PRINCIPLES OF FORENSIC

SCIENCE
BLS-221-3
> Forensic science refers to a group of scientific disciplines which are concerned with the

application of their particular scientific area of expertise to law enforcement, criminal, civil,

legal and judicial matters.

» Forensic scientists examine evidences - substances (including blood/drug samples), chemicals

(paints/explosives/toxins), tissue traces (hair/skin) or impressions (fingerprints/tyre impressions)

left at the scene of crime.

» Forensic medicine: It is the application of principle and knowledge of medical sciences to legal

purposes and legal proceedings so as to aid in the administration of justice.

 THANATOLOGY

Definition:

» Thanatology (Greek thanatos: death) is the scientific study of death in all its aspects including its

cause and phenomena. It also includes bodily changes that accompany death (postmortem

changes) and their medico-legal significance.

» Death occurs in two stages

> e« Somatic, systemic or clinical.

> ¢ Molecular or cellular.

Somatic death:

Life could be compared to a triped according to Bichat,with its three legs representing the three vital

systems—

the nervous, circulatory and respiratory system— tripod of life.

All systems would fail if any one of the vital systems fails, and these systems are known as ‘atria mortis’

(death’s portal of entry or gateways of death).

Diagnosis of Somatic Death

1. Permanent and complete cessation of function of brain -flat E.E.G

2. Permanent and complete cessation of function of heart -flat E.C.G

3. Permanent and complete cessation of function of the lungs ---negative Winslow*s Test, Mirror Test, Feather Test

etc.
Molecular Death

» Itis the death of all individual cells within the body .

e It follows 2-3 hrs after somatic death.

Diagnosis of Molecular Death ’ 3 minutes

1-Muscle does not respond to strong stimuli.

2-Pupil does not respond to stimuli and drug.

within 20 minute

3 minutes
French physician Marie Bichat (1771 -1802).
Medico-Legal Aspect of Stages of Death

From legal aspect

1-A person is dead when somatic death has occurred hence a death certificate can be issued for the

disposal of the body.

2-The organs for transplantation must be removed from the deceased before the onset of molecular death.

(Supravita period)

O Liver-within 15 mins

O Kidney-within 45 mins

O Heart-within 1 hr

O Cornea-within 3 hrs
 Modes of Death

As per Gordan there are 4 modes of death

1. Anoxic anoxia- due to lack of oxygen.
2. Anemic anoxia- due to reduced oxygen carrying capacity of the blood.
3. Stagnant anoxia- due to defective blood circulation.
4. Histotic anoxia- due to defective utilization of oxygen
- Impairment of central nervous
by tissue. system function

As per Xavier Bichat, a French physician, there are three

modes of death. Stoppage

Pag of ,
Asphyxia| =% respiration function

1- Coma: Death due to failure of brain function. Syncope | —p Stoppage of function

of heart and circulation

2- Syncope: Death due to failure of heart function.

3- Asphyxia: Death due to failure of lungs function

 CAUSE, MECHANISM AND MANNER OF DEATH

Two of the most important functions of the forensic doctor are the determination of the cause and

manner of death.

» Cause of death is any injury or disease producing physiological derangement, briefly or over a

prolonged period and which results in the death of the individual, e.g. a gunshot wound to the

abdomen, a stab wound to the chest, adenocarcinoma of the lung or coronary atherosclerosis.

» Mechanism of death is the physiological derangement produced by the cause of death that results in

death, e.g. hemorrhage, septicemia, metabolic acidosis or alkalosis, ventricular fibrillation or

respiratory paralysis.

» A particular mechanism of death can be produced by multiple causes of death and vice versa.
Example:

If an individual dies of hemorrhage, it can be produced by a gunshot wound or a stab wound or a

malignant tumor of the lung eroding into a blood vessel.

A cause of death, e.g. a gunshot wound of the abdomen can result in many possible mechanisms of death,

like hemorrhage or peritonitis.

Manner of death explains how the cause of death came about.

Manner of death can generally be categorized as the following

i. natural (death due to disease),

ii. homicide,

iii. suicide,

iv. accident or

v. undetermined.

A cause of death may have multiple manners of death.

An individual can die of massive hemorrhage (mechanism of death) due to stab wound of heart (cause of

death), with the manner being homicide (someone stabbed him), suicide (stabbed himself), accident

(fell over the weapon) or undetermined (not sure what happened).

For some deaths, the manner may be undetermined because the circumstances are unclear; for e.g.

whether drowning was accidental or suicidal.

Deaths from alcohol and drug abuse are difficult to classify and are sometimes described as

‘unclassified’.

* Agonal period is the time between a lethal occurrence and death

Natural Deaths

» Natural is defined as death caused solely by disease or natural process.

> If natural death is hastened by injury (such as a fall or drowning in a bathtub), the manner of death

is not considered natural.

» Sudden Unexplained Infant Death (SUID), formerly known as sudden infant death syndrome

(SIDS), is a subset of natural death.

» It is the sudden death of an infant under one

year of age which remains unexplained after

a thorough and complete investigation.

Accidental Deaths

Accident is defined for medical examiner death certification purposes as — An unnatural death resulting from an

inadvertent chance happening.

Traffic related fatalities (involving vehicles used for transportation on any public roadway) are classified as

accidents.

» On the job injury related deaths are referred to as industrial deaths and are classified as accidents. Deaths
related to illicit drug or excessive medication use, in the absence of specifically supporting the conclusion of
the manner of death being homicide or suicide, are classified as accident.

