. With severed head, help of photography and superimposition technique may be taken, if the head is suspected to be that of a known missing person.

9. Use of D.N.A. technique may be helpful.

II. Cause of Death

1. The cut ends of the segmented body parts should be closely examined to ascertain, if the wound margins of the severed body parts show antemortem reactions or not. Dismembered body parts showing antemortem wounds do not prove that, death was due to those wounds or even that, death was due to wound or injury. With or without antemortem wound, death could be due to strangulation, throttling, suffocations, poisoning etc. The victim might have not died even.

III. Time of Death : Time of death (if death has occurred) or time of dismemberment of the body parts can be estimated out by observing the changes in the examined body parts, which are similar to post-mortem changes, e.g. rigor mortis, decomposition etc.

IV. Weapon involved : In case of presence of antemortem injury, the weapon used to inflict the same and the type of weapon used to dismember the part, can be said.

V. The Place of occurrence and disposal of the parts can be said in many cases from trace materials adhered with the part from the place of disposal.

VI. Cadaveric spasm of the hand may show foreign hair etc. in the hand, nail beds may show presence of foreign tissue.

VII. Defence cuts should be looked for, particularly while examining fore-limbs.

N.B. In examining a dismembered body part, tissue or material should be preserved, as and when felt necessary.

Examination of Charred (Burned) Body Parts

Sometimes charred remains of a body are sent for postmortem examination. In these cases detail opinion about different medicolegal aspects may not be possible. But the autopsy surgeon should remember that, whatever information he will give to the I.O., may be of immense importance to him (the I.O.). Like dismembered body parts, by examining charred body remains, the autopsy surgeon can say about any or many of the points, discussed in the previous pages. In addition to these aspects, the autopsy surgeon shall have also to opine, whether the burning was antemortem or post-mortem in nature. Sometimes charred bones or even ash from the cremation ground may be sent. From these charred bones it may be easily possible (may not be also) to know the sex and age of the victim. Sometimes type of antemortem mechanical injury, if any, and the weapon used can be known. From the charred bones and from the ash from the cremation ground, poison like, arsenic can be detected. Some ornaments and teeth may remain unburnt or partly burnt. These may help identification of the victim.

Examination of Skeletal remains

The questions which the autopsy surgeon usually faces in connection with examination of skeletal remains are as follows:
1. Whether the bones belong to human being or not?
2. If they belong to human being then whether they are from one individual or more than one individual ?
3. What was the race of the person/s ?
4. What was the sex ?
5. What was the stature ?
6. What was the cause of death ?
7. What type of weapon was used ?
8. What was the time of death ?
9. Whether there is any evidence of disease or pathology in the bones ?
10. What was the mode and place of disposal ?
11. Nature of death, if possible.
12. Special information, if any.

Answers to the questions:

1. Answer to question 1: From the knowledge of human anatomy the autopsy surgeon can say, whether the bones belonged to human being or not. If these do not belong to human being, the autopsy surgeon is not expected to say to which animal did these belong. Precipitation test speaks confirmly, if the bones belonged to a human being or any other animal.

2. Whether the bones belonged to one individual or more than one ? If there is no duplication of one side bones, if the bones are of same race, sex, age, stature and if the corresponding bones fit snugly and nicely at their corresponding joints, then, for ail practical purposes the bones belonged to the same individual. For comparatively fresh bones, mixed agglutination test may also be helpful. Time of death, estimated from all bones being same will act as corroborating evidence, in support of their being from one individual.

3. Race of the subject can be determined from the skull bone, including study of cephalic index, the teeth as well as from features and indices of different long bones.

4. Sex can be determined from the bones quite satisfactorily. When all the bones are available then, sex can be accurately determined in 100% cases. With pelvis and skull, in 98% cases; with pelvis alone, in 95% of cases; with skull alone, in 90% cases and with long bones alone, in 80% cases sex can be determined accurately.

5. Age can be estimated from the ossification activities of the bones ; eruption, falling and decaying changes of teeth; from the osteoporetic changes of all bones; from the special changes in the mandible; changes at the symphyseal surface of the pubis and at the margin of the glenoid cavity of the scapula.