> A traffic death is defined as an unintentional death of a driver, passenger, or pedestrian involving a motor
vehicle on public roadways.

» Complication of Therapy Deaths are accidental deaths that occur during or due to complications that occur
during medical, surgical, therapeutic, or diagnostic procedures.
Suicide

» Suicide is defined for medical examiner death

certification purposes as - a death from self-inflicted

injury with evidence of intent to die.

» Evidence of intent includes an explicit expression, such ’ e 1§

Ry e aa®
as a suicide note or verbal threat, previous attempts, or ”j ’

an act constituting implicit intent. Help is available

N Speak with someone today
> Example: a self-inflicted contact/close range gunshot

wound (particularly of the head, chest, or abdomen) that

is recognized as having very high potential for lethality,

and is considered to be implicit evidence of intent to die.

Homicide

Homicide is defined as the action of one person directly causing the death of another.

A death that occurs during and is related to the commission of a felony is also considered homicide.

> A violent death may stem from some

kind of deliberate or purposeful action,

but intent to cause death need not be

present or proven for the classification

as homicide.

» Homicide and murder are not the same.

All murders are homicides, not all

Undetermined

» Undetermined is an appropriate designation for cases that have very little available information about the

circumstances surrounding the death (e.g., partial skeletal remains) or where known information equally

supports, conflicts with, more than one manner of death.

» An undetermined manner of death is assigned to cases of unnatural death when a clear preponderance of

evidence supporting a specific manner (homicide, accident, or suicide) is not available.

» Some unexpected infant deaths that are not classified as "natural" (SIDS), such as when an unsafe

sleeping environment is present, may be classified as "undetermined" in manner.

Pending

» Pending may be listed temporarily on the death certificate for cause and/or manner when additional

investigation, information and/or test results are required for certification.

» These classifications are generally amended when information becomes available.

SIGNS OF DEATH

The changes which occur after death are helpful in estimation of time of

death.

1. Immediate signs

2. Early signs

3. Late signs
Following death, numerous physical and chemical changes occur that ultimately leads to disintegration of
body.
The importance of these changes is related primarily to their sequential nature that can be utilized to
estimate the time since death.
Some changes occur early whereas some changes appear late. The changes are as mentioned below.
Immediate changes after death

1. Stoppage of function of nervous system

2. Stoppage of respiration

3. Stoppage of circulation
Early changes after death

1. Changes in eye
2. Changes in skin
3. Cooling of body
4. Postmortem lividity
5. Rigor mortis and changes in muscle

6. Changes in body fluid

Late changes after death
1. Putrefaction or decomposition
2. Adipocere
3. Mummification

Changes after death Type of death

Immediate change after death Somatic death
Early changes after death Molecular death
Late changes after death Molecular death
Stoppage of Function of Nervous System

With somatic death all functions of nervous system ceases.

The subject is insensible with loss of sensory and motor functions.

There is loss of reflexes with flaccid muscle.

The pupils are widely fixed and dilated and not reacting to the light.

Stoppage of Respiration

With somatic death, there is entire and permanent cessation of respiration. The clinical examination and tests to

establish cessation of respiration are mentioned below.

1. Inspection — no respiratory movements will be visible

2. Palpation — respiratory movements cannot be appreciated

3. Auscultation — no breath sound can be heard from any part of either lung

4. Tests — following are the tests (some tests are obsolete but briefed only for historical importance)

* Feather test — if feather is held in front of nose, no movement of feather will be noted if a person is dead.

* Mirror test — if the surface of mirror is held in front of mouth and nostrils, the surface gets dense due to

condensation of warm and moist air exhaled from lungs. The phenomenon suggests on-going respiration and

indicates person is alive.

Winslow’s test — a small bowl with water is placed over the chest of the person with arrangement of some light rays

falling on the surface of water in the bowl.

If the person is respiring then due to respiration his chest will move and slightest movement of chest wall will disturb

the plain surface of water in bowl and that can be viewed as the rays of light reflected from the surface of water.

Stoppage of Circulation

With somatic death, the function of heart will cease with consequent cessation of circulation.

The clinical examination and tests to establish cessation of cardiac activity are mentioned below.

1. Palpation —radial, brachial, femoral and carotid pulsation will be absent due to cessation of circulation

2. Auscultation — the whole pericardial area is ausculted for presence or absence of heart sounds. The auscultation

should be done for at least one minute and repeated at short intervals if necessary.

3. Tests —
» Diaphanous test — if in a dark room the outstretched hand is held against some bright light source then
in presence of circulation, the hand will appear pinkish and translucent.
If circulation has stopped then the hand will appear yellowish and opaque.
* Magnus test — if a ligature is applied on a finger sufficiently to occlude superficial veins but not the
deeper arteries then in case of continuing circulation, the finger distal to ligature will be swollen and appear
bluish due to venous obstruction and accumulation of deoxygenated blood
If circulation has stopped then no such change will be evident.
* Icard’s test — in this test, 1 ml of 20% alkaline dye fluorescence solution is injected either in the dermis
or subcutaneous tissue.
In case of continuing circulation, the solution injected in the dermis spread locally
at the site of injection whereas in case of subcutaneous tissue injection, the dye will travel to the farther part
of body
EARLY CHANGES AFTER DEATH
Early signs of death denotes onset of molecular death.

The early changes of death are mentioned below.

1. Loss of reflex — soon after death, eye loses its luster with loss of corneal and pupillary reflexes
2. Loss of muscle tone — after death there is loss of muscle tone in eyelids.

3. Cornea — after death there occurs drying and desiccation of cornea with deposition of dust if eye
remains open.

With ongoing process, initially cornea becomes partially hazy and subsequently becomes hazy after
10 to 12 hours after death.

Increase in atmospheric humidity and temperature are known to hasten the process but may be delayed if
eye remains closed.
With the onset of

decomposition, the cornea becomes opaque.

Tache Norie sclerotiques —
this sort of change is seen in sclera when eye remains
open.
It develops because of drying and desiccation of the
conjunctiva and sclera and appears as blackish brown
discolouration.
The phenomenon may be mistaken for contusion.

Two such triangular areas appear on both side of cornea.

Within 2-3 hours, the exposed white part of eyeball

becomes yellowish and within 8-10 hours it becomes

blackish brown
 Pupils dilated and
fixed
Loss of pupillary
reflex /
Fall of ocular o
tension \

Loss of corneal reflex

Changes in eye after death e
Fundus showing phenomenon of
trucking

Immediately after death, on fundoscopic examination, there is evidence of arrest of capillary circulation
with retinal veins appear segmented (blood in retinal vessel break up into segments — the phenomenon is
known as ‘trucking’) with settling of red blood cells in a rouleaux or boxcar pattern
COOLING OF BODY
Synonym: Algor mortis (algor = coldness, mortis = after death)
Normal oral temperature in living individual is 37°C (98.6°F) whereas rectal temperature is about 0.5°C higher

than oral temperature.

After death, temperature of the body decreases progressively until it reaches the ambient temperature. The fall
of temperature from the dead body is due to following two reasons:
* After death there is no heat generation due to loss of all physical, chemical and metabolic activity
* There is constant loss of body heat until it comes to the level of the environmental temperature, as the heat
regulating center gets inactive due to death.

Loss of body heat occurs from the surface by three mechanisms as:
1. Conduction —transfer of heat occurs by direct contact with nearby object. Internal organs cool by conduction.
2. Convection —transfer of heat occurs through moving air currents adjacent to the body
3. Radiation —transfer of heat from body occurs to the surrounding by infrared rays.
 Surface | |Rate of fall of temperature
from core and constant and
Core therefore we could get simple
curve for fall of temperature

Inert body

Surface = Initially there is loss of

temperature from surface of the
body with no loss from core of
bodz As the rate fall of
temperature from
surface and core of
Core = //—&fter initial phase when surface of cadaver occur one
cadaver has loss the lemperature after another we get
h then begins fall of temperature actually a sigmoid
from the core of cadaver and this is shape curve
because of insulation provided by
Cadaver the skin, fat and subcutaneous
tissue
\
i

Diagrammatic representation to show difference between rate of fall of temperature in an inert

body and a cadaver
Factors Affecting the Cooling of Body

Various factors affect the cooling of dead body and may affect the reading and in turn the estimation of time since
death may be affected.
1. Atmospheric temperature — if there is difference between the atmosphere and the body then cooling of body

occurs in fashion as described above.

2. Media of disposal — the rate of cooling of dead body differs according to the media of disposal - whether
disposed
in water, air or buried in ground. Optimum cooling occurs in water media followed by disposal in air over
ground and least in bodies buried in ground. The ratio of fall of body temperature in the three media - water: air:
grave is 4: 2: 1, popularly known as Casper’s dictum.
3. Body built — thin built person loose heat rapidly in contrast to fatty because fat act as insulating cover and
retains heat for longer duration.
4. Age — maximum heat loss occurs in infants and children in comparison to adults because of larger body surface
area in the formers.
5. Clothing — clothing or protective gears like jacket, sweater etc. retains heat for longer duration so
cooling of body is slower.
6. Air movement — environment with more air breeze movement will cause the faster cooling of body.

7. Position and posture of body — body with outstretched hand loses more heat because of greater
surface of body is exposed.
8. Cause of death — if death is attributed to some infectious disease or septicemia or Bacteraemia then
there may be high temperature of body at the time of death with postmortem production of heat by the
action of infective organism so heat loss from the body will be slower.
Postmortem Caloricity

Postmortem caloricity is a term applied to a condition of a dead body where there is rise of body temperature
observed in contrast to fall of body temperature. This phenomenon is observed for the first two — three hours
after death. The rise in body temperature can be credited to following conditions.
* Postmortem glycogenolysis — this is compulsory phenomenon observed nearly in all bodies and starts soon
after death.
In an average adult person, postmortem glycogenolysis produces up to 140 calories that has capacity to
increase the body temperature at an instant time by 3.6°F or 2°C.
Thus, considering the inner core body temperature, when the body is yet to loose heat there may be virtual rise
of temperature of body.
* Cause of death — death caused by infective conditions or septicemia or Bacteraemia increases the body
temperature by postmortem action of these organisms whereas in case of sunstroke or Pontine hemorrhages,
there is loss of heat regulatory center.
In case of strychnine or tetanus poisoning, the rise in body temperature is due to increase in muscular activity
that causes to raise the body temperature.
 postmortem caloricity
Cause of death Mechanism
Septicemia Increased production of heat
Infectious disease Increased production of heat
Sunstroke Heat regulation center disturbed
Pontine hemorrhage Heat regulation center disturbed
Tetanus Heat production due to muscular
activity
Strychnine Heat production due to muscular
activity
POSTMORTEM LIVIDITY
Synonyms: Livor mortis, postmortem hypostasis, postmortem
staining.