6. Stature can be calculated out from the long bones by applying any of the available formulae, chosen, depending on the geographic origin of the deceased.

7. The special features in the teeth (tortion, angulation, staining, cracks, caries, sealing etc.) and bony deformities, healed fractures, malunion etc. may serve as special identification features.

8. Cause of death – In most of the cases it is not possible to find out the cause of death of the subject. When some antemortem fracture is found on some bone, covering some vital organs then, it can be assumed that, injury to that vital organ may be the cause of death e.g. antemortem fracture of skull, ribs or cervical vertebrae are suggestive of death due to injury to vital organs covered by these bones. Antemortem fractures of bones of the non-vital parts of the body suggest that, death could have been due to serious assault. Some poisons like arsenic can be detected from bones if death has occurred due to subacute or chronic arsenic poisoning.

9. From the fracture or nature of injury of the bones, it can be said, whether a hard blunt weapon, a light or heavy sharp cutting weapon, a pointed weapon or a firearm has been used.

10. Disease or pathology in the bone like, tuberculosis or sarcoma may help further to identify the subject and to assume the cause of death.

11. The time of death can only be roughly ascertained. If soft tissues namely, fascia, ligaments etc. are still attached with the bone, then death might have occurred within about two weeks to two months back. If no soft tissue is attached, but the bone is still not completely dried then, death might have occurred about one to three months back. If the bone is completely dry but has putrid smell in it then, death has occurred within the last three months. If the bone is dry, with no putrid smell, but has retained its normal colour then the time passed after death is between 3 months to 1 year. After this unpreserved bones get destroyed and gradually reduce to dust. But exact ageing of skeletonisation is not possible. Ageing of bones by estimation of C14 (half life being 5,600 years) is of anthropological interest mainly.

12. Mode and place of disposal. A body buried in deep grave skeletonizes comparatively later. A body disposed of in open air dries up early. Bones of the bodies disposed in forest may be partly eaten off by animals. Similarly, bodies disposed in water may have their bones partly eaten off by aquatic animals. Stains on the surface of the bone may also give some idea about the place of disposal. Place of disposal disturbs the sequence of natural changes in the bones to a great extent, through the effects of climate, environment, gnawing by animals etc.

13. Sometime some additional information may be obtained from bones.

Obscure and negative Autopsy : In about 20% of all postmortem examination cases, the cause of death may not be clear at the time of dissection of the body. These are cases of obscure autopsy. In many of these cases the cause of death etc. can be made out after detailed laboratory examinations of different materials preserved from the dead body. In about 5% of all postmortem examination cases the cause of death remains unknown, even after all laboratory examinations and investigations are exhaustively performed (negative autopsy).

Post-mortem Artefacts

Post-mortem artefacts mean alteration, modification, addition or absence of some post-mortem features, due to certain causes originating after death.

1. Thus, it may origin just at the time of death, e.g. resuscitation attempt on the patient at the time of death by external cardiac massage, may cause fractures of ribs, sternum and injuries to lung and heart, which may be taken as antemortem injuries causing death.

2. After death, attempt to remove ornaments from body parts like nose, ear lobules, may cause injuries to these parts, which may be mistaken as to have criminal involvement. Impression of necklace may be confused and taken as ligature mark.

3. During transportation of the body from the place of death to the mortuary, abrasion or some other mechanical injuries may be caused which may mislead interpretation.

4. During transportation again, the dead body may be contaminated with dirt, soil, grease which may give wrong idea about the place of occurrence of death.

5. Tear of the wearing apparels during transport may appear to be due to ante-mortem struggle.

6. Artefacts may originate during preservation of the body in the mortuary.

7. During the stage of rigor mortis, there may be ejaculation of semen which may wrongly suggest either death due to violent asphyxia or involvement of sexual activities with the cause of death.