Defi nition
Postmortem lividity is a purplish blue or reddish blue
discolouration due to settling of blood by gravitational force
within the dependent, dilated and toneless small veins and
capillaries of rete mucosum.
Formation and Spread of Lividity

If body is left undisturbed without change of its position, then

the postmortem staining starts appearing in small patches over
the dependent part of body by the end of first hour after death.
Complete spreading of postmortem staining, takes about 5-6
hours.
Rigor Mortis

Synonyms: Cadaveric rigidity (rigor = rigidity, mortis = of death)

Definition

Rigor mortis is that state of muscles of dead body where they

become stiff with some degree of shortening that follows the period
of primary flaccidity.
Rigor mortis is the stiffening of muscle after death. Along with
stiffening of muscle, shortening of muscle fibers, albeit small, have

been noted.
When rigor mortis is developed completely, the body and joints
become stiff with flexion attitude of upper limb muscles.
Appearance of rigor mortis indicates death of individual cells (i.e.
molecular death has occurred).
Mechanism of Rigor Mortis

Contraction and relaxation of muscles requires ATP, the process is ATP dependent.
Synthesis of ATP, glycogen is required, after death the failure of re-synthesis of ATP leads to a
fall in its concentration within the muscle and accounts for the hardness and rigidity of muscle — the rigor mortis
(stiffness after death).
* The extensibility of muscle begin to fall when its ATP levels drops to 95% and the muscles are least extensible

when the ATP falls to the level of 15% of normal.

» At the stage of somatic death, ATP is present in muscles is utilized for the process of relaxation (ATP is

breakdown to ADP and phosphate).

After somatic death, with glycogen available in the muscle, there is re-synthesis of ATP.
With depletion of glycogen amidst anaerobic respiration and constant accumulation of lactate and phosphate in
the muscle, no further ATP re-synthesis is possible and muscle begins to lose softness, elasticity and
Appearance of rigor mortis in body. Note the joints become stiff and the entire body can be placed over small
top of table with maintaining the posture of trunk and lower limbs.
Rule of 12: It is generally considered that it takes about 12 hours after death to develop rigor

mortis, remains for another 12 hours and takes about 12 hours to pass-off. This is also called as

March of rigor
 Late changes after death

Modified decomposition

Mummification

Skeletonization

Showing late changes after death

6ompl;ie Fossfi
dissolution formation
DECOMPOSITION
1t is disintegration of body tissues after death.
Mechanism

Decomposition follows the arrest of biochemical process that develops, maintains and preserves the integrity
of cellular element.

During decomposition, the tissue components leak and break up releasing hydrolytic enzymes.
The complex organic body tissues break down into simpler compounds.
The bacteria and other microorganism thrive on the unprotected organic components of the body.
1. Autolysis — Self dissolution of body tissues by the enzymes released from the disintegrating cells.
2. Putrefaction — These are the changes produced by the action of bacteria and other microorganism thriving
on the body.
3. A third kind of postmortem destruction can be identified in some bodies that are not disposed. Such
postmortem destruction is brought out due to attack of various types of animals such as insect, rodents,
canines, fox, jackal, vulture, fi sh etc.
 FORENSIC ENTOMOLOGY

After death, if body is not disposed and left uncovered, the decomposition process and the peculiar odour of
decomposition attracts flying insects, especially flies.
The study of these insects and their life cycle that are infesting the dead bodies is known as forensic
entomology.

Forensic entomology is based on the analysis of insects and other invertebrates sequentially colonizing a corpse
as decomposition progresses and on the developmental stages of their offspring.
Various flying insects are attracted toward dead body and infest it but two groups are more common and they
are:
1. Diptera (true flies)

2. Coleoptera (beetles)
Life Cycle of Fly

Flies are the first to attract toward corpse. Flies are of various types such as blue bottle flies, houseflies, and
flesh flies.

After invasion of the body, flies lay eggs in about 18 to 36 hours.

These eggs are usually laid down at mucocutaneous junctions such as lips, nostrils, anus, and vagina or even
in open wounds.

These eggs hatch within 12 to 24 hours, depending on type of fly and environmental conditions, to larvae.
These larvae are called as maggots.
Maggots are voracious eaters, they secrete proteolytic enzymes that causes more destruction.
These larvae grow in size and enclose themselves inside shell-like structures; the process is called as pupation
to form

pupa.
The pupa may break out to release young flies capable of reproduction thus completing the life cycle
 Eggs ———— Larva {maggot)

Adult fly | —— Pupa

Autopsy

Synonyms: Necropsy or postmortem examination

Autopsy means (autos = self, opis = view) to see for oneself.

Necropsy (necros = dead, opis = view) is most accurate term for the investigative dissection of the dead

body, but the term autopsy is commonly used and is more popular.

Postmortem (post = after, mortem = death)

Types of autopsy

1. Clinical autopsy (pathological autopsy or academic autopsy)

2. Medico-legal autopsy (forensic autopsy)

Clinical autopsy
* It is done by Medical Practitioner or treating doctor

with the consent of relatives to know the diagnosis or to

confirm

the diagnosis.
* Here the autopsy may be complete or incomplete

(partial) depending upon the consent obtained for that

part of body.
* It is not done under legal obligation therefore no
requisition from police is required.
* For doing clinical autopsy, consent of relatives is must.

Without consent, a doctor cannot proceed for clinical

autopsy.
Medicolegal autopsy

* Medicolegal autopsy is a scientific examination of a dead body.

It is carried out under the laws of State only on the requisition of a legal authority responsible for the

investigation of sudden, suspicious or unnatural death.

The legal authority is usually a police officer not below the rank of sub-inspector or an Executive Magistrate.
» Medicolegal autopsy is also called as forensic autopsy.

Clinical autopsy Forensic autopsy

Complete | Always complete

 Difference between forensic and clinical autopsy
Features Forensic autopsy Clinical autopsy
Synonyms Also called as postmortem examination or Also called as pathological autopsy or academic
medicolegal autopsy autopsy
Consent No consent is required Consent of relatives is must
Conducted Conducted under legal authority Not so
Requisition Requisition from legal authority is necessary Ho such requisition is required
Procedure Autopsy is always complete The autopsy may be complete or incomplete
(partial) depending upon the consent
Aim - To know cause of death Performed to confirm the clinical diagnosis or to
- To ascertain time since death arrive at diagnosis
- To know manner of death
- To collect evidences etc.
Objectives for medicolegal autopsy

1 . To determine the cause of death

2. To determine the manner of death

. To estimate time since death

. To establish identity of deceased when not known

. To collect evidences to identify the object causing death and to identify criminal

. To document injuries and to deduce how the injuries occurred

. To retain relevant organs/viscera and tissues as evidence

. In newborn infants — to determine the issues of live birth and viability

Rules for medicolegal autopsy

» Medicolegal autopsy should be conducted by Registered Medical Practitioner only.

* Medicolegal autopsy should be conducted only on receiving official order (requisition) from the competent
authority (i.e. police or magistrate) authorizing to conduct autopsy.
* The autopsy should be conducted at the earliest
» Whenever dead body is sent for medicolegal autopsy, it should be accompanied by a dead body challan and
an inquest report.

A dead body challan is a requisition submitted to doctor by investigating officer and contains name, age, sex,
address along with probable date and time of death, date and time of examination of dead body.
An inquest report is preliminary investigation to ascertain the matter of fact, the details of body, presence of
any injury etc.

» The autopsy should be done at authorized center, preferably well-equipped mortuary.

* The doctor-conducting autopsy should carefully read the inquest report and requisition along with treatment
record, if available.
* The body should be identified by police accompanying the body

* No unauthorized person should be allowed to be present at autopsy

* Autopsy should be done in daylight because colour changes such as jaundice, changes in contusion,

postmortem artefacts, changes in postmortem lividity etc. cannot be appreciated in artificial light.

* Video recording — in case of death occurring in custody, video recording should be done and the video

film/tape

should be send to the Chairman, National Human Right Commission, New Delhi by doctor himself.

* Visit to scene of crime — if it is possible, visit to scene of crime by doctor should be practiced and is often

beneficial and fruitful.

Autopsy report

Autopsy report consist of following parts

1. Introductory part or preamble — in this part name, age, sex, and residence of deceased is mentioned. The
place from where the body was brought, date and time of examination of dead body, mention of authority
ordering the examination are included.
2. Examination part — it consists of external examination and internal examination and findings recorded by
doctor.

3. Opinion or conclusion — the opinion regarding the cause of death is given. The opinion is deduced from
autopsy findings.
Autopsy procedure
It consists of external examination and internal examination.
External examination

It consists of
1. Examination of clothes for any stains, soiling material, foreign material, any cut marks, tears, stab marks,

loss of buttons etc.

2. Identity — in case of known body, police constable accompanying the body should identify body. If
feasible, relatives

can also be asked to identify the body. In unknown bodies, record identification marks like mole, tattoo,

scars,
deformity, fingerprint etc.

The investigating officer may be requested to have photograph and fingerprints of body.
3. Preliminary particulars

— Like height, weight, nutritional status, built, gross deformities, patterns of hair, colour of hair, any

stains, presence of any foreign body, mud, grease, paint etc. should be noted.
— Rigor mortis — presence or absence of rigor mottis, its distribution should be noted.

— Postmortem lividity — regarding appearance, fixed, unfixed, site, colour, disintegrating etc. should be noted

— Presence or absence of sign of decomposition, extent, presence of maggots, larvae, eggs etc should be
recorded

— Features — whether identifiable, distorted, bloated etc. should be noted

— Skin and body surface should be search for any dermatological lesion, disease, any stains, foreign body,
mud, grease etc.
— Dermal lesions may be in form of pustules, vesicles, any infections, boils, macular lesion, papule, purpura,

bleeding spots, edema, cyanosis etc. should be sought for.

— Perceive for any odour emitting from body, for example, insecticide like smell, fermentation like, kerosene
like, garlicky etc.
— State of natural orifices such as nose, mouth, ear, anus, vagina, urethra for any disease, injury, foreign body

— Documentation of injuries — abrasion, contusion, laceration, incised, stab, chop, crush, burn, electrical

injury etc. should be look for and properly recorded.

The injuries should be described in a sequential manner for example starting from head to toe.
The injuries should be noted in accordance with size, site, dimensions, and orientation to the axis of body and

relations
from the fixed anatomical landmarks.
The dimensions should be recorded in metric system.

The shape should be described whenever possible.

The state of margins, angle and depth of wound along with direction should be recorded with reference to
stab wounds.