8. P. M. ant bite, cockroach bite and rodent bite injuries may be wrongly considered as antemortem injuries.

9. P. M. expulsion of blood-tinged decomposition fluid from nose may be wrongly taken as bleeding from before death.

10. Artefacts may originate during P. M. examination. Fracture may be caused during hammering of chisel during dissection of skull bone which may be mistaken for antemortem fracture.

11. During dissection of thorax and abdomen some of the viscera may be injured.

12. During removal of larynx and trachea, fracture may be caused to the cornu of hyoid.

13. The viscera preserved from the body may not show poison after chemical analysis, though death might have occurred from poisoning, due to faulty preservation technique or delay in examination or many other causes.

14. In some cases, where death was not due to poisoning, some poison may be detected due to impurity of the preservative or use of containers, not chemically free from poison.

15. The wearing apparels and belongings of the dead body may bear artefactual findings. There may be fresh tear or staining of the clothes with blood, mud or soil during carriage of the body, which were not there originally.

16. Sometimes, while sending a naked dead body to the mortuary, it may be wrapped with a cloth and the autopsy surgeon may take it as being the wearing apparel during death which the police might have already seized. But, as this may have no mention in the inquest, the autopsy surgeon may find it very difficult to match the bodily injuries with such clothes.

EXAMINATION OF THE DEAD BODY AT THE SCENE OF CRIME

A practitioner doctor or a medicolegist may sometimes be requested to visit the place of death of a person for various reasons like —

1. To issue a death certificate
2. If the subject is not yet dead then, for his treatment
3. To study the circumstance of death from various medicolegal angles.

For obtaining a death certificate or for the purpose of treatment, a doctor is usually called by the relatives or friends of the deceased/victim/ patient. If, on arrival the doctor finds the person already dead; then, he must not issue death certificate mentioning the cause of death, if he did not treat the person for some natural disease which could have caused the death. If he finds the person still alive, he should do whatever necessary, to save his life and if situation demands he should also try to arrange for recording a dying declaration.

In any case, if there is suspicion of a foul play, he should closely examine the dead body/patient and the surrounding, take history, preserve materials which may help to know the cause and nature of death or offence, if any. He should also inform the police when necessary.

Examination of the scene in medicolegal cases

To study the circumstance of death from various medicolegal angles, a medicolegist may be requested by the police to visit the place where the dead body is lying or discovered. This may be of great help for proper investigation of the case. Here lies the additional advantage and importance of medical examiner’s system of inquests.

On arrival at the site, the doctor should take note of the followings :
1. The place where the dead body lies
2. The position and manner in which the dead body is lying
3. The condition of the dress and wearing apparels
4. Any apparent injury
5. The extent of bleeding
6. Any spurting of blood. If present then the direction
7. State of rigor mortis or decomposition
8. Body temperature
9. Cadaveric spasm with the content in the grip of hand
10. If a case of strangulation, then, the nature of ligature material, the position of knot etc.
11. Whether hands and limbs are tied
12. In case of hanging, whether it is partial or total; nature of ligature material; position of knot; dribbling of saliva ; point of suspension and its approachability
13. Whether there is any faecal, urinary or seminal discharge
14. If the deceased is a woman, then if there is anything to suggest commission of sexual assault before killing. If there is any seminal stain, foreign pubic hair, any injury near the private parts
15. If there is any sign of struggle or disturbance in the surrounding
16. Presence of any weapon, its placement
17. Approach and exit to and from the room or place
18. Presence of different types of foot prints
19. Presence of any article left by the assailant
20. In case of suspected fall from a height, the length of fall, distance of shifting of the body during fall, whether the body struck at different points during the fall
21. In case it is lying in an open space, say a grassy lawn then, any disturbance on the lawn; foot prints, if present
22. if there was any rain then, whether the body was lying there from before the rain or after
23. Whether there was anything to suggest that the victim was killed elsewhere and the body was left over there after death
24. Whether there is any evidence of dragging of the body
25. If the body is concealed then, the method used for concealment.

In addition to the above, the medicolegist may advise the police about taking of photographs, of dead body and other things from different angles. He may also advise about collection of evidence and their preservation. However, the doctor, should in no way disturb the place, touch anything without informing the police officer and pass any hasty comment.