— External genitals — examine to know presence of any disease, injury, foreign body, stains, secretions, and

any signs of sexual insult.

Internal examination

1. Cranial cavity

2. Thoracic cavity

3. Abdominal cavity

4. Dissection of spinal cord (when indicated)

5. Dissection of extremities (when indicated)

The cavity to be opened first depends on the requirement and convenience of autopsy surgeon, any cavity can

be opened first, but in fetus, usually abdominal cavity is opened first to record the position of diaphragm.
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 Incision

Incision
Types of incisions used for autopsy.
A) For head

Coronal incision — is more preferable and easy type of incision. The incision begins from behind the
ear and extends upwards on either side to meet coronally on head

Scalp off the skull

Sawing skull along

Scalp incision dotted lines
For trunk Common Autopsy Incisions
Dependi h need, an autopsy surgeon can use the
pending on the @
tm-y‘ @
tm-{ EJ\
W{
incision r_.()u . P )C ~ p I
[ ~o7 ) | ! | | :
1. I-shaped incision
- a straight incision is made from the | ]‘ T "E : | ]“ : "E : | ]‘ :
chin (symphysis mentis) to pubis (symphysis pubis). //‘lf'
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2. Y-shaped incision — it begins at a point close to ly )I I
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and then medially across the xiphoid process. J‘E 2‘) 2‘)[,

A similar incision is made at opposite side of the body - “ i s

P Modified I-shaped incision
and from xiphoid process the incision is carried Y-shaped incision Y-shaped incision

downwards in a straight line to the pubis.

3. Modified Y-shaped incision — a straight incision from

sternal notch to pubis is made. Clavicle

o Sternum
This incision is extended from suprasternal notch to the —
mid-point of clavicle and then upwards towards the neck —Manubrium
behind ear. - Body

Xiphoid
process
Autopsy technique
1. Technique of Virchow

— In this technique, the organs are removed one by one

— It is widely practiced and more popular method

— Itis considered as more convenient

2. Technique of Rokitansky

In this technique, there is partial in situ dissection of organs with en-bloc removal.

3. Technique of Ghon

In this technique, thoracic, cervical, abdominal and urogenital system organs are removed

separately as organ blocks.

4, Technique to Letulle

¢ |n this technique, cervical, thoracic, abdominal and pelvic organs are removed en-masse and

subsequently dissected into organ blocks.

¢ This technique is considered as best technique.

Cranial cavity

¢ After coronal incision, scalp is reflected

¢ The skullcap is removed by sawing through the bones.

* The line of cutting the bone extends horizontally on both sides from about the center of forehead

to the base of mastoid process to external occipital protuberance backward.

¢ The skull vault is examined for any fracture or hematoma

¢ Dura is examined for any collection of blood, any injury, any disease.

¢ The superior sagittal sinus is examined for presence of thrombosis

e Brain is examined in situ and then dissected out.

Chest and abdominal cavity

¢ The chest and abdominal cavity are examined for presence of any injury, disease, pathological

lesion or collection of blood/fluid.

¢ The organs should be examined for presence of any injury, disease, and pathological lesion. The weight

of organs, the size, shape, surface, consistency, cut surface, colour should be noted.
The Arachnoid &
Dural Sinuses
Opening of spinal cord

Spine is not routinely opened except

Laminectomy
for indications.

Following are the indications:

1. Injury

2. Disease affecting spinal cord

3. Poisoning— strychnine.

Methods of opening spinal cord

1. Posterior approach - Midline skin

Laminectomy

incision given over back over

Spine
spinous process and bilateral Spinous
process
laminectomies done with use of {] Cleveland Clinic ©2023

saw.
2. Anterior approach.
Laboratory investigations
Laboratory support becomes essential at times for arriving at conclusion and opinion.

Toxicology

For chemical analysis, it is duty of doctor to collect and preserve viscera, body fluids and other exhibits

properly for analysis of drugs, toxins and poisons.

Histopathology

e For histopathological examination, organ or pieces of organs are preserved in 10% formalin.

¢ Immunopathologic technique is also being applied to aid in diagnosis.

Microbiology

¢ Autopsy samples for bacteriological, virological or mycological examination are taken

¢ Microbiological evaluation is more difficult in postmortem setting than clinical background. Within a

postmortem interval of 4 to 6 hours, there is a body-wise redistribution of endogenous flora and becomes

more pronounced with lengthening of postmortem interval.

¢ Blood is taken in sterile syringe from large blood vessel before starting the autopsy.

If culture from organ is required, the organ area should be seared to dryness with a flat-faced soldering

iron and piece taken.

e The microbiological investigation is required in fungal infection, gastroenteritis, meningitis, septic

abortion, toxic shock syndrome etc.

Biochemical

¢ The blood sample obtained at autopsy should be centrifuged and the serum separated.

¢ Along with blood, vitreous humor, cerebrospinal fluid, urine, pericardial fluid and synovial fluid can be

utilized.

Glucose, urea, creatinine, cholesterol, lipoprotein, catecholamine, magnesium, uric acid, proteins etc. can

be determined

¢ Biochemical tests are used to estimate time since death or to elucidate cause of death.
I Non-Paradoxical Venous Air Embolism

Retrograde
Flow of
Bubble

‘Venous
Blood
Flow
&

Cerebral Venous Air Embolism Obstruction of Pulmonary Circulation

o
B& :
Enzyme study

* Enzyme and isozyme are utilized in postmortem state to elucidate cause of death. CK (creatinine

kinase) isozymes were evaluated in the pericardial fluid for diagnosing myocardial infarction and enzyme

immunoassay for hCG determination in blood stains.

Molecular biology

¢ Certain condition can be diagnosed at postmortem period by utilizing molecular biology. A case report

of diagnosis of sickle cell disease was reported by molecular analysis of the B globin gene.20

Immunological study

The method is mainly used to explicate cause of death.

e Specific meningococcal polysaccharide (CPS) can be detected in postmortem blood by latex

agglutination assay.

e Specific IgE can be detected in postmortem sample in case of snakebite cases or wasp/bee

envenomation.

DNA Profiling
Radiology

Radiology offers immense help at autopsy for deduction of subtle findings.

At autopsy, X-rays are used for following purpose:

. For identification
P

. To locate bony injury

N

. Battered baby syndrome

W

. Suspected fire arm and bomb blast cases

B~

. Suspected cases of Pneumothorax, barotraumas

uu

. Mutilated remains
oo

. For hyoid bone fracture/laryngeal skeleton fracture

N

. Air embolism.
00
Preservation of Dead bodies

Preservation

It’s the art and science of human body to treat it with chemical components for preservation by preventing

or intercepting microorganisms such as bacteria and fungi which are classified as main causes of organic

decomposition which lead to putrefaction.

Embalming is an ancient art established by old Egyptians. It is used in purposes such as transportation of

dead body from place to another, as religious practice in some countries etc.

Types of Body Preservation

Natural Preservation

This type of preservation occurs by natural factors including freezing and dryness that may occur by dry-

heat or dry-cold and the soil nature.

The body or body parts preserved by this can be called the naturally mummified one.
Mummification
It can be divided according to the causative agents which cause
preservation of dead body.
A) Natural mummification: This is caused by the Mother Nature which
occurs when buried in dry heat or dry cold climatic conditions.
B) Artificial mummification or true mummification: This is the type of
preservation that had been done by Ancient Egyptian civilization for
religious concepts.
Ancient Egyptian mummy
According to Greek historian Herodotus there are three types of Pe

artificial mummifications and all of them share the same target of

interception of decomposition of the dead body.
Different materials used in the mummification include materials that
desiccate and dehydrate such as natron salt and vegetable materials and
those act as anti-bacterial factors such as Mastic, Lichen, Myrrh,

Bitumen, Cassia, Onions, Beeswax, Lichen, Coniferous resin, Henna

and Gum Arabic.
5300 year old Iceman found in Alps Mountains
Plastination

> This is a method or technique used for the long term preservation of body or part of body.

> This technique was established by German scientist Gunther von Hagens in 1977 in laboratory of

Heidelberg University.

The main advantage of this way of preservation that the specimens were dry, durable, odorless,

handleable and storable.

In the process of plastination the fluids and lipids in biological tissues substitute by curable

polymers commonly epoxy, silicone and polyester.

As a result of this procedure the specimen gets harden with a natural look and the decomposition which

lead to putrefaction of biological tissues is intercepted.

a) Silicone plastination

» Silicone plastination is one of most common techniques of

plastination which can be used for body, organs, part of organ

and slices.

» The Plastination techniques depend on vacuum of original body

or tissue fluid and replace it by special curable polymer of the

standard silicone S-10.

» The fixative chemical mostly used is formaldehyde.

b) Epoxy plastination

> This techniques of plastination is usually used for

tissue examination especially sections of 2 - 4 mm.

It substitutes of all water and most of lipid with

curable resin.

The result of epoxy plastination is durable sections

looking like magnetic resonance Image and computed

tomography images for anatomical studies.

Dehydration Defatting

-25°C Room Temperature

Acetone Bath Acetone Bath Vaouurm

Curing Agent w
¢) Polyester plastination
» In Polyester plastination the tissue fluids are withdrawn
and replaced by curable Polyester resin.
This method is suitable to study the anatomical formation
of 4 - 8 mm slices of nervous tissue.

The basic steps in polyester plastination technique are

preparation of specimen, slicing and dehydration.
The chemicals used include the following:
+ fixatives (if necessary)

= acetone

* methylene chloride (if necessary)

* polyester resin.
Embalming
» The term of Embalming derived from Latin origin and it is defined as treatment of body cadavers with

special chemicals so as to prevent decay or putrefaction.

» Embalming is done in the ancient cultures

» Many ancient cultures including Egyptian culture practiced embalming as they believed that decayed

dead of the body would preclude it from life after death.

» Significance of using body cadavers in anatomical studies made the embalming for preservation more
important.

The process of embalming consists of the following four steps :

Arterial embalming: it is the injection of embalming fluid through the blood vessels usually the

common carotid artery. This is to replace the body fluid by embalming solution.
= Cavity embalming: this refers to substitute gas and fluid in the organ and inner side of the body with
embalming fluid using a trocar.
» Hypodermic embalming: this is a complementary

step to ensure that concentrated embalming fluid reach

all parts of the body, especially to those sites of body

where the arterial fluids might not reached.

» Surface embalming and washing: this is a remedy

or treatment in damaged area in the surface which may

occur due to a lot of causes such as skin diseases,

cancer, decomposition or other epidermal injury.

 Virtopsy
Psychological Autopsy
Suspended Animation
Virtopsy is a word combining ‘virtual” and ‘autopsy’.

Virtopsy technique uses the modern radiographical aids like computed tomography (CT) and/or magnetic
resonance imaging (MRI) to scan the dead bodies and obtains a more sensitive, specific, and accurate
result than that of the conventional autopsy.

The comparison between conventional autopsy and CT has shown that CT is a superior tool in identifying
entry and exit pattern of wounds (fracture patterns), pathological gas collections, and gross tissue injury.

The postmortem CT though has the above advantages, is less specific and sensitive in assessing
intravenous contrast.

Postmortem MRI is highly sensitive, specific, and mainly used for assessing soft tissue injuries,
neurological/non-neurological trauma, contusions, and hematomas.
Magnetic resonance spectroscopy (MRS) is another technique in
virtopsy which helps in determining the metabolic concentrations in
the tissues, thus helping in estimating the time of death.
MR microscopy is a microimaging technique which is used to study

the soft tissue injuries like retinal hemorrhage, electric injury to the
skin, etc.

Microtomography is used to study the weapon involved and its

injury patterns.

Virtual autopsy is used in cultures where conventional autopsies are

not accepted. It also has advantages that the archives can be easily
retrieved for medicolegal purpose and bodies that are toxic can be
easily examined without any contamination.
The term psychological autopsy was coined by Edwin Schneidman, who first defined the procedure as “a
thorough retrospective investigation of the intention of the decedent.”

A psychological autopsy is the process of determining whether a deceased person has died as the result of a
suicide.
This process is often the most efficient tool for providing answers and necessary information when a suicide
occurs.

The psychological autopsy helps police determine suicide by investigating pertinent events in the deceased's
life and his/her reaction to stress.

Mental health workers help resolve unexplained deaths through psychological autopsies, or by investigating
antecedents of death which could reveal suicide.
The mental health worker investigates the deceased's character, the amount of stress in his life, and

how he reacted to it.

The deceased's friends and relatives are interviewed, and any estrangements in close relationships that
may have been sources of tension are noted.
Stressful situations, subtle or obvious, are sought and identified, as individuals who have difficulty

coping with daily life are more likely to deteriorate under cumulative pressure.

The deceased's intent to commit suicide can be determined by the means of death, crime scene
evidence, and unusual behavior, such as prior threats to commit suicide, the settling of financial

accounts, or preoccupation with death.

Reviews of military or employment records are also especially valuable.
An example of a psychological autopsy of a suicide and directions for interviewing persons significant
to the deceased are provided.
Performing a Psychological Autopsy

Some categories included in a psychological autopsy (Shneidman, 1969):

1.Identifying information of the victim, including name, age, address, and other essential information

2.All details surrounding the death, including method or cause, if available

3 Brief history outline, including medical illness, treatment, therapy, etc.
4 .Family history of death

5.Personality description and lifestyle of the victim

6.The typical patterns of behavior of the victim, especially in response to stressful events
7 Recent history of stressful events
8.Substance use, including alcohol and drugs
9.Victim’s interpersonal relationships
10.Information on drecams, fantasies, fears, ctc.
1.Any relevant changes before death in terms of habits, hobbies, eating, and relationships

2.Information on plans, successes, upswings

3.Information on the victim’s role in their own death, assessment of intention

4 Rating of lethality, which is a scale measuring the degree of lethality in a suicide attempt

5.The reaction of informants upon finding out about the victim’s death

6.Any special features and comments

The process of performing a psychological autopsy is complex and requires a great amount of time. Several

disciplines are applied throughout the procedure, including psychology, sociology, biology, epidemiology, and

anthropology.
 SUSPENDED ANIMATION

» Apparent death is also called as suspended animation.

» It is defined as “a state of body in which the vital functions are at such a low pitch that the body

functions cannot be determined by ordinary methods of clinical examination”.

» In suspended animation, a person may last for few seconds to hours or more. In this condition, the

circulation, respiration and other vital functions do not completely stop but is being maintained in their

minimum.

» Prompt resuscitation can revive the state. Apparent death is of two types as:

1. Voluntary suspended animation — here the person practiced it voluntarily for example yogis or

‘sadhus’ or ‘sanyasi’ may practice this method.

2. Involuntary suspended animation — here the person lands in apparent death spontaneously.

Causes of suspended animation

Yogi
Trance
Cataplexy
Hysteria
Sunstroke
Concussion
Drowning
Electrocution
Frozen coma
Narcotics poisoning
Anesthesia
Exhumation
» Exhumation means to dig out corpse from the ground.

It is a lawful process of retrieval of previously buried body for postmortem examination.

* The term should be restricted to the removal of a body interred in a legitimate fashion in the graveyard.
Purpose

Exhumation is carried out with following purpose

1. Identification

2. For second autopsy when first autopsy report is doubtful or ambiguous

3. In civil cases — such as for insurance purpose or negligence cases
4. Disputed cause of death
5. Suspected foul play
Authorization for exhumation

The exhumation is carried out only on receipt of written order from the Executive Magistrate or Judicial
Magistrate.
Time limit for exhumation
In India, there is no time limit for carrying out exhumation.

The period of exhumation is restricted in other countries for example it is about 10 years in France and 30
years in Germany.
Procedure

» The procedure of digging out should be carried out under supervision of the Magistrate and in presence of
medical examiner and police.

* The grave should be identified and dug out carefully.

* The body is lifted and identified by relatives.
* The condition of clothes should be noted
* 500 gm of soil from actual contact of body from above, lateral sides and below should be collected for

chemical analysis in suspected poisoning. Soil from control site should be collected